Enhanced Premium Tax Credits Expiring: What Miami Residents Need to Know NOW

Open Enrollment Deadline: January 15, 2026 | The Clock Is Ticking

If you're enrolled in an ACA Marketplace plan in Miami, there's a crucial change happening right now that could dramatically increase what you pay for health insurance in 2026. Enhanced premium tax credits—the extra subsidies that have kept health insurance affordable for millions of Americans since 2021—expired on December 31, 2025.

Unless Congress acts to extend them (which is still being debated), Miami residents across nearly all income levels will see their health insurance costs spike dramatically. Some families will pay more than double what they paid in 2025.

As a licensed insurance broker serving Miami families, I want to make sure you understand exactly what's happening, who's affected, and most importantly, what you can do about it right now during Open Enrollment.

What Are Enhanced Premium Tax Credits?

Let's start with the basics. Premium tax credits (also called subsidies) have been part of the ACA since 2014. They help lower your monthly health insurance premium based on your income and family size.

In 2021, Congress significantly boosted these subsidies through the American Rescue Plan Act. These "enhanced" subsidies made coverage more affordable by increasing the amount of financial help people received and eliminating the income cap that previously cut off subsidies at 400% of the federal poverty level. The Inflation Reduction Act later extended these enhancements through 2025.

The enhanced subsidies officially expired on January 1, 2026. That means for 2026 coverage, subsidies have reverted to the original 2014 ACA formula—which is significantly less generous.

The Bottom Line: What This Means for Your Wallet

Here's the harsh reality: under current law, premium payments for Marketplace coverage will increase by 114% on average—an estimated $1,016 per year more. But that's just the average. For many Miami residents, the increase will be much more dramatic.

Real Miami Examples: How Much More You'll Pay

Let me show you what this looks like in real dollars for Miami residents at different income levels:

Example 1: Young Professional

• 27-year-old making $35,000/year (224% of poverty)

• With enhanced credits: $1,033 annually ($86/month). Without enhanced credits: $2,615 annually ($218/month)—a $1,582 increase (153% jump)

Example 2: Family of Four (Lower-Middle Income)

• Family of four earning $45,000/year (140% of poverty)

• With enhanced credits: $0/month. Without enhanced credits: $1,607/year ($134/month)

• Impact: Going from free coverage to paying $134/month—that's a significant household budget hit

Example 3: Middle-Income Family

• Family of four earning $110,000/year

• Premium increase of $3,201 annually, with premiums reaching 10% of family income ($10,956) instead of 7.1% ($7,755)

Example 4: Near-Medicare Age Couple (THE WORST HIT)

• 55-year-old couple making $85,000/year

• Currently receiving $13,567 in annual tax credits, covering 65% of a benchmark plan's cost. If enhanced credits expire and gross premiums rise 18%, their out-of-pocket premium payments could more than triple—increasing by $17,310 (240%), from $7,225 to $24,535 annually

• This couple would face paying nearly 29% of their annual income just on health insurance premiums

Example 5: Just Over the Cliff (COMPLETE LOSS OF SUBSIDIES)

• 60-year-old couple making $85,000/year (402% of poverty—just over the 400% cutoff)

• Could pay a yearly premium of $22,600 in 2026, or about a quarter of their annual income

• In 2025, they could get a Bronze plan with no premium. In 2026, even the lowest-cost Bronze plan will cost nearly 40% of their household income just for premiums

These aren't scare tactics—these are the actual calculations based on current law and 2026 premium data.

Who Gets Hit Hardest? (You Might Be Surprised)

While nearly everyone with Marketplace coverage will see increases, certain groups are being devastated:

1. People Earning Just Over $62,600 (Singles) or $128,600 (Family of Four)

This is the infamous "subsidy cliff." If the enhancements expire, Marketplace enrollees with incomes over 400% of the federal poverty level (around $63,000 for an individual or $129,000 for a family of four) will no longer receive any premium tax credit.

One dollar over the limit, and you lose thousands in subsidies. It's brutal and unfair, but it's the reality if Congress doesn't act.

2. Near-Retirees (Ages 50-64)

Among enrollees with incomes over 400% of poverty, just over half are between ages 50 and 64, and will therefore have high unsubsidized premiums. Age-rating means older adults pay significantly more for the same coverage.

In 46 states and the District of Columbia, a 60-year-old at 401% of poverty will see their average annual premium payment for a benchmark silver plan at least double without enhanced tax credits. In 19 states, this person would see their premium payment at least triple on average, consuming more than 25% of annual income.

Miami's premium market is expensive, so South Florida's near-retirees are among those hit hardest.

