How Affordable Care Act premiums are estimated to rise across the region

If tax credits expire, how much your premiums go up will depend on where you live, how old you are, and what you earn.

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If you pay for your doctor visits with an Affordable Care Act health plan – Pennie in Pennsylvania., Get Covered NJ in New Jersey, or Healthcare.gov in Delaware – the cost of your premium might be about to go way up. Experts say costs could rise fivefold unless lawmakers move to review or replace tax credits – that ensure no one pays more than 8.5% of their income on premiums – before they expire at the end of the year.

Without these tax credits, people on ACA health plans will need to pay for a greater share of the premium themselves. This was a central issue in the recent standoff between congressional Republicans and Democrats that led to the longest ever U.S. government shutdown.

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The shutdown ended after eight senators broke ranks with the Democrats and voted on compromise legislation to reopen the government. Senate Majority Leader John Thune of South Dakota pledged to hold a vote in December on the ACA subsidies. Congress would need to approve extending tax credits.

If they’re not extended, here is how much premiums could increase across the region, according to estimates by KFF, an independent source for health policy research, polling, and journalism:

  • For an average 27-year-old from

    AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

    , making $35,000 a year, insurance premiums could go from costing 27_35k_yesEPTC to 27_35k_noEPTC, an increase of 27_35k_diffEPTC.

  • The expiration of tax credits could mean the end of free insurance for the lowest earners, according to KFF’s estimates. For example, a 27-year-old from

    AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

    making $22,000 a year will have to pay 27_22k_noEPTC if these tax credits expire.

    This can be a meaningful amount for someone making less than $2,000 a month. Especially as those in lower income brackets are more likely to forgo health insurance to steer limited financial resources to other household expenses, according to KFF surveys.

  • Enshrined into the original ACA are coverage subsidies for those who earn less than $62,600. As a result, anyone who makes below that threshold would be impacted similarly.

    ACA calculates this value at 4 times the poverty rate, which is currently at $15,650.
  • The expiring tax credits were added later to ensure that nobody pays more than 8.5% of their income in premiums. In

    AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

    , a 27-year-old making $65,000 could pay a premium of 27_65k_noEPTC, while a 60-year-old in the same income bracket could pay 60_65k_noEPTC. Older people in higher income brackets, who are generally charged more since they are generally less healthy than younger people, are set to see large premium increases.

  • The impact will be greatest in some rural parts of Pennsylvania. For example, in Fulton County, 60-year-olds making $65,000 could pay an estimated 60_65k_diffEPTC more a month, an almost five times increase from existing premiums.

    Lisa Davis, director at Pennsylvania Office of Rural Health, explained that generally, “in rural communities, there’s often very little competition” between providers and rural populations “are generally older, poorer, and have more chronic health conditions.”

  • New Jersey could see larger price increases than Philadelphia and the collar counties. In Camden County, for instance, 60-year-olds making $65,000 could pay almost 60_65k_diffEPTC more a month.

    Premium estimates are uniform across New Jersey because the state does not have rates that vary by region, as seen in Pennsylvania.
  • See what price increases look like for those across Pennsylvania, New Jersey, and Delaware. Select your county:

    AdamsAlleghenyArmstrongBeaverBedfordBerksBlairBradfordBucksButlerCambriaCameronCarbonCentreChesterClarionClearfieldClintonColumbiaCrawfordCumberlandDauphinDelawareElkErieFayetteForestFranklinFultonGreeneHuntingdonIndianaJeffersonJuniataLackawannaLancasterLawrenceLebanonLehighLuzerneLycomingMcKeanMercerMifflinMonroeMontgomeryMontourNorthamptonNorthumberlandPerryPhiladelphiaPikePotterSchuylkillSnyderSomersetSullivanSusquehannaTiogaUnionVenangoWarrenWashingtonWayneWestmorelandWyomingYorkAtlanticBergenBurlingtonCamdenCape MayCumberlandEssexGloucesterHudsonHunterdonMercerMiddlesexMonmouthMorrisOceanPassaicSalemSomersetSussexUnionWarrenKentNew CastleSussex

As a result of these changes, the Congressional Budget Office estimates that 4.2 million Americans will choose to drop their coverage. Pennie administrators estimate about 150,000 of the 500,000 people who bought plans this year will drop out because they find the plans unaffordable.

“Individuals who are least likely to be able to afford these premium increases will not be enrolled. Of course, people want to have health insurance, whether or not they can afford it is a different conversation. It’s a tough, challenging situation,” Davis said.

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In addition to tax credits shrinking, premium prices are rising. Rates requested by insurers for 2026 reflected the expectation that only the sickest (and most expensive to cover) individuals will continue to prioritize buying health insurance, Pennsylvania Insurance Commissioner Michael Humphreys said during a call with reporters in September. If this happened, there would be fewer healthier people to share the cost, resulting in higher premiums for those who stay enrolled.

Already, many uninsured people cite the high cost of insurance as the main reason they lack coverage. Sixty-three percent of uninsured adults ages 18-64 said that they were uninsured because the cost of coverage was too high in a 2024 KFF survey.

The impact of this is that those without insurance coverage are more likely to delay or forgo care because of costs, which could lead to worse healthcare outcomes for the individual.

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Devon Trolley, Executive Director of Pennie expressed, although it is still early in this year’s open enrollment, the uncertainty could already be having an impact. “So far this year, Pennie is seeing 16-18% less new enrollees and a lot more people drop enrollment compared to prior years” said Trolley.

“When people call in, they are making the connection between congressional debate around healthcare subsidies and rising premiums on the consumer side.”

The focus remains on D.C., where lawmakers will determine whether the existing tax credits are extended. President Donald Trump said last week that “some kind of an extension may be necessary” but didn’t go into specifics.

Davis said “Pennie extended the enrollment deadline through to the end of January, but we’re running out of time.”

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Methodology

Every year, KFF collects premium information from a variety of sources, such as contacting the state insurance regulator in Pennsylvania. From these data, KFF identifies the benchmark silver plan (typically the second-lowest cost silver plan) by county.

Premiums are calculated based on the age and location of the individuals. KFF then calculates the premium tax credits based on family size and income, using the applicable percentage tables produced by the IRS.

You can use KFF’s calculator tool to find out how much you or your family would pay in premiums with and without the ACA's Enhanced Premium Tax Credits.

Staff Contributors

  • Design, data analysis, and reporting: Jasen Lo
  • Development: Jasen Lo and Garland Fordice
  • Data: KFF
  • Editing: Sam Morris
  • Copy Editing: Brian Leighton