Becker's Healthcare December 31, 2025
Health insurers face a wave of regulatory and policy changes in 2026, from the expiration of enhanced ACA premium tax credits to tighter prior authorization rules and new state coverage mandates.
Here’s a rundown of major federal and state payer policies taking effect:
Affordable Care Act
Enhanced premium tax credits expire: The enhanced ACA premium tax credits expired Dec. 31, leaving millions of marketplace enrollees facing significantly higher premiums. The enhanced subsidies, enacted under the 2021 American Rescue Plan Act, expanded eligibility to households earning more than 400% of the federal poverty level and capped benchmark plan premiums at 8.5% of income. Marketplace enrollment reached 24.3 million in 2025 under the enhanced credits.
Congressional action to extend the subsidies...
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