3. Low-Income Workers (100%-150% Poverty)

About 45% of all enrollees (or 10.9 million people) with plan selections had incomes between 100% and 150% of the federal poverty level in 2025. Many of these individuals could see their premiums increase from $0 in 2025 up to 4% of income (for those at the top of the income range) in 2026.

For someone working a minimum wage job or part-time, going from $0 to $50-100/month can be the difference between having coverage and going uninsured.

4. Self-Employed, Gig Workers, and Small Business Owners

The people who will be impacted if the enhanced tax credits expire include part-time workers, gig workers, small business owners, self-employed people, and people who work in industries that don't usually provide health benefits.

If you're driving for Uber, running a consulting business, or own a small shop in Miami, you're likely relying on the Marketplace. You're about to see your business expenses spike dramatically.

The Bigger Picture: What Happens to Healthcare in America?

This isn't just about higher bills. When millions can't afford coverage, the entire healthcare system feels the impact:

Millions Will Lose Coverage

Urban Institute researchers estimate that the end of enhanced tax credits will lead to 7.3 million people losing their ACA coverage in 2026, of whom 4.8 million would become uninsured.

When healthy people drop coverage because they can't afford it, the risk pool becomes sicker and more expensive, which drives premiums even higher in future years—a vicious cycle.

Premium Death Spiral Concerns

The Congressional Budget Office projects that, on average, gross benchmark silver premiums will ultimately be 7.9% higher than they would otherwise be as the risk pool becomes sicker on average, and that many enrollees will become uninsured.

Insurers are already building these expectations into their 2026 rates. All 23 insurers from DC and three states that posted their proposed 2026 rates referenced the expiration of enhanced premium tax credits. Over half stated that the expiration will cause premiums to increase and have publicly quantified the expiration's effects.

Economic Ripple Effects

Research indicates there could be broader economic consequences, including large reductions in state economies, some 340,000 people without jobs, and lower tax revenues for states and localities.

When people can't afford healthcare or are forced to drop coverage, they delay care, rack up medical debt, and have less money to spend in the local economy.

What Can Miami Residents Do Right Now?

The good news: you're not helpless. Here are your concrete action steps during this Open Enrollment Period:

Action #1: Don't Wait for Congress—Enroll Based on Current Law

Congress might extend the enhanced subsidies (there's bipartisan legislation pending), but they might not. Or they might act too late. If Congress renews the subsidies, federal and state marketplaces would need to retool the 2026 plans already available to consumers. It's possible a new plan could be made retroactive to January 2026, even if it's passed later in the year.

Bottom line: Enroll now based on what subsidies are actually available today. If Congress acts and retroactively extends the subsidies, you'll get the extra help backdated to January 1.

Action #2: Calculate Your EXACT Premium Increase

Don't guess—know your numbers. Use the KFF Enhanced Premium Tax Credit Calculator (search "KFF subsidy calculator 2026") and enter:

• Your Miami ZIP code

• Your household size

• Your age(s)

• Your estimated 2026 income

This will show you side-by-side what you'll pay with and without the enhanced credits. Knowledge is power.

Action #3: Get Your Income Estimate RIGHT

This is more critical than ever because another major change for 2026 impacts tax reconciliation.

Previously, if you underestimated your income and received more subsidies than you should have, there were caps on how much you had to repay. Starting with your 2026 income, those repayment caps have been eliminated—you will have to repay the entire difference in your subsidy amount.

How to protect yourself:

• Estimate your 2026 income conservatively (it's better to underestimate subsidies than to owe thousands at tax time)

• If your income fluctuates (gig work, commission-based, seasonal), build in a cushion

• Update your Marketplace application immediately if your income changes mid-year

• Keep documentation of income changes

Action #4: Consider Lowering Your MAGI Strategically

Your subsidies are based on Modified Adjusted Gross Income (MAGI), not your gross salary. There are legal ways to reduce your MAGI:

Strategies to lower MAGI:

• Maximize 401(k) or traditional IRA contributions (pre-tax retirement accounts reduce MAGI)

• Contribute to a Health Savings Account (if eligible—remember, all Bronze and Catastrophic plans now qualify for HSAs)

• Contribute to a traditional IRA (up to $7,000 in 2026, or $8,000 if age 50+)

• If self-employed, maximize business expense deductions

Example: A single person earning $63,000 is just over the 400% poverty cliff ($62,600). By contributing $7,000 to a traditional IRA, their MAGI drops to $56,000—putting them safely in subsidy territory and potentially saving $5,000-8,000 in annual premiums.

That's a massive return on investment for a retirement contribution you should probably be making anyway.

Action #5: Shop EVERY Plan on the Marketplace

With subsidy formulas changing, the plan that was cheapest in 2025 might not be cheapest in 2026. Some insurers raised rates more than others. Some changed networks.

