Premium Tax Credit Changes After 2025: 2026 Covered California Premium Increases by ZIP Code
Overview
The Premium Tax Credit is a refundable federal tax credit that reduces health insurance premiums for eligible households purchasing coverage through the Health Insurance Marketplace. In California, that marketplace is Covered California. The credit is calculated using a benchmark Silver plan premium and a required household contribution that is based on income and family size.
Temporary enhancements that expanded eligibility and reduced required household contributions expired on December 31, 2025. Beginning with 2026 coverage, the credit generally reverts to its pre enhancement structure unless Congress enacts new legislation.
What Changed After December 31, 2025
Under current law, households with income above 400% of the federal poverty level are no longer eligible for the Premium Tax Credit after 2025. In addition, required household contribution percentages increase across all income bands below that threshold. These changes reduce subsidy amounts and increase the portion of premiums paid directly by enrollees.
For many California households, premium increases beginning in 2026 are driven by the credit reverting to its pre enhancement formula rather than by changes in insurer pricing.
Why the True Impact Is Hard to Quantify
There is no single statewide premium increase number that applies to all households. The Premium Tax Credit amount depends on several variables that interact with each other:
- Household income as a percentage of the federal poverty level
- Family size and which family members enroll in marketplace coverage
- Ages of enrolled family members, because premiums are age rated for adults
- Geographic location, because benchmark Silver premiums vary by county and rating region
- Type of coverage selected, because Bronze and Gold premiums are priced relative to the Silver benchmark
- Advance credit payments during the year and reconciliation on the tax return
Because these variables change the credit calculation, two households with the same income can have very different premium outcomes. The analysis in this article uses a standardized household profile and consistent plan pricing assumptions to illustrate how premium changes can vary across different parts of California.
The sample ZIP codes were selected to represent a range of California regions and to reflect areas where Covered California enrollment is more common. Higher income areas were excluded because households in those areas are generally less likely to rely on marketplace coverage. The objective is to show practical examples that are directionally useful while still acknowledging that real outcomes are household specific.
Methodology and Assumptions Used in the Examples
To provide clear and comparable results, the examples below use a single standardized household profile and apply it consistently across ten California ZIP codes.
- Household: two adults age 40 and two children age 10
- Benchmark: second lowest cost Silver plan used for the Premium Tax Credit calculation
- Plan pricing relationships: Bronze at 85% of Silver, Gold at 120% of Silver
- All figures shown are monthly premiums
- % Increase is computed as monthly increase divided by the With Enhanced PTC amount
These examples isolate the effect of geography and plan selection. They do not attempt to model every possible household variation.
Monthly Premiums With and Without Enhanced Premium Tax Credits
Each section shows the estimated monthly premium paid by the household in 2025 with enhanced Premium Tax Credits and the estimated premium beginning in 2026 after the enhancements expire.
| ZIP Code | Plan | With Enhanced PTC | After 2025 | Monthly Increase | % Increase |
|---|---|---|---|---|---|
| 94541 Hayward | Bronze | $830 | $1,700 | $870 | 104.8% |
| Silver | $975 | $2,000 | $1,025 | 105.1% | |
| Gold | $1,170 | $2,400 | $1,230 | 105.1% | |
| 90650 Norwalk | Bronze | $760 | $1,550 | $790 | 103.9% |
| Silver | $890 | $1,820 | $930 | 104.5% | |
| Gold | $1,070 | $2,180 | $1,110 | 103.7% | |
| 94565 Pittsburg | Bronze | $700 | $1,480 | $780 | 111.4% |
| Silver | $825 | $1,740 | $915 | 110.9% | |
| Gold | $990 | $2,090 | $1,100 | 111.1% | |
| 92804 Anaheim | Bronze | $300 | $710 | $410 | 136.7% |
| Silver | $355 | $835 | $480 | 135.2% | |
| Gold | $425 | $1,000 | $575 | 135.3% | |
| 95823 Sacramento | Bronze | $280 | $665 | $385 | 137.5% |
| Silver | $330 | $780 | $450 | 136.4% | |
| Gold | $395 | $935 | $540 | 136.7% | |
| 93722 Fresno | Bronze | $240 | $585 | $345 | 143.8% |
| Silver | $285 | $690 | $405 | 142.1% | |
| Gold | $340 | $830 | $490 | 144.1% | |
| 92407 San Bernardino | Bronze | $230 | $560 | $330 | 143.5% |
| Silver | $270 | $660 | $390 | 144.4% | |
| Gold | $325 | $795 | $470 | 144.6% | |
| 92105 San Diego | Bronze | $195 | $495 | $300 | 153.8% |
| Silver | $225 | $580 | $355 | 157.8% | |
| Gold | $270 | $695 | $425 | 157.4% | |
| 90011 Los Angeles | Bronze | $145 | $395 | $250 | 172.4% |
| Silver | $165 | $465 | $300 | 181.8% | |
| Gold | $200 | $560 | $360 | 180.0% | |
| 93702 Fresno | Bronze | $100 | $305 | $205 | 205.0% |
| Silver | $115 | $360 | $245 | 213.0% | |
| Gold | $140 | $435 | $295 | 210.7% |
Key Takeaways
- Premium increases shown above are driven by subsidy changes rather than insurer pricing.
- The largest dollar impacts occur when eligibility above 400% of the federal poverty level is no longer available after 2025.
- Even households below that threshold can see significant premium increases as required household contribution percentages rise.
- Gold plans show larger dollar increases because they scale off the Silver benchmark premium.
See current federal rates on the Economic Dashboard.
