ACA subsidy reconciliation is coming. Earned more than you estimated? You may owe it back—plus 2026 premiums are up 10-30%.
ACA subsidies reconcile when you file taxes—if you earned more than estimated, you may owe money back. With 2026 premiums jumping 10-30%+, we help you model accurate income estimates and compare ACA vs private PPO to avoid surprises.
Tax Time & ACA Subsidies: Reconciling Income, Avoiding Payback, and Managing Rate Increases
Fast take: If you received ACA tax credits in 2025, your actual income gets reconciled when you file taxes—and if you earned more than estimated, you may owe money back. With 2026 premiums jumping and subsidy rules potentially changing, now's the time to plan ahead and compare all your options.
Worried about subsidy payback or rising 2026 premiums?
We'll model your 2026 costs with accurate income estimates and compare ACA vs private PPO options.
Get Free Quotes Book a CallHow ACA subsidy reconciliation works
When you enroll
You estimate your 2025 income. The Marketplace calculates your monthly tax credit (Premium Tax Credit or PTC) based on that estimate.
When you file taxes
IRS Form 8962 reconciles your actual income against what you estimated. If you earned more than expected, you may owe money back.
Common reconciliation scenarios
Earned less than estimated
✓ You may get a tax refund
✓ You were entitled to larger credits
Earned what you estimated
✓ No change
✓ Credits were accurate
Earned more than estimated
✗ You may owe money back
✗ Credits were too high
Why payback happens (and how to avoid it)
Common triggers
✓ Got a raise or bonus
✓ Started a side business
✓ Spouse got a new job
✓ Sold investments or property
✓ Under-estimated self-employment income
How to avoid surprises
✓ Update income estimates mid-year on Healthcare.gov
✓ Report major life changes immediately
✓ Set aside funds if income is variable
✓ Consider private PPO if income exceeds subsidy thresholds
2026 rate increases compound the problem
Premiums are jumping 10-30%+ for 2026. If you're already facing subsidy payback and higher premiums, your total costs could spike significantly.
If subsidies shrink or disappear
✓ Your net premium goes up
✓ You pay more out-of-pocket monthly
✓ Private PPO may become competitive
If income puts you over limits
✓ You lose all subsidies at certain thresholds
✓ Full-price ACA can be more expensive than private PPO
✓ Broader networks available off-exchange
What to do before filing taxes
1. Calculate your actual 2025 income
Pull your W-2s, 1099s, and business income records. Calculate your Modified Adjusted Gross Income (MAGI) to see if you're over or under what you estimated.
2. Estimate your potential payback
Use the IRS 8962 instructions or a tax calculator to estimate what you might owe. Payback caps exist, but they vary by income level.
3. Project your 2026 income accurately
Don't repeat the same mistake. If your income is rising or variable, estimate conservatively for 2026 enrollment to avoid another payback situation.
4. Compare ACA vs private PPO for 2026
If your income puts you at or above subsidy limits, private PPOs may offer lower net costs with better networks and no reconciliation hassles.
Decision guide: Stay on ACA or switch to private PPO?
Stay on ACA Marketplace if...
✓ You still qualify for meaningful subsidies
✓ Your income is stable and predictable
✓ Your doctors are in-network
✓ You're comfortable with annual reconciliation
Consider Private PPO if...
✓ You're at or above subsidy income limits
✓ You had subsidy payback issues before
✓ Your income varies significantly year-to-year
✓ You want nationwide PPO access without annual tax reconciliation
How RKA helps with tax-time planning
Accurate 2026 income modeling
We help you estimate 2026 MAGI realistically to avoid subsidy surprises
Side-by-side cost comparison
ACA with subsidies vs ACA without subsidies vs private PPO—total annual cost
Network verification
We confirm your doctors are in-network before you switch plans
No reconciliation hassles
Private PPO premiums don't change based on income—no Form 8962 at tax time
Avoid subsidy payback surprises in 2026
We'll model your costs accurately, compare ACA vs private PPO, and verify your doctors—before tax season hits.
Get Free Quotes Book a CallQuick FAQs
What is Form 8962 and when do I need it?
Form 8962 is the Premium Tax Credit reconciliation form. You must file it if you received any advance premium tax credits during the year—even if you only had coverage for part of the year.
Is there a cap on how much I have to pay back?
Yes, repayment caps exist based on your income as a percentage of the Federal Poverty Level (FPL). However, if your final income exceeds 400% FPL (in years when caps apply), you may owe back the full amount.
Do private PPOs require tax reconciliation?
No. Private PPO premiums are not subsidized, so there's no Form 8962 and no reconciliation. Your premium is your premium—no surprises at tax time.
