Several recent shifts in Marketplace policy are expected to reduce subsidized Marketplace coverage and its affordability. First, in 2026, enhanced premium tax credits (PTCs) ended, and subsidies returned to their original levels. Second, the One Big Beautiful Bill Act (OBBBA) of 2025 introduced new restrictions on Marketplace subsidy eligibility and added new administrative barriers to enrolling in Marketplace plans. We assess how subsidized Marketplace coverage could change among young adults ages 19 to 24 under these policy changes.

Why This Matters

Young adults navigate a distinct set of challenges when it comes to health insurance coverage. Several factors contribute to this, including young adults having lower incomes and less access to employer-sponsored insurance than older adults; experiencing changes in eligibility for Medicaid, the Children’s Health Insurance Program, subsidized Marketplace coverage, and dependent coverage under parents’ health plans as they age; undergoing life transitions that affect access to coverage, such as leaving parental homes and starting or completing education or careers; and facing challenges in learning to navigate the nation’s complex health insurance system. Loss of coverage could affect their access to health care and harm their financial stability and health both immediately and in the long term.

Key Takeaways

• Young adults’ subsidized Marketplace enrollment is reduced by over a million under expiration of enhanced PTCs and OBBBA’s Marketplace provisions. We estimate large effects of the expiration of Marketplace subsidy enhancements on young adults’ subsidized Marketplace enrollment, as well as a more moderate effect of OBBBA’s Marketplace eligibility restrictions. The number of young adults with subsidized Marketplace coverage would be over twice as high under enhanced PTCs than under original PTCs, and more than two and a half times higher than under original PTCs and OBBBA Marketplace provisions.
• Young adults face higher net Marketplace premiums under original PTCs than enhanced PTCs, with the largest differences among lower-income young adults. Young adults who do enroll in subsidized Marketplace coverage without enhanced PTCs will face less affordable Marketplace plans. Under original PTCs, single net premiums are over six times higher for those with incomes below 250 percent of the federal poverty level (FPL), more than twice as high for those with incomes of 250 to 400 percent of FPL, and 31 percent higher for those with incomes above 400 percent of FPL.
• Effects of enhanced subsidy expiration and OBBBA Marketplace provisions on young adults’ subsidized Marketplace enrollment are concentrated in Medicaid nonexpansion states. Young adults’ subsidized Marketplace enrollment is projected to be lower under expiration of enhanced subsidies and OBBBA than without those policy changes in every state. But most of the reduction in subsidized Marketplace enrollment among young adults under expiration of the enhanced subsidies and OBBBA provisions is among residents of one of the 10 states that have not expanded Medicaid under the Affordable Care Act, and half of the overall reduction is concentrated in just three states: Texas, Florida, and Georgia.
• Policymakers Could Consider Several Actions to Support Young Adults’ Marketplace Coverage. Options could include federal policies to resume PTC enhancements and roll back OBBBA’s Marketplace provisions, state actions to improve Marketplace affordability, and targeted support for young adults in navigating enrollment processes.

How We Did It

We use the Urban Institute’s Health Insurance Policy Simulation Model to project how Marketplace coverage among young adults will be affected by these changes in 2028. We first examine subsidized Marketplace coverage and net premiums among young adults ages 19 to 24 enrolled in Marketplace plans under original and enhanced PTCs, assuming no effects of OBBBA. We then assess additional effects of OBBBA’s Marketplace provisions.