What to compare:

• Monthly premium (after subsidies)

• Annual deductible

• Maximum out-of-pocket

• Copays for doctor visits and prescriptions

• Network (are your doctors included?)

• Prescription drug formulary (are your medications covered?)

Don't just look at the premium. A plan with a $50 lower monthly premium but a $3,000 higher deductible could cost you more if you actually use healthcare.

Action #6: Consider Different Metal Tiers

The subsidy changes might shift which metal tier makes the most financial sense:

When to consider Bronze:

• You're healthy and rarely need medical care

• You want the absolute lowest monthly premium

• You have substantial emergency savings for the high deductible

• You want HSA eligibility (all Bronze plans now qualify)

When Silver might still be best:

• You earn between 100%-250% of poverty (you qualify for cost-sharing reductions that ONLY apply to Silver plans—these weren't affected by the subsidy expiration)

• You use healthcare regularly

• You have ongoing prescriptions

When Gold/Platinum make sense:

• You have chronic conditions

• You expect high medical use in 2026 (surgery, treatment, etc.)

• The higher premium is offset by dramatically lower out-of-pocket costs

• After the subsidy loss, Gold might actually be cheaper than Bronze when you factor in actual care

Action #7: Get Expert Help (It's Free!)

Health insurance experts advise enrollees to speak with an agent, broker, or navigator who can help make sure they understand their options and get the best plan for their financial and healthcare situation.

Why work with a broker:

• We compare ALL available Miami plans across ALL carriers

• We verify your doctors and prescriptions are covered before you enroll

• We help you accurately estimate income to avoid tax-time surprises

• We explain the subsidy math in plain English

• We provide ongoing support if issues arise

• Our services cost you $0—we're paid by insurance companies, so the premium you pay is identical whether you enroll alone or with expert help

At Truly Care Insurance Broker, we're licensed, local, and specialized in navigating exactly these kinds of major changes. We know the Miami healthcare landscape and can steer you away from common mistakes.

What If You Earn Just Over the 400% Cliff?

If you're single earning around $62,600 or a family of four earning around $128,600, you're in the worst position. Here are your specific strategies:

Strategy 1: Reduce Your MAGI Below the Cliff

Even a small reduction can save thousands:

• Max out your 401(k) ($23,500 limit in 2026, or $31,000 if age 50+)

• Contribute to traditional IRA ($7,000, or $8,000 if 50+)

• If self-employed, set up a SEP-IRA or Solo 401(k) with much higher contribution limits

• Contribute to HSA if eligible ($4,300 individual, $8,550 family in 2026)

Example: Single person earning $63,000. By contributing $7,000 to IRA, their MAGI becomes $56,000—qualifying them for approximately $5,000-8,000 in annual subsidies. That's a better than 100% return on their retirement contribution.

Strategy 2: Consider Catastrophic Coverage (If Under 30 or Eligible for Hardship)

If you're under 30 or qualify for a hardship exemption, Catastrophic plans offer:

• The absolute lowest premiums

• Protection from worst-case medical bankruptcy

• Three free primary care visits annually

• Full coverage after meeting a high deductible

• HSA eligibility (new for 2026)

Strategy 3: Explore Short-Term Health Plans (Use Cautiously)

For people just over the cliff facing truly unaffordable premiums, short-term health plans (if available in Florida) might bridge gaps. However, be aware:

• They don't cover pre-existing conditions

• They're not comprehensive ACA coverage

• They should only be a last resort, not a primary strategy

• Consult with a broker to understand the risks

Strategy 4: Price Shop Aggressively

Check if private insurance (outside the Marketplace) might actually be cheaper once you lose subsidies. Sometimes, for healthy individuals over the cliff, non-Marketplace plans offer competitive rates without the ACA's community rating requirements.

The Coverage Gap: Florida's Medicaid Challenge

Florida is one of the states that has not expanded Medicaid. This creates a painful coverage gap for the lowest-income Miami residents.

In states like Florida that haven't expanded Medicaid, buyers are eligible for premium subsidies if their income is at least equal to the federal poverty level. That's $15,650 for an individual in 2026.

What this means:

• If you earn less than $15,650/year, you don't qualify for Marketplace subsidies

• You also don't qualify for Medicaid (Florida's Medicaid is limited to specific categories like pregnant women, children, elderly, and disabled)

• You fall into a coverage gap with no affordable options

If you're in this situation, options are extremely limited:

• Community health centers offering sliding-scale fees

• Charitable healthcare programs

• Consider ways to increase income above poverty level to qualify for subsidies

This is a major policy failure, but understanding your situation helps you plan.