Can I switch to a private PPO mid-year to avoid reconciliation?
Yes, but you'll still need to reconcile the months you had ACA subsidies. Private PPOs are available year-round for eligible applicants, and we can time your start date to minimize coverage gaps.
For education only; consult a tax professional for specific advice. Eligibility and benefits vary by carrier and state. Always review official plan documents.
FINAL DAY: Open Enrollment Ends Tonight | Act Now
Open Enrollment ends tonight at 11:59 PM. If you don't enroll or update your plan by midnight, you're locked out until next year. Don't let auto-enrollment cost you thousands—compare all options before the deadline.
FINAL DAY: Open Enrollment Ends Tonight at Midnight
Fast take: Open Enrollment for 2026 health insurance ends tonight at 11:59 PM. If you don't enroll or update your plan by midnight, you're locked out until next year—unless you qualify for a Special Enrollment Period. Don't let auto-enrollment cost you thousands.
⏰ DEADLINE: TONIGHT AT MIDNIGHT
We'll compare your options, verify networks, and walk you through enrollment in minutes—before time runs out.
Get Free Quotes NOW Book Emergency CallWhat happens if you miss tonight's deadline
No coverage
✗ No health insurance for 2026
✗ Pay full price for all medical care
✗ Can't enroll again until November 2026
✗ No protection from surprise medical bills
Auto-enrollment trap
✗ Stuck in current plan at higher 2026 rates
✗ Miss cheaper plan options
✗ Doctors may no longer be in-network
✗ Could overpay thousands annually
If you don't have coverage: Do this NOW
Contact us immediately
We'll pull all available plans in your area, calculate your tax credit if you qualify, and show you every option side-by-side in minutes.
Compare plans fast
We'll focus on monthly premium, deductible, out-of-pocket maximum, and whether your doctors are in-network. Having coverage is better than having no coverage—we'll help you decide quickly.
Enroll before midnight
We'll handle the enrollment process and make sure everything's completed before 11:59 PM tonight. You can always change plans next year, but you can't go back and enroll today once the deadline passes.
If you have Marketplace coverage: Review before auto-enrollment locks you in
We'll review your current plan
Plans change every year—networks shift, premiums adjust, benefits get redesigned. We'll check if your current plan is still the best option or if better alternatives exist.
Update your income for accurate subsidies
If your income changed from last year, this recalculates your tax credit and shows your true monthly cost. We'll update this for you and compare all available plans based on your actual 2026 pricing.
Compare every available plan
We'll look at total annual cost—not just premium. We factor in deductible, copays, out-of-pocket maximum, and expected usage based on your health needs. We also verify your doctors and prescriptions are still covered.
Actively select your plan
Don't rely on auto-enrollment. It's designed for convenience, not savings. We'll help you select the best plan and can save you hundreds or thousands of dollars in 2026.
If you're paying full price: Consider private health insurance
If you don't qualify for subsidies or your income is above 400% of the federal poverty level, you're not required to use Marketplace plans.
- Private PPOs often cost less: For those paying full premium, private plans frequently offer better value with broader networks
- Year-round enrollment: Private plans aren't limited to Open Enrollment periods for ACA-compliant coverage
- Nationwide networks: Many private PPOs offer coast-to-coast access without referrals or HMO restrictions
- Direct specialist access: No primary care gatekeepers—see specialists when you need them
If Marketplace premiums jumped significantly and you're receiving minimal or no tax credits, we'll show you private options before midnight.
Why tonight's deadline matters
Open Enrollment ends at 11:59 PM tonight. Not tomorrow morning. Not next week. Tonight.
Once the deadline passes, you're locked out until November 2026 unless you experience a qualifying life event like losing other coverage, getting married, or having a baby.
Medical costs don't care if you missed the deadline. Emergency room visits can cost thousands. Routine prescriptions add up fast. Doctor appointments, specialist visits, lab work—all of it comes out of your pocket without insurance.
Stop reading. Call us now.
We'll compare your options and walk you through enrollment in minutes—before midnight tonight.
Get Free Quotes NOW Book Emergency CallFAQ
What if I miss tonight's deadline?
You're locked out until November 2026 Open Enrollment unless you qualify for a Special Enrollment Period due to losing coverage, marriage, birth, adoption, or moving to a new state.
Can you still help me enroll tonight?
Yes—contact us immediately. We'll walk you through your options and complete enrollment in minutes before the deadline.
Are private PPOs cheaper than Marketplace plans?
