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. 2025 Oct 23;3(11):qxaf202.
doi: 10.1093/haschl/qxaf202. eCollection 2025 Nov.

Will expanding catastrophic coverage eligibility increase marketplace premium affordability in 2026?

David M Anderson  1 , Dylan Nagy  2 , Coleman Drake  2
Affiliations

Will expanding catastrophic coverage eligibility increase marketplace premium affordability in 2026?

David M Anderson et al. Health Aff Sch. .
No abstract available

Keywords: Affordable Care Act; Health Insurance Marketplace; Obamacare; One Big Beautiful Bill Act; health insurance; premium tax credit subsidy; underinsurance; uninsured.

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Conflict of interest statement

Conflicts of interest: Drs. Drake and Anderson received funding from the Commonwealth Fund and the Agency for Healthcare Research and Quality. Dr. Anderson has received personal fees from Alliant Health Plans, MEAPTA LLC, Evensun LLC for non-related ACA work. Dr. Anderson has received consulting fees from Pharmaceutical Care Management Association and Dr. Anderson has received research funding from Pharmaceutical Care Management Association Foundation for work on Medicare Part D. No other disclosures are made. Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials.

Figures

Figure 1.
Figure 1.
Differences between 2025 mean monthly premiums for the lowest premium catastrophic plan and the lowest premium subsidized bronze plan, with and without expand premium subsidies for a 45-year-old marketplace enrollee with an income from 250% to 500% FPL. The sample consisted of 1420 counties in 21 healthcare.gov states where catastrophic plans are available in 2025. We weighted premiums by 2025 enrollment above 250% of the FPL ($39 125 dollars in annual income for a single person and $80 375 dollars for a family of four). We identified the lowest premium catastrophic and subsidized bronze plans for each county using the 2025 Qualified Health Plan Landscape File from healthcare.gov. We calculated subsidies for each age and FPL unit using: (1) marketplace age rating multipliers from the CMS; (2) 2025 federal poverty guidelines from the Department of Health and Human Services; (3) the latest marketplace expected contribution percentages from the CMS—2025 for expanded premium tax credits and 2026 for non-expanded premium tax credits; and (4) benchmark plan premiums from the 2025 Qualified Health Plan Landscape File. We calculated the difference between the lowest premium catastrophic plan and the lowest premium subsidized bronze plan. We report differences and 95% confidence intervals at 25-percentage point intervals in Appendix Table S1. Results for enrollees of different ages are shown in Appendix Figure S1.
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References

    1. Expanding Access to Health Insurance: Consumers to Gain Access to “Catastrophic” Health Insurance Plans in 2026 Plan Year | CMS . Accessed October 3, 2025. https://www.cms.gov/newsroom/fact-sheets/expanding-access-health-insuran...
    1. Centers for Medicare and Medicaid Services . HHS expands access to Affordable Health Insurance. cms.gov. 2025. Accessed September 8, 2025. https://www.cms.gov/newsroom/press-releases/hhs-expands-access-affordabl...
    1. 2025 Marketplace Open Enrollment Period Public Use Files | CMS . Accessed October 3, 2025. https://www.cms.gov/data-research/statistics-trends-reports/marketplace-...
    1. Anderson DM, Golberstein E, Drake C. Georgia's reinsurance waiver associated with decreased premium affordability and enrollment. Health Aff. 2024;43(3):398–407. 10.1377/hlthaff.2023.00971 - DOI - PubMed
    1. House Republicans launch bill to extend health subsidies past midterms—POLITICO . Accessed October 3, 2025. https://www.politico.com/news/2025/09/04/aca-enhanced-tax-credits-extens...

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