Older adults who buy their own health insurance through the Affordable Care Act Marketplace are facing a sharp jump in out-of-pocket premiums for the 2026 plan year. A 60-year-old couple earning $85,000 annually now owes an estimated $22,600 per year for benchmark silver coverage after the enhanced premium tax credits, first enacted in 2021, expired at the end of 2025. That sum represents roughly a quarter of the household’s gross income, a cost level that could force difficult tradeoffs between coverage and other essentials.
How the pre-2021 premium formula returned for 2026
The enhanced credits that Congress introduced in 2021 temporarily capped what any Marketplace enrollee paid as a share of income, regardless of age or geography. When those provisions lapsed, the original statutory formula under Section 36B took effect again for the 2026 coverage year. That formula ties a household’s expected premium contribution to an “applicable percentage” that rises with income, indexed annually for insurance-cost growth.
The IRS finalized the 2026 numbers in Revenue Procedure 2025-25, published in Internal Revenue Bulletin 2025-32. For households between 300 and 400 percent of the federal poverty level, the applicable percentage is 9.96 percent. A couple at $85,000 falls squarely in that band. Under the restored formula, their required contribution equals 9.96 percent of household income, or about $8,466. The gap between that figure and the full-price benchmark premium in their rating area determines the size of the tax credit they receive. In high-cost markets where benchmark silver plans price well above that threshold for two 60-year-olds, the household’s net annual cost can reach $22,600 or more after the credit is applied.
Before 2021, this structure routinely exposed older enrollees to much higher net premiums than younger adults with the same income, because insurers can charge up to three times more for a 64-year-old than for a 21-year-old. The temporary enhancements muted that age-based disparity by lowering the maximum share of income that any household had to pay for the benchmark plan. With those caps gone, the underlying age-rating rules again play a central role in determining what older adults owe.
What is verified so far
Several official data releases confirm the regulatory and pricing inputs behind this scenario. CMS published a fact sheet on plan year 2026 Marketplace offerings, documenting issuer participation, premium trends, and consumer plan options across federally facilitated Exchange states. Separately, the QHP Landscape PY2026 Individual Medical dataset, available through data.healthcare.gov, provides county-level plan offerings, rating areas, and premium amounts that researchers and consumers can use to reconstruct benchmark costs for specific ages and locations.
The statutory framework itself is well established. Section 36B defines the benchmark plan as the second-lowest-cost silver option in a given rating area, and it sets the mathematical relationship between household income, the applicable percentage, and the resulting credit. The IRS updates the applicable percentage table each year through a revenue procedure, and the 2026 table restores the steeper income-based contribution schedule that existed before the temporary enhancements. At 9.96 percent for the 300-to-400-percent FPL bracket, the required contribution is meaningfully higher than the capped rates households paid during the enhancement period.
In practice, calculating the couple’s net premium involves three steps that are all grounded in these official sources. First, analysts identify the second-lowest-cost silver premium for two 60-year-old adults in a specific rating area using the QHP Landscape file. Second, they compute the household’s expected contribution as 9.96 percent of $85,000, using the IRS table. Third, they subtract that contribution from the full benchmark premium to derive the tax credit and, by extension, the remaining amount the couple must pay. Where local benchmark premiums are especially high, the final figure aligns with the $22,600 estimate cited here.
What remains uncertain
The $22,600 annual premium figure depends on variables that no single federal document pins down in one place. The exact benchmark silver premium for two 60-year-old enrollees varies by county, rating area, and ZIP code. Neither the IRS bulletin nor the CMS fact sheet models a specific scenario for this age and income combination. Reconstructing the number requires combining age-rated premiums from the QHP Landscape files with the applicable percentage from the IRS revenue procedure, and the result shifts substantially depending on geography. A couple in a low-cost rural county could pay thousands less than peers in a metro area with fewer competing insurers.
Premiums can also change from year to year as insurers adjust their rates, enter new markets, or exit existing ones. While CMS documents overall premium trends and issuer participation, it does not guarantee that any given county’s benchmark plan will follow the national average. Local market dynamics-such as hospital consolidation, prescription drug spending, and the presence of narrow-network plans-can all influence where the benchmark premium lands relative to the couple’s expected contribution.
Federal agencies have not published direct estimates of how many households between 300 and 400 percent of FPL will drop coverage because of the higher contributions. CMS tracks enrollment and plan selection data, but projections about coverage loss at this income level are not included in the available fact sheets or datasets. Independent analysts may model potential enrollment declines, but those projections are not reflected in the official materials. The scale of the enrollment effect, if any, will not become clear until open-enrollment results for the 2026 plan year are tallied and compared with prior years.
Another unknown is how many affected households will respond by downgrading coverage rather than leaving the market entirely. Some older adults may opt for bronze plans with lower premiums but higher deductibles, or choose narrower provider networks to keep monthly costs down. These shifts would not immediately show up as coverage losses in federal statistics, but they could still leave households more exposed to financial risk when they need care.
How to read the evidence
The strongest evidence in this story comes from two primary government sources. The IRS revenue procedure provides the binding contribution percentages, and the CMS plan-level datasets supply the premium inputs needed to calculate what any household actually owes. Together, they form the building blocks of the $22,600 estimate. Readers evaluating that figure should treat it as a plausible outcome in higher-cost rating areas rather than a single national average.
Contextual sources, including CMS affordability summaries and issuer-participation counts, help frame the broader market but do not independently confirm the specific dollar amount for a 60-year-old couple at $85,000. Any analysis that arrives at a precise premium figure is necessarily location-dependent. Consumers can see their own county’s options by reviewing Marketplace plan data, which reflect the same underlying premiums used in the QHP Landscape files.
For readers, the key is to distinguish between what is fixed and what is variable. The contribution formula and applicable percentage are fixed nationwide, as set out in federal law and IRS guidance. The benchmark premium and resulting tax credit, by contrast, vary from one rating area to another. When advocates or policymakers cite examples like the $22,600 premium, those figures should be understood as illustrative case studies grounded in official data, not as guarantees of what every similar household will pay.
What is clear from the available evidence is that the expiration of the enhanced credits has shifted more of the premium burden back onto older middle-income enrollees. For a 60-year-old couple earning $85,000, the restored formula can translate into premiums that consume a significant share of income, especially in high-cost markets. How many households ultimately maintain coverage at those prices-and how many adjust by changing plans, reducing coverage, or leaving the Marketplace-will be one of the central questions as the 2026 plan year unfolds.
