By Kris McDowell
This time of year, when open enrollment for health insurance is underway, there is a key change that may be relevant to upcoming Oregon Health Insurance Marketplace coverage, affordability or consumer guidance. Enhanced premium tax credits—which have lowered monthly premiums for people living in Oregon enrolled through the Marketplace since 2021—are currently set to expire at the end of 2025. When they expire, many individuals—especially those above 400 percent of the Federal Poverty Level (FPL) or whose plan options are considered affordable under federal rules—may see higher premiums in 2026. While standard tax credits will still be available, the additional savings many have relied on will phase out unless Congress acts.
Premium rates have largely stabilized in Oregon over the past few years, with only modest cost increases from one year to the next. With the cost of health care also increasing due to inflation, there has been some increase to premiums across the board, although Oregon premiums have increased at lower rates than other states. People who pay full cost for their premiums will feel these increases, while people who qualify for premium tax credits through the Marketplace will be partially sheltered from these increases.
The Enhanced Premium Tax Credits that are set to expire were temporary savings that were initiated under the American Rescue Plan Act in 2021 and extended under the Inflation Reduction Act in 2022 to make health care more affordable for individuals and families in the middle-income range. In addition to people at or above 400 percent of the FPL (approximately $62,600 for a single adult and $128,600 for a household of four) that will no longer be eligible for assistance, other individuals who receive premium tax credits will see a decrease in the amount of help they get monthly. Thousands of Oregon enrollees could pay an average of $147-$456 more per month, depending on income level. Older enrollees with 400 percent FPL could pay $900 or more per month and nearly 35,000 people in Oregon may lose financial assistance altogether.
Amy Coven, Communications and Public Engagement Analyst for the Oregon Health Insurance Marketplace explained the three main reasons for the changes. Enhanced Premium Tax Credits temporarily removed the income cap, but starting in 2026 the cap returns to 400 percent of the FPL, resulting in people with incomes above that threshold no longer qualifying. Additionally, some lawfully present immigrants with very low incomes qualified during the enhanced period but beginning in 2026, that temporary option ends. Many of these individuals may still qualify for Oregon Health Plan benefits through the Healthier Oregon Program however. Finally, the expected contribution—the amount the Marketplace expects you should be able to pay toward your monthly premium each month under the Affordable Care Act—is increasing. If the second-lowest-cost Silver plan in your area costs less than that amount, you may now qualify for zero premium tax credits.
Oregon’s Reinsurance Program helps keep rates lower than in many other states and the Oregon Division of Financial Regulation closely reviews, and sometimes adjusts, the premiums insurance companies propose charging. The division ensures that insurance companies are charging enough that they can pay for the care their customers get, but that premiums are not excessive. The Oregon Reinsurance Program continues to help stabilize the market, lowering rates by at least 6.5 percent annually and nine percent for the 2026 plan year.
During open enrollment, consumers have options and support available. The Marketplace Window Shopping Tool, OregonHealthCare.gov/WindowShop, allows people to preview 2026 plans and find out how much financial help they may qualify for. Comparing plans is the best way to ensure you’re getting the best value for your coverage needs.
It is important for consumers to review and update household and income information with their coverage plan. Even small changes can affect how much financial help is available.
Speaking of help, licensed insurance agents and certified community partners across Oregon can help you understand your options, compare plans and enroll—all at no cost to you. Find out more about what help is available and near you at OregonHealthCare.gov/GetHelp.
If you have concerns about your coverage, reach out to the Division of Financial Regulation’s Consumer Advocates. Oregon provides state protections which includes requiring coverage for essential services like gender-affirming care and offers resources to help you stay insured.
It’s also important to keep an eye out for proof requests from the Marketplace. If HealthCare.gov asks you to verify your income or eligibility, respond quickly so your coverage is not delayed.
Finally, don’t ignore your renewal notice. If you don’t take any action, you may be automatically re-enrolled—possibly at a higher premium. Review your options early to avoid surprises.