If you don't qualify for subsidies, private PPOs can offer lower total costs with broader networks—especially for healthy applicants. We'll compare both options for you.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Marketplace Premium Change Notifications: What They Mean & How to Respond
Marketplace premiums are jumping for 2026. If you received a rate increase notification, don't auto-renew without comparing options. We verify your doctors, compare ACA vs private PPO plans, and show total annual costs before the January 15 deadline.
Marketplace Premium Change Notifications: What They Mean & How to Respond
Fast take: If you received a Marketplace premium change notification, your 2026 rate is likely increasing—sometimes significantly. Don't auto-renew without comparing options. We'll verify your doctors, compare ACA plans vs. private PPOs, and show total annual costs before you commit.
Got a premium increase notice?
We'll compare your current plan against new Marketplace options and private PPOs—and verify your doctors stay in-network.
Get Free Quotes Book a CallWhat your notification means
Premium increase
✓ Your monthly cost is going up for 2026
✓ Increase can range from 10-30%+ depending on your state
✓ Driven by medical inflation, drug costs, and policy changes
Plan changes
✓ Network may have changed—verify your doctors
✓ Deductibles and out-of-pocket maximums may be higher
✓ Prescription formulary tiers may have shifted
Why premiums are jumping for 2026
- Medical inflation: Hospital and provider costs continue rising faster than general inflation
- Specialty drugs: GLP-1 medications and other high-cost drugs are pushing claims higher
- Subsidy uncertainty: Enhanced ACA subsidies may expire, raising net costs for middle-income families
- Carrier adjustments: Insurers are repricing based on 2024-2025 utilization patterns
What to do right now
1) Don't auto-renew blindly
If you do nothing, your current plan will automatically renew at the higher 2026 rate. You have until January 15 to switch plans during Open Enrollment.
2) Verify your provider network
Marketplace plans frequently change networks. Your current doctors may no longer be in-network for 2026—check before you commit.
3) Compare total annual cost
Don't just look at premium changes. Factor in:
- New deductible amounts
- Copays and coinsurance changes
- Out-of-pocket maximum increases
- Expected usage based on your health needs
4) Check alternative options
If your Marketplace premium is jumping significantly and you don't qualify for strong subsidies, private PPO options may offer:
- Lower total annual costs for healthy applicants
- Broader nationwide PPO networks
- Fewer referral requirements and restrictions
How to decide in minutes
Stay on Marketplace if...
✓ You qualify for strong income-based subsidies
✓ Your doctors are still in-network for 2026
✓ A different Marketplace plan offers better value
✓ You're comfortable with HMO/EPO restrictions
Consider Private PPO if...
✓ Your premium jumped 20%+ and subsidies are minimal
✓ You want nationwide PPO access and flexibility
✓ You travel frequently or need specialists
✓ You prefer direct access without referrals
How RKA handles premium increase notifications
- Network verification: We confirm your doctors are in-network for 2026—before you commit
- Side-by-side comparison: Current plan vs. new Marketplace options vs. private PPOs
- Total cost projection: Annual costs including premiums, deductibles, and expected usage
- Fast enrollment: We'll switch you to the best option before the January 15 deadline
Don't pay more without comparing options
We'll verify your doctors, compare all available plans, and show clear annual costs—before January 15.
Get Free Quotes Book a CallFAQ
Can I switch plans after getting a premium increase notice?
Yes—during Open Enrollment (through January 15), you can switch to any Marketplace plan or explore private PPO options if eligible.
Will my doctors still be covered in 2026?
Not necessarily. Networks change annually. We verify your specific providers before you commit to any plan.
Are private PPOs always more expensive than Marketplace?
No. If you don't qualify for subsidies, private PPOs can offer lower total costs with broader networks—especially for healthy applicants.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Extended Open Enrollment 2026: Final Days Before January 15 Deadline | RKA
Open Enrollment 2026 closes January 15. Enroll by Dec 15 for Jan 1 coverage, or by Jan 15 for Feb 1 coverage. Don't auto-renew into higher 2026 rates—compare ACA Marketplace plans vs private PPOs and verify your doctors are covered.
Extended Open Enrollment 2026: Final Days to Lock Coverage – Deadline January 15
Fast take: Open Enrollment 2026 runs through January 15 in most states. If you enroll by December 15, coverage starts January 1. Enroll by January 15, coverage starts February 1. This is your last window to compare ACA Marketplace plans vs. private PPOs and secure your 2026 rate.
Need help choosing the best plan before Jan 15?
We'll verify your doctors and prescriptions, compare ACA vs. PPO options, and show clear costs—no pressure, just answers.
