In this episode of Health Insurance Simplified, our experts help Marketplace insurance plan members navigate the next open enrollment period.

Written by Mick Garry

Mick Garry (host): Welcome to Sanford Health Plan’s “Health Insurance Simplified” podcast, your go-to for smart, easy to understand insights on health coverage. I'm your host, Mick Garry.

Today we're diving into the expiration of enhanced premium tax credits coming on Dec. 31, 2025. It's a big change to the Affordable Care Act, or the ACA, that could affect millions of Americans.

Joining me today are two experts from Sanford Health Plan: Jennie Nickles, senior director of sales, and Dylan Wheeler, head of government affairs.

So let's start with the basics, Dylan. What exactly are these premium tax credits and why are they expiring? 

Dylan Wheeler (guest): Great question. So, premium tax credits are subsidies that help our members and people afford health insurance through the Affordable Care Act marketplace. During the pandemic, Congress passed what's called the American Rescue Plan Act, which temporarily made these credits more generous. Then, through the Inflation Reduction Act, extended those enhancements through the end of 2025. But unless Congress acts again yet this year, those enhancements will expire on Dec. 31, 2025, meaning that many people will see their monthly premiums go up in 2026.

Mick Garry: So you're saying enhanced premium tax credits were always meant to be temporary.

Dylan Wheeler (guest): Exactly. It was a pandemic-era solution to make coverage more affordable and more accessible during that time. But now we're approaching the end of that timeline.

Mick Garry: Jennie, what does this mean for someone, perhaps with a family, who is shopping for a health plan in 2026 with these new conditions?

Jennie Nickles (guest): It means they may be in for a surprise without the enhanced credits. People with incomes over the federal poverty limit of 400% may no longer qualify for that financial assistance or those subsidies. Those who may, you know, generally qualify to get access to additional financial help may not be able to be eligible for that in 2026 like they have been in previous years.

I think it's great to break this down into an example:

Someone who may be paid $50 a month for a Silver plan in ‘25 on the Marketplace might see that jump to $150 or more in 2026. It's again, really going to depend on their household income, size and the location of where they reside. 

Mick Garry: Good grief, that's potentially a pretty radical change for some people there. Might this lead to people losing coverage?

Jennie Nickles (guest): Some might. If premiums become unaffordable, that's certainly something that we're monitoring and are concerned about. People are going to either have to make a choice between dropping coverage or certainly switching plans to something maybe with a higher deductible, which could mean more out-of-pocket cost for them as well in 2026. That's why it's certainly important to be aware of these upcoming potential changes and plan ahead.

Mick Garry: What can listeners do to prepare for this?

Dylan Wheeler (guest): First thing, stay informed. Congress could yet act this year to extend these credits, but there's no guarantee, so it’s smart to review your income and household details now, and how those affect your eligibility looking ahead. Also, you can reach out to your congressional delegation, your representative, your senator, ask questions about these tax credits and how action by Congress, or inaction by Congress, could affect your health plan.

They'd like to hear from you: the member and the patient.

Jennie Nickles (guest): I also think it's important to talk to a health insurance agent. Our agents can walk you through your options and help you assist in your planning for 2026 and what those costs may be. You can also visit sanfordhealthplan.com/shop-plans and use our shopping tools and get personalized help.

Mick Garry: Can you map out a deadline that people should be paying attention to right now? 

Jennie Nickles (guest): Yes. So the open enrollment for 2026 will start here on Nov. 1, and it'll end on Jan. 15, 2026. Those specifically shopping for a plan for Jan. 1 need to make sure that they take action by Dec. 15.

That's through the open enrollment period when you're going to see updated plan information, pricing, a lot of things coming from us as an insurance carrier or healthcare.gov to really make sure that you can plan ahead so you don't have surprises.

You certainly don't have to wait until the open enrollment period to start asking questions. The earlier you can prepare, the better your choices will be.

Mick Garry: Before we wrap up, any final advice?

Dylan Wheeler (guest): Keep an eye on the news. Keep an eye on those policy updates wherever you get your news. Traditional media, social media – this will be big news if Congress extends these credits. But if not, be ready to adjust your plan.

Jennie Nickles (guest): And don't go at it alone. Just remember, Sanford Health Plan is certainly here to help you navigate through these changes. Whether you're new to the Marketplace or looking to renew your coverage in 2026, we're here to help.

Mick Garry: Thank you. To our listeners, if you have questions or want to explore your options, visit sanfordhealth plan.com/shop-plans or reach out to a licensed Sanford Health Plan agent at (888) 535-4831 (TTY: 711). We’ll see you next time on Sanford Health Plan’s "Health Insurance Simplified" podcast.