If you're a Utahn who buys health insurance through the ACA marketplace, you already know something changed. Your January premium was higher. Maybe a lot higher.
You're not imagining it. The enhanced premium tax credits that kept marketplace insurance affordable for five years expired on December 31, 2025 — and Utah has done nothing to replace them. Nearly 422,000 Utahns are feeling the impact right now.
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Here's what actually happened, what it means for your wallet, and what you can do about it today.
What Changed: The Premium Tax Credit Expiration Explained
From 2021 through 2025, the federal government boosted ACA marketplace subsidies through the American Rescue Plan Act (2021) and the Inflation Reduction Act (2022). These enhanced premium tax credits did two big things:
Eliminated the income cap. Previously, you lost all subsidies if your household income exceeded 400% of the federal poverty level (about $124,800 for a family of four). The enhanced credits removed that cliff.
Lowered everyone's share. The percentage of income you had to pay toward your benchmark plan dropped significantly. People earning under 150% FPL paid $0.
Congress let these credits expire at the end of 2025. The result? Subsidized enrollees are paying 114% more on average — from $888/year to $1,904/year, according to the Kaiser Family Foundation. On top of that, base premiums themselves rose 26% — the largest increase since 2018 — driven by rising hospital, physician, and prescription drug costs.
How This Hits Utah Families
Utah has the 4th highest ACA marketplace enrollment rate in the country. Nearly 12% of our population — 421,900 people — enrolled through the marketplace in 2025, and almost 90% received premium tax credits. Utah's weighted average gross premium increase for 2026 is 14.2%. But that's before the subsidy loss.
Family of 4, Income $45,000/year
2025: $0/year (fully subsidized). 2026: $1,607/year ($134/month). Increase: $1,607/year.
Family of 4, Income $85,000/year
2025: $4,148/year ($346/month). 2026: $7,536/year ($628/month). Increase: $3,388/year (+94%).
60-Year-Old Couple, Income $85,000/year
2025: Premiums capped at 8.5% of income. 2026: Premiums jump to ~25% of income. Increase: $22,600/year.
Family of 4, Income $130,000/year
2025: Received credits (no income cap). 2026: Loses ALL credit eligibility (income now exceeds the reinstated 400% FPL cap). Increase: $11,450/year (+104%).
Utah's Carrier Landscape Has Changed Too
Adding to the disruption, Aetna exited Utah's individual marketplace entirely at the end of 2025. BridgeSpan Health raised rates 16%, Regence BCBS of Utah raised rates 15%, and Molina Healthcare raised rates 31.6% while exiting most Utah counties. SelectHealth, University of Utah Health Plans, and Imperial Health Plan remain available. If your carrier left or raised rates dramatically, you may be on a plan that no longer fits your budget or your needs.
What Makes This Worse: The OBBBA's Hidden Changes
The One Big Beautiful Bill Act, signed in July 2025, added restrictions that many Utahns don't know about. Income-based Special Enrollment Periods no longer qualify for subsidies — if you enrolled outside open enrollment based on low income alone, you won't get premium tax credits. Repayment caps for overpaid credits are also gone. Previously, low-income enrollees who received too much in advance credits were protected from owing more than a set amount at tax time. That protection is gone. You could owe the full amount back.
Utah Isn't Helping (But Some States Are)
Six states — New Mexico, Connecticut, Washington, California, Colorado, and Maryland — created their own programs to replace or offset the lost federal subsidies. Utah is not one of them. Our state has not enacted any premium assistance program, does not operate its own exchange, and has no Section 1332 reinsurance waiver to lower premiums. Utah marketplace enrollees are fully exposed to the federal subsidy reduction.
Your Options Right Now
Open enrollment for 2026 is closed. But depending on your situation, you have more options than you might think.
1. Review Your Current ACA Plan
Standard premium tax credits still exist for incomes between 100–400% FPL — they're just smaller. Switching to a Bronze or Catastrophic plan (available if you're under 30 or have a hardship exemption) could significantly reduce your monthly premium.
2. Check If You Qualify for Medicaid
Utah expanded Medicaid to cover adults earning up to 138% FPL — that's $21,597 for an individual or about $42,768 for a family of four. If your income dropped, you may qualify. There's no open enrollment window for Medicaid; you can apply anytime.
3. Look Into Employer Coverage
If you or your spouse has access to employer-sponsored insurance, it's often more affordable than unsubsidized marketplace plans. Gaining access to employer coverage is a qualifying life event that triggers a 60-day Special Enrollment Period.
4. Consider Short-Term Health Insurance
Short-term plans offer lower premiums and quick enrollment. But they exclude pre-existing conditions, lack essential health benefits like maternity and mental health coverage, and have coverage caps. They're a fit for healthy individuals who need temporary bridge coverage — not a long-term replacement.
5. Explore Direct Primary Care + Catastrophic Coverage
A growing option in Utah: pay $50–$100/month for a Direct Primary Care membership covering unlimited primary care visits, then pair it with a high-deductible or catastrophic plan for major events.
6. Talk to an Independent Agent
This is where an independent insurance agency earns its value. Unlike the marketplace website, we compare plans across multiple carriers and coverage types — ACA, short-term, supplemental, and more. We can model your specific household's costs and find coverage you might not know exists. At The Insurance Box, we've been walking Utah families through exactly these conversations since January.
Don't Wait Until November
The next open enrollment period starts November 1, 2026 for 2027 coverage. But if you're overpaying now or underinsured, waiting seven months could cost you thousands — or leave you exposed to a medical event without adequate coverage. If you've had a qualifying life event (marriage, new baby, job change, move, loss of other coverage), you have a 60-day window to enroll in a marketplace plan right now.
Frequently Asked Questions
Can I still get ACA subsidies in 2026?
Yes, standard premium tax credits are still available if your household income is between 100–400% of the federal poverty level. They're just less generous than the enhanced credits that expired.
I missed open enrollment. Can I still get health insurance?
You can enroll through a Special Enrollment Period if you have a qualifying life event (marriage, birth, job loss, move, etc.). You can also apply for Medicaid at any time if your income qualifies.
Will the enhanced subsidies come back?
There's no active legislation to restore them as of April 2026. The CBO estimates permanent extension would cost $335–350 billion over 10 years.
Is going uninsured a good option to save money?
The federal penalty is $0, but going uninsured means a single ER visit (average $2,200+) or hospital stay ($30,000+) comes entirely out of your pocket. We'd recommend exploring lower-cost coverage options before going without.
How can The Insurance Box help?
We're independent — we work with multiple carriers and coverage types, not just one company. We'll review your household situation, compare options across the full market, and help you make the most informed decision. Book a free consultation or take our coverage quiz to get started.
