Your January premium bill probably looked unrecognizable.
Pennie, Pennsylvania's marketplace, reports one in five enrollees dropped coverage between December and February. Nevada Health Link approved 26% gross rate hikes for 2026. The Kaiser Family Foundation found 60% of marketplace enrollees can't absorb a $300 annual premium increase, and most are facing increases ten times that.
For a 60-year-old couple sitting just above 400% of the federal poverty line, the math looks like this: a plan that cost $500-600 a month last year is $2,000-3,000 a month now. Same plan. Same household. Same income. The subsidy is what changed.
What happened
The enhanced premium tax credits expired December 31, 2025. The House passed a three-year extension on January 8. The Senate didn't. As of right now there is no extension. The American Rescue Plan and Inflation Reduction Act expansions that kept the subsidy curve smooth for people above 400% of the federal poverty line are gone. The hard cliff is back. If your household income is above $62,600 single, $84,600 couple, $128,600 family of four, $150,600 family of five, you get zero subsidy this year.
That's the demographic that uses my office most. Self-employed. Small business. Families just over the line. Older couples with stable income. The exact people who built their financial life around the math working a certain way are watching the math break.
Here's what you can actually do about it.
Move 1: Drop your MAGI below the cliff before December 31
The cliff sits at 400% of the federal poverty line. $62,600 single, $84,600 couple, $128,600 family of four, $150,600 family of five. If you're $5K over, you could be paying $15K-30K more for insurance than someone $5K under. The math of dropping under the cliff usually beats the math of staying over it.
Self-employed has a few main levers. Solo 401(k), SEP-IRA, HSA, business expense optimization. A Solo 401(k) lets you defer up to $23,500 as employee plus another 25% of net self-employment earnings as employer in 2026. A SEP-IRA caps at 25% of net SE earnings, simpler to set up. HSA contribution limit is $4,400 single, $8,750 family. Stack them deliberately and you can drop MAGI by $30K-60K depending on your situation.
The catch: these have to be funded before specific deadlines, most of them December 31. After that, the door closes for the 2026 tax year.
Move 2: Bronze plan plus HSA plus Direct Primary Care
New rule as of January 1, 2026, through the One Big Beautiful Bill Act and IRS Notice 2026-5: every ACA Bronze and Catastrophic plan is HSA-eligible. Previously most Bronze plans didn't qualify because they didn't meet the strict HDHP design rules. That's gone. Now any Bronze plan works. That changes the math for people who didn't have HSA access before.
Also new: HSAs can fund Direct Primary Care memberships up to $150 a month for individuals, $300 a month for families. DPC is a flat-fee primary care arrangement, usually $75 to $150 a month, where you get unlimited visits, same-day appointments, and no insurance billing for routine care. Pair it with a low-premium Bronze plan and an HSA, and you've covered everyday care plus catastrophic, often for less total spend than a subsidized Silver plan would have cost.
Move 3: ACA-compliant off-exchange Bronze
Off-exchange ACA-compliant plans don't show on HealthCare.gov but meet the same coverage standards. They sometimes cost less for the same network because the carrier doesn't pay the exchange fee. If you don't qualify for subsidies anyway, the exchange has no advantage over off-exchange. None.
Caveat: this only works for ACA-compliant plans. Short-term medical, fixed indemnity, healthshare ministries, and limited-benefit plans are not ACA-compliant. They're cheaper but they're different products with different protections. Make sure you know which one you're buying.
Move 4: The spousal split or ICHRA
If both spouses are self-employed, or one has W-2 access, splitting coverage across employers can shift the household math. ICHRA arrangements (Individual Coverage Health Reimbursement Arrangements) let small businesses reimburse owner and employee health premiums tax-free. Works especially well if one spouse runs an S-corp and the other has variable income.
Move 5: Do not underestimate your income
APTC repayment caps are gone for the 2026 tax year. Previously if you underestimated your income and got more subsidy than you qualified for, the IRS capped how much you had to pay back. That cap is gone. Underestimate your MAGI and you owe full clawback at tax time. For a couple expecting $80K who ends up at $95K, that could be a five-figure surprise nobody saw coming.
If your income varies, and most self-employed income does, estimate high not low. You can always get a refund. You can't always afford the clawback.
Why this matters before November
Open Enrollment for 2027 opens November 1 and closes December 15. Forty-five days. Thirty shorter than last year.
The income moves above have to be done before December 31, 2026 to affect this year's MAGI. That means the math conversation has to happen in late summer or early fall, not during OE itself. By the time enrollment opens, your 2026 income picture is mostly locked.
If you're going to make a move, the window is now through October.
If you want help running the math
I help self-employed and small business clients across 38 states figure out which combination of moves fits their situation. There isn't one answer. The cliff hits different at $90K than at $200K. SEP-IRA math doesn't fit everyone. ICHRA needs the right business structure. The right Bronze plan in Nevada may not be the right Bronze plan in Texas.
Call (702) 379-9084 or book a time at jonestrueinsurancesolutions.com. Consultations don't cost anything.
People in this business have been warning clients since 2023 this might happen. It happened. The math doesn't fix itself.
Mary