Miami-Specific Considerations

Our Local Healthcare Landscape

Miami-Dade County has several major healthcare systems:

• Jackson Health System

• Baptist Health South Florida

• Mount Sinai Medical Center

• University of Miami Health System

• Nicklaus Children's Hospital

Provider networks vary significantly across plans. Just because a plan includes "Baptist Health" doesn't mean all Baptist facilities are covered. Always verify your specific doctors and hospitals.

Miami's Diverse Community

Our community includes many bilingual families, recent immigrants, and small business owners—all groups significantly impacted by subsidy changes. Language assistance is available through the Marketplace and through licensed brokers (like us) who serve Miami's diverse population.

South Florida's Higher Healthcare Costs

Healthcare in Miami-Dade is more expensive than many parts of the country. Our premiums reflect this. That means subsidy losses hit Miami residents particularly hard compared to lower-cost areas.

The Congressional Debate: Will Enhanced Subsidies Be Extended?

As of now (November 2025), Congress is debating whether to extend enhanced subsidies. The Senate voted on a deal to end the government shutdown that did not resolve the future of the tax credit. Senate Republicans agreed to hold a separate vote on extending the ACA tax credits by mid-December, but a vote isn't guaranteed to succeed, and even if the legislation makes it out of the Senate, House GOP leaders have not committed to holding a vote.

Three-quarters of Americans favor renewing the subsidies, including 94% of Democrats and about half of Republicans.

The reality: Don't count on Congressional action. Plan based on current law, and be pleasantly surprised if they extend subsidies retroactively.

Important 2026 Open Enrollment Deadlines

November 1, 2025: Open Enrollment begins

December 15, 2025: Deadline to enroll for January 1, 2026 coverage start date

• This is your most important deadline if you want continuous coverage

January 15, 2026: Final deadline for Open Enrollment

• Last chance to get 2026 coverage (starts February 1)

• After this, you need a qualifying life event to enroll

April 15, 2027: Tax filing deadline

• You'll reconcile 2026 premium tax credits

• Remember: No repayment caps—you could owe significant money if you overestimated subsidies

Your Next Steps: A Checklist

Here's your action plan for the next few weeks:

☐ Week 1: Understand Your Situation

• Calculate your 2026 estimated income

• Use the KFF calculator to see your subsidy with and without enhancements

• Identify if you're near the 400% poverty cliff ($62,600 single / $128,600 family of four)

☐ Week 2: Explore MAGI Reduction Strategies

• Review retirement account contribution options

• Calculate if HSA contributions make sense

• If self-employed, explore SEP-IRA or Solo 401(k) options

• Determine if you can strategically reduce MAGI below critical thresholds

☐ Week 3: Shop and Compare Plans

• Log into HealthCare.gov or contact a licensed broker

• Compare ALL available plans in Miami-Dade County

• Verify your doctors are in-network for top plan choices

• Check that your prescriptions are covered

• Calculate total annual costs (premiums + expected medical expenses) for each option

☐ Week 4: Make Your Decision and Enroll

• Choose the best plan for your situation

• Enroll by December 15 for January 1 coverage

• Set up automatic premium payments

• Save confirmation documents

• Calendar a reminder to review again during 2027 Open Enrollment

☐ Throughout 2026: Stay Vigilant

• If your income changes, update your Marketplace application immediately

• Keep pay stubs and income documentation for tax reconciliation

• Review medical bills to ensure claims are processed correctly

We're Here to Help

These changes are complex, confusing, and financially significant. You don't have to navigate them alone.

At Truly Care Insurance Broker, we're helping Miami families understand their options and find the best coverage for their budget every single day. Our services include:

✓ Side-by-side comparison of ALL Miami-Dade Marketplace plans
✓ Subsidy calculations and MAGI optimization strategies
✓ Doctor and prescription verification before you enroll
✓ Income estimation guidance to avoid tax-time surprises
✓ Plain-English explanations of your options
✓ Bilingual support for Miami's diverse community
✓ Ongoing assistance throughout the year

And remember: our help is completely free to you. We're compensated by insurance companies, so the premium you pay is exactly the same whether you enroll alone or with our expert guidance.

📞 Call us today: (786) 502-0219
🌐 Visit: www.trulycareinsurancebroker.com
📍 Serving all of Miami-Dade County
🗣️ Se habla español

Open Enrollment ends January 15, 2026. The decisions you make in the next few weeks will impact your health coverage and your finances for the entire year.

Don't wait. Let's find you the best coverage at the best price, even with these challenging subsidy changes.

Truly Care Insurance Broker is an independent, licensed insurance agency serving Miami, Florida. We are not affiliated with or endorsed by the federal government or the Health Insurance Marketplace. Information in this guide is based on current law as of November 2025. Subsidy amounts and premiums are estimates based on publicly available data; individual circumstances may vary. For specific questions about your situation, please contact us or visit HealthCare.gov.