At CoverME.gov, we know that buying health insurance coverage on your own can be expensive for a lot of Maine households. Today, more than eight in ten (85%) CoverME.gov members receive financial savings that helps them afford monthly premiums. However, due to federal law, some of these savings could go away at the end of this year unless Congress acts soon. We are working to call attention to this issue so you can plan ahead.
- What are Enhanced Premium Tax Credits?
-
The Affordable Care Act (ACA) established federal tax credits, called Premium Tax Credits (PTCs). PTCs help eligible households lower their monthly payments for health insurance coverage offered through health insurance exchanges, like Maine's marketplace (CoverME.gov). Individuals and families who enroll in a CoverME.gov plan and who are eligible for PTCs can claim the full federal tax credit when filing their income taxes. Alternatively, eligible individuals and families can choose to receive the federal tax credit in advance, which lowers the amount they have to pay for premiums each month. In 2021, Congress took action and expanded the federal tax credits, making more individuals and families eligible for PTCs and increasing the amount available for all who are eligible. This "Enhanced Premium Tax Credit" (EPTC) was extended for three additional years (through the end of 2025).
- What is happening?
-
EPTC will expire at the end of 2025 unless Congress takes action. If you receive financial savings, these savings will decrease starting in 2026 and result in your monthly premium payments increasing. This does NOT affect your premiums in 2025.
- How will this impact CoverME.gov members who receive financial savings?
-
The original tax credits offered through the Affordable Care Act will remain in place. However, if Congress does not take action, additional savings that further reduced the premiums for eligible CoverME.gov members --EPTCs -- will expire at the end of 2025. On average, CoverME.gov members are likely to see premium increases of nearly $180 per month. Households that will see the largest premium increases include those that have members aged 60-64, who live in rural areas of the state, have children covered, and have household incomes of more than $62,500 for a single individual or more than $84,500 for a two-person household.
- How much will I pay next year?
-
Nearly all CoverME.gov consumers will likely see higher monthly premiums if Congress does not take action to extend, or make permanent, the enhanced tax credits. You can use a premium calculator at KFF.org to estimate how much you might pay in 2026. Please note that this calculator cannot provide you with a price quote but will give you a ballpark estimate of what you can expect to pay without the enhanced premium tax credit. Beginning in October, CoverME.gov will send notices to members to let them know if they qualify for financial savings in 2026. Then, starting November 1, we will notify members about their 2026 monthly payments.
- Are there other reasons my costs might change?
-
Health insurance carriers determine premium rates for their plans, which are filed with and reviewed by Maine's Bureau of Insurance each year. The Bureau of Insurance approves or disapproves of these rate filings. The rates filed by health insurance carriers largely reflect health care costs. For individuals and families, the monthly premium cost of health insurance coverage can vary based on geographic location, age, and the number of household members who are covered by the plan. For CoverME.gov members, your monthly premium can vary based on household income, family size or tax filing status.
- What is CoverME.gov doing?
-
The CoverME.gov team has been working to model and share the impact on our members if the enhanced health care tax credits expire. CoverME.gov has been working with members who are willing to share their story about the impacts on their households and communities if the EPTC are not extended. We have been sharing data and stories with policymakers, the media, and the public. CoverME.gov will continue to focus on our role to help Mainers who are purchasing health coverage on their own to compare plans and find one that best meets their needs and budget.
- What can I do?
-
Be sure to read the communications CoverME.gov or your insurance company sends to you over the next few months.
By law, the EPTC is set to expire at the end of 2025. In order for the EPTC to continue past then, Congress needs to take action to extend it.