President Donald Trump signed the law on July 4th to change health insurance coverage for millions of Americans.
If you have a market health insurance plan also known as the Obamacare or Affordable Care Act (ACA) plan, your premiums may rise and you may need to do more work to stay qualified.
Below are some important changes to market health insurance in the new law, plus one thing plus what to do about them.
»More: What does “big and beautiful bills” mean for your finances?
1. Premium may be more expensive
How it works: premium tax credits help taxpayers provide market health insurance premiums. Since 2021, “enhanced” premium tax credits have become larger and more accessible to more people.
In states using Healthcare.gov, enhanced tax credits earned subsidized premiums in 2024 at around $624 cheaper per year. This is estimated by KFF, a health policy nonprofit organization.
Enhanced subsidies are set to expire after 2025. Less tax credits, and therefore more expensive premiums, will come into effect from 2026.
What Changes: The new law was an opportunity for Congress to expand its strengthened subsidies. That wasn’t the case.
Marketplace Health Insurance members at all income levels will pay more if the enhanced subsidies expire. Estimates from the Commonwealth Fund, a think tank for healthcare policies, net premiums rise from 25% to 100% based on income.
The grants will expire by 2034 to an additional 4.2 million people without health insurance, according to the nonpartisan Congressional Budget Office.
What to do about it: It is still possible to extend the strengthened grants before Congress expires. Members of Congress can be contacted about potential changes.
If the grant expires, you may need a higher premium budget. You can also consider other ways to get health insurance if your marketplace plan is no longer affordable.
2. You must re-register for grants every year
How it is now: Those who currently have Marketplace health insurance will be automatically re-registered next year. It can also be eligible for premium tax credits and cost sharing reductions. Eligibility is automatically checked using original application information and updated tax data.
Approximately 11 million people were automatically re-registered in the 2025 Health Insurance Market Plan, according to the Centers for Medicare and Medicaid Services. This is approximately 44% of total members.
What Changes: Under the new law, eligibility for premium tax credits and/or cost sharing reductions will not be carried over yearly.
Eligibility needs to be reaffirmed to maintain these grants. Otherwise, insurance premiums and out-of-pocket costs will increase. Potentially several hundred dollars a month.
The change will take effect from the 2028 tax year.
What to do about it: Even if you want to maintain the same plan, take action every year during your open registration. To maintain your grant, be prepared to provide the following information:
Household income. Family size. address. Immigration status. Other health insurance you have or qualify for.
3. Registration is more restrictive for low-income people
How it works: If your income is below 150% of the Federal Poverty Level (FPL), you have a special registration period all year round. This means you can sign up for market health insurance any time without waiting for open registration. You can also qualify for premium tax credits and cost sharing reductions.
What’s changing: Under new law, if you apply during this income-based special registration period, you will not be eligible for premium tax credits or cost-sharing reductions. (The special registration period for other types has not been changed.)
This change will begin in the 2026 Planned Year.
What to do about it: If possible, plan to apply for compensation while you are open registration. Open registrations with most states run from November 1st to January 15th (some state markets use different dates).
Registering under a different type of special registration period may result in grants. For example, if you lose other health insurance, move out, get married, get divorced, or have a baby, you can qualify.
4. Some immigrants will lose their premium tax credit
How it works: Legally presented immigrants can obtain market health insurance plans. They can also qualify for the grant.
What Changes: Under the new law, only certain categories of immigration qualify for market compensation and subsidies.
Legal permanent resident (green card holder). Certain Cuban and Haiti immigrants. Immigrants subject to the Compact of the Free Association.
Even if it is legally presented, others are no longer eligible. Examples include refugees, ASYLEEs, and people with temporary protected status. Changes begin with taxes in 2027.
What to do about it: Check if your immigration status qualifies for compensation and grants. If not, you may need to find another source of insurance.
5.Premium tax credits in advance are risky
How it works: Prepaid Premium Tax Credits pay some or all of your health insurance premiums. Credit amount is based on estimated annual income.
Your actual income may be higher than estimated. If that happens, you will qualify for a lower tax credit and will need to pay back to the IRS for differences.
You may not need to pay the full amount. There is an income-based cap. For example, according to the IRS, individuals with incomes below 200% of their FPL will repay under $375 in 2024.
What Changes: Under the new law there is no cap on repayment of premium tax credits. Those with low or shortfall in income should pay back the full amount starting with 2026 tax.
What to do about it: We will provide you with the best information possible in your application about your expected income. The more accurate your estimated income, the less you will need to pay it back.
You can choose not to get a premium tax credit in advance. Instead, you can get credits when you file your taxes. In that case, you will avoid the possibility that you will need to pay it back later. However, paying full, unsubsidized premiums each month can be very expensive.
“It should be noted that the IRS regularly collaborates with taxpayers who borrow amounts they cannot afford,” according to the IRS website. Consider contacting the IRS to arrange payments.
Alex Rosenberg writes for Nald Wallet. Email: arosenberg@nerdwallet.com.
Article 5, “Big and Beautiful Invoices” has been changed to Marketplace Insurance. It was originally featured on Nerdwallet.
