ACA Subsidies Have Expired — And Millions Are Losing Coverage

The expiration of enhanced Affordable Care Act (ACA) subsidies — first authorized under the American Rescue Plan Act of 2021 and extended through the Inflation Reduction Act of 2022 — has created a coverage crisis for millions of Americans enrolled in marketplace health insurance plans. Without those enhanced premium tax credits, monthly premiums for ACA marketplace plans have risen sharply for many households, and early data shows a significant number of enrollees are dropping coverage rather than absorbing the higher costs. If you're among those who've lost coverage or are struggling to afford your current plan, several programs may be available depending on your income, household size, and state of residence.

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What Exactly Expired — and Why It Matters

The enhanced subsidies that expired were not the original ACA premium tax credits — those still exist. What ended were the boosted credits that had, for several years, made marketplace coverage dramatically more affordable across a wider income range. Under the enhanced structure, households earning up to 400% of the Federal Poverty Level (FPL) received larger subsidies, and those above 400% FPL became newly eligible for some assistance for the first time.

With those enhancements gone, the subsidy cliff at 400% FPL has returned. Households earning just above that threshold — roughly a family of four earning above that benchmark — may now face full unsubsidized premiums, which can run into hundreds or thousands of dollars per month depending on plan type, age, and location.

For lower-income households still within the original subsidy range, the credits are smaller than they were under the enhanced structure, meaning premiums are higher than enrollees have been accustomed to paying over the past several years.

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Programs That May Help If You've Lost ACA Coverage

Medicaid: Year-Round Enrollment, No Deadline

Medicaid is the most immediate option for households with lower incomes. In the 40 states (plus Washington, D.C.) that have adopted Medicaid expansion under the ACA, adults generally may be eligible if household income falls at or below 138% of the Federal Poverty Level. Medicaid enrollment is open year-round — there is no open enrollment window — and coverage can often begin the month you apply or even retroactively in some states.

To apply, contact your state Medicaid agency directly or use HealthCare.gov, which screens applicants for both marketplace plans and Medicaid simultaneously. Required documents typically include: - Proof of identity (driver's license, passport, or state ID) - Proof of income (recent pay stubs, tax returns, or employer letter) - Proof of residency (utility bill, lease agreement) - Social Security numbers for all household members applying

In the 10 states that have not expanded Medicaid, eligibility thresholds are significantly lower and may exclude many low-income adults without dependent children. If you live in a non-expansion state, check your state Medicaid agency's specific rules.

CHIP: Coverage for Children Up to 300% FPL in Many States

The Children's Health Insurance Program (CHIP) covers uninsured children in households that earn too much for Medicaid but cannot afford private insurance. Income limits vary by state but commonly range from 200% to 300% of FPL, and some states go higher. Like Medicaid, CHIP enrollment is open year-round.

Parents can apply for their children through their state CHIP agency, HealthCare.gov, or by calling 1-800-318-2596 (the federal marketplace helpline). Coverage typically includes doctor visits, immunizations, dental care, and emergency services.

Special Enrollment Periods: You May Still Have a Window

If you dropped your marketplace plan because you could no longer afford the premium after the subsidy reduction, that loss of coverage may qualify as a qualifying life event, triggering a Special Enrollment Period (SEP). An SEP generally gives you 60 days from the qualifying event to enroll in a new marketplace plan.

Other qualifying events that may open an SEP include: - Loss of job-based coverage - Moving to a new coverage area - Changes in household size (marriage, birth, adoption) - Gaining citizenship or lawful immigration status

Contact HealthCare.gov or your state-based marketplace to determine whether your situation may qualify. Do not assume you've missed your chance without checking.

Federally Qualified Health Centers (FQHCs): Care Regardless of Coverage Status

For people who are currently uninsured and cannot immediately access Medicaid or marketplace coverage, Federally Qualified Health Centers (FQHCs) — also called community health centers — provide primary care, preventive services, mental health care, and dental services on a sliding-fee scale based on income. By federal law, no one is turned away due to inability to pay.

There are more than 1,400 FQHC organizations operating roughly 15,000 service delivery sites across the United States, including rural and underserved areas. To find the nearest location, use the HRSA Health Center Finder at findahealthcenter.hrsa.gov.

Prescription Assistance Programs

If prescription drug costs are a barrier, several programs may help:

  • Extra Help (Low Income Subsidy): For Medicare Part D enrollees, this federal program may help cover drug costs for those at or below approximately 150% FPL. Apply through the Social Security Administration.
  • Pharmaceutical Manufacturer Patient Assistance Programs (PAPs): Most major drug manufacturers offer free or reduced-cost medications for uninsured or underinsured patients who meet income criteria. NeedyMeds.org and RxAssist.org maintain searchable databases.
  • State Pharmaceutical Assistance Programs (SPAPs): Many states operate their own drug assistance programs with varying eligibility rules.

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How to Take Your Next Step

The most efficient first step for most people is visiting HealthCare.gov or calling 1-800-318-2596, which screens for Medicaid, CHIP, and marketplace plan eligibility simultaneously. If you prefer in-person help, Navigators and Certified Application Counselors are federally funded, free assisters who can walk you through the process without any sales pressure. Find one at localhelp.healthcare.gov.

If you complete any online inquiry form requesting a callback, note that by submitting your information you may be consenting to be contacted by phone, text, or email regarding program options — review any consent language carefully before submitting.

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Program eligibility and availability vary by state. Not affiliated with any government agency.

Last reviewed: May 2026