What REALTORS® Need to Know About 2026 Health Coverage Changes
Heads up, REALTORS®. A major health care shift is on the horizon. The enhanced ACA subsidies that have helped lower Marketplace premiums for many self-employed professionals are scheduled to expire at the end of 2025 unless Congress acts to renew them.
If those subsidies lapse, middle-income households could see significant premium increases, and the old “subsidy cliff” would return, meaning some earners would no longer qualify for any premium assistance at all.
Now is the time to get ahead of it:
- Review your options early during Open Enrollment this fall.
- Explore HSA-eligible plans, which can offer tax advantages and flexible savings for care expenses.
- Talk with your tax professional about timing your income, deductions, or retirement contributions. These can affect your eligibility for future credits.
- If you operate a small brokerage or team, ask your benefits advisor about ICHRA or QSEHRA programs, which can help offset rising costs for you and your staff.
The good news: Telehealth remains HSA-friendly, and No Surprises Act protections against unexpected out-of-network medical bills are still in place.
Planning ahead now can prevent sticker shock later and help ensure you and your family have the right coverage going into 2026.
The Big One: ACA Marketplace Subsidies Are Scheduled to Shrink
- The enhanced Affordable Care Act (ACA) premium tax credits, expanded during COVID and extended by the Inflation Reduction Act, are set to expire after 2025 unless Congress acts.
- If they lapse, many enrollees will see premium payments jump in 2026, and the old 400% of Federal Poverty Level (FPL) “subsidy cliff” would return.
- Lawmakers are negotiating, but there is no guarantee of renewal yet.
What This Means for REALTORS®
Most REALTORS® are self-employed or 1099 and buy coverage on the Marketplace:
- If your 2025 household income was above about 400% FPL (for example, roughly $125,000 for a family of 3, thresholds adjust annually), you may lose eligibility for any premium help in 2026 if the cliff returns. Budget for a full-price premium.
- If you currently get a large subsidy, expect a noticeable increase in your monthly bill starting January 2026 unless Congress renews the enhanced credits. Use KFF’s estimator to preview potential 2026 impacts (illustrative only, not a quote).
Premium Cost Scenarios
| Example Household | 2025 Premium with Subsidy | 2026 if Subsidies Expire | Monthly Increase |
|---|---|---|---|
| Single Agent, $55,000 income | $280 | $520 | +$240 |
| Family of 3, $120,000 income | $460 | $1,050 | +$590 |
Note: Examples are for illustration only. Actual premiums vary by state, plan, age, and household income.
What Is Not Expiring
- Telehealth coverage in HSA-compatible high-deductible plans (pre-deductible) was made permanent in 2025 legislation. Agents who use HSAs can continue using first-dollar telehealth without losing HSA eligibility.
- No Surprises Act protections against most out-of-network “balance bills” remain in force. Agencies continue to refine rules, but the consumer protections do not sunset at year end.
Action Checklist for Brokers, Team Leaders, and Individual Agents
Complete these steps October through December.
- Run the numbers now.
Use a 2026 “what if” to see how your premium could change if enhanced credits expire. KFF’s calculator is a good starting point. - Income planning for 2025 taxes.
Marketplace subsidies are based on your 2026 projected income, but the policy change interacts with your 2025 tax picture. Work with a CPA before year end on timing of commission income, retirement contributions (for example, SEP-IRA or Solo 401(k)), and deductions. These can affect your expected 2026 subsidy eligibility and reconciliations. - Shop early in Open Enrollment.
Open Enrollment for 2026 plans typically starts November 1. If subsidies shrink, compare Bronze, Silver, and Gold options, networks, and HSA-eligible HDHPs, especially if you can fund an HSA and value permanent telehealth flexibility. - Small brokerage under 50 FTEs: consider ICHRA or QSEHRA.
If several agents or W-2 staff need coverage, an ICHRA (Individual Coverage HRA) or QSEHRA may let you reimburse tax-advantaged dollars toward individual policies, cushioning premium hikes while avoiding a one-size group plan. Rules are nuanced, so consult a benefits professional. This is strategy information, not tax or legal advice. - Budget for the “cliff scenario”.
Build a 2026 line item assuming worst-case premiums at full price so your personal or team budget is not blindsided if credits are not extended. - Keep proof of coverage handy.
Transactions increasingly ask for evidence of coverage when onboarding to new brokerages or programs. Keep your 1095-A (Marketplace) or plan confirmations organized for tax season and credentialing.
Action Timeline
| Month | Action |
|---|---|
| October | Review income, adjust deductions, check HSA contributions |
| November 1 | Marketplace Open Enrollment begins |
| December | Compare renewal options and finalize plan |
| January 1 | 2026 coverage starts, new premium rates apply |