Enhanced premium tax credits (ePTCs) provide additional subsidies to people who are eligible for the Affordable Care Act’s (ACA) Marketplace premium tax credits and are also available to qualifying individuals with an annual income equivalent to 400% of the federal poverty level or higher. ePTCs allow for a reduction in the insurance premiums that enrollees pay based on their projected income for the next year. Many people who purchase health insurance through the ACA’s Marketplaces are eligible for tax credits that lower their monthly premiums and make essential health coverage more affordable. 

In 2020, Congress increased the ACA Marketplace premium tax credits to ensure that Americans had access to affordable health insurance during the pandemic. These enhanced tax credits were then extended in 2022 through 2025, as part of the Inflation Reduction Act. 

ePTCs are set to expire this year on December 31, 2025. The Congressional Budget Office estimates that 4 million Americans will lose coverage if enhanced premium tax credits (ePTCs) are not renewed. In rural areas, ePTCs are saving rural enrollees an average of $890 per year, which is about 28% more than their urban counterparts. Rural residents also benefit the most from ePTCs, with benchmark premiums in rural areas being about 10% higher than in urban areas. If ePTCs are not renewed, rural residents with Marketplace coverage will feel the greatest impact. As a result, health coverage in these areas would drop and thereby worsen rural population health outcomes, which already lag behind urban health outcomes.

It is vitally important for Congress to renew enhanced premium tax credits by passing H.R. 247 / S. 46, the Health Care Affordability Act of 2025, which would permanently lower health care costs for millions of Americans by making ePTCs permanent for people who get their health care through the ACA Marketplace.

For more information on state-level coverage data, please find NRHA’s state factsheets here.

For resources on how to calculate how much your premiums would increase as well as a map for district and state-level data, please use Keep Americans Covered’s calculator and map tools.