Get Free Quotes Book a CallKey dates to remember
Open Enrollment Window
Nov 1, 2025 → Jan 15, 2026
(most states)
Enroll by Dec 15
Coverage starts Jan 1, 2026
Enroll by Jan 15
Coverage starts Feb 1, 2026
What to do before the deadline
1) Verify your providers
Marketplace networks can be narrow—HMO/EPO-heavy with referral requirements. Private PPOs often offer broader access. We'll confirm your doctors are in-network before you enroll.
2) Compare total annual cost
Don't just look at premiums. Factor in deductibles, copays, coinsurance, and out-of-pocket maximums with your expected usage patterns.
3) Check subsidy eligibility
Income-based tax credits can dramatically lower Marketplace premiums. We'll estimate your 2026 subsidy eligibility and show net costs.
4) Consider private PPO alternatives
If you don't qualify for subsidies or need nationwide PPO access, private medically underwritten PPOs may offer lower total costs and fewer restrictions.
How to decide in minutes
Pick an HMO or POS if…
✓ You want lower premiums and you're comfortable staying within a local network.
✓ You prefer having one doctor coordinate all care and provide referrals.
✓ You rarely travel or need specialists outside your area.
Pick a PPO or EPO if…
✓ You want the freedom to see specialists without referrals and value a larger network.
✓ You travel often or need access to doctors across multiple states.
✓ You're willing to pay higher premiums to avoid network restrictions or referrals.
How RKA helps with last-minute enrollment
- Fast comparisons: ACA vs. PPO side-by-side with your providers
- Network verification: We confirm your doctors before you commit
- Clean enrollment: We'll hit the deadline and set your correct effective date
Quick FAQs
What if I miss the January 15 deadline?
You'll need a Qualifying Life Event for a Special Enrollment Period, or you'll wait until next Open Enrollment. Private PPOs may still be available year-round if eligible.
Can I change plans if I already enrolled?
During Open Enrollment, you can switch plans. After January 15, changes require an SEP.
Will my 2025 plan auto-renew?
Yes, but you may pay more in 2026. Many insurers raised rates significantly—review before auto-renewal hits.
Missing the deadline doesn't mean you're out of options. Our licensed advisors help you explore marketplace plans, private PPO options, and special enrollment opportunities year-round. Get coverage options now.
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.
Government Shutdown & ACA Subsidies: What It Means for You
Federal subsidy delays could impact millions of Americans if a government shutdown continues. Learn how to protect your coverage and compare PPO alternatives before Open Enrollment 2026.
Open Enrollment 2026
Oct 1 • Written by Robert Adams
Nov 1, 2025 → Jan 15, 2026 (most states)
Coverage starts Jan 1, 2026
Coverage starts Feb 1, 2026
Premium hikes already on the horizon
According to insurer filings and multiple reports, 2026 premiums are projected to rise 10–18% on average, with some state requests topping 30%. That can mean hundreds more per month for unsubsidized families—and thousands annually. See the map below for where requests are running hottest.
If subsidies pause (shutdown/lapse), what actually happens?
- No one is “kicked off” a plan mid-month. Carriers still bill the full premium; the advance-credit portion can be delayed.
- Net premium could temporarily jump until payments resume or are reconciled at tax time.
- Eligibility doesn’t vanish. Credits reconcile on your tax return; amounts due can be settled then.
- Timelines matter. Short pauses may be smoothed by carriers; longer gaps create real cash-flow strain.
How to protect your wallet now
- Lock in your coverage window. Enroll early so your start date and network are set.
- Model the true annual cost. Premium + expected usage (copays/coinsurance + deductible + max OOP).
- Verify doctors & meds first. Keep your physicians in-network and Rx tiers on-formulary.
- Compare Marketplace vs Private PPO. If you don’t qualify for large subsidies, PPOs can beat exchange nets for access.
- Have a back-up payment plan. Be ready to bridge a month if a subsidy delay hits to avoid cancellation.
Not sure which option fits your family?
We’ll compare ACA vs PPOs, check doctors, and give you a clean cost forecast so you can enroll with confidence about 2026.
Get Free Quotes Book a CallQuick FAQs
Will a shutdown cancel my plan?
No — coverage continues, but billing may shift.
How much more could I pay?
Some families could see hundreds more per month unsubsidized if subsidies pause.
Can a Private PPO be cheaper than Marketplace?
Yes — depending on income, network, and benefits, PPOs may beat ACA net cost.
What if my subsidy is delayed?
Have a bridge plan (savings, credit, or employer coverage) to avoid cancellation risk.
Robert Adams • President & Licensed Agent • NPN 19540130
Licensed in AL, CO, DE, FL, GA, IA, IL, IN, KY, KS, LA, MD, MI, MO, MS, MT, NC, NE, NV, OH, OK, SC, SD, TN, TX, UT, VA, WI, WV, WY
For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.