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'Eli Lilly employees planning their retirement should consider how income levels influence ACA subsidies, as even small adjustments in taxable withdrawals can affect future health care affordability.' – Tyson Mavar, a representative of The Retirement Group, a division of Wealth Enhancement.
Healthcare Provider Update: Eli Lilly's primary healthcare provider initiatives are often tied to their pharmaceutical products and drug distribution networks, which include partnerships with a variety of healthcare systems and organizations to ensure that patients have access to their medications and therapies. Looking ahead to 2026, the healthcare landscape is expected to witness significant cost increases, particularly in health insurance premiums for Affordable Care Act (ACA) marketplace plans. With some states projecting hikes exceeding 60%, many individuals could see their out-of-pocket costs soar by over 75% if enhanced federal premium subsidies are not extended. This surge is driven by a combination of rising medical costs, including both hospital and prescription drug expenses, and the profitability pressures on insurers, prompting them to request substantial rate increases. As a result, consumers, especially those relying on ACA coverage, might face unprecedented financial strain in their quest for adequate healthcare. Click here to learn more
'Eli Lilly employees approaching retirement should recognize that proactive income and health care planning can make the difference between preserving subsidy eligibility and facing sharply higher ACA premiums.' – Paul Bergeron, a representative of The Retirement Group, a division of Wealth Enhancement.
In this article, we will discuss:
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How the expiration of enhanced ACA subsidies after 2025 could impact health care costs for retirees and early retirees.
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Real-life case studies illustrating how different individuals are adjusting to rising ACA premiums.
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Practical steps Eli Lilly professionals can take before enrolling in 2026 Marketplace plans.
by Brent Wolf, CFP®, Wealth Enhancement
As open enrollment for 2026 Marketplace plans begins, many households are seeing dramatic shifts in their renewal letters. Rising base premiums and the possible end of enhanced subsidies after 2025 could mean significantly higher out-of-pocket costs for anyone purchasing coverage through the Affordable Care Act (ACA) exchange.
The Kaiser Family Foundation (KFF) estimates that if Congress does not extend enhanced premium tax credits, average net premium payments could more than double in 2026. 1
“It feels like a second mortgage to pay this premium.”
Profile: A couple in their early 60s who retired a few years before becoming Medicare-eligible.
What changed: Their ACA premium had been manageable due to increased subsidies. Their renewal now indicates a rise of about $1,000 to $1,200 monthly if enhanced credits expire.
Decision pressure: They faced hard choices—drawing more taxable income from IRAs, going without coverage, or returning to the workforce for employer-based insurance.
Our response: We reworked their income plan to align with the ACA’s income-based subsidy structure. By controlling their Modified Adjusted Gross Income (MAGI) through smaller IRA withdrawals, use of cash reserves, and partial Roth conversions, we kept them eligible for key subsidies. Comparing a Bronze high-deductible plan with a health savings account (HSA) to a Silver plan revealed the Silver plan—thanks to cost-sharing reductions—was more economical given their expected medical treatments.
“I can’t risk losing coverage while battling an illness.”
Profile: A single client in her early 60s undergoing ongoing medical treatment.
What changed: Without enhanced subsidies, her premiums nearly tripled.
Decision pressure: Balancing affordability with the need to keep her care team and prescriptions consistent.
Our response: We prioritized staying with her provider network and controlling her out-of-pocket costs. A dedicated “medical reserve” fund—equal to one year’s maximum out-of-pocket limit—gave her a cushion without liquidating investments during market declines. We also worked with her physicians to identify lower-cost prescriptions through her plan’s formulary.
“The new premiums are hurting our business margins.”
Profile: A self-employed couple—one partner managing asthma and the other a cardiac rhythm condition.
What changed: Without subsidies, their net premiums are expected to rise sharply.
Decision pressure: Continue paying high premiums, choose a plan with a very high deductible, or seek W-2 employment for benefits.
Our response: We compared total annual costs for a Silver plan versus a Bronze option, factoring in frequent specialist visits and prescriptions. Once total medical costs were considered, the Silver plan proved more cost-effective. We also aligned their life and disability coverage and tailored their tax approach to reflect potential changes in premium tax credits.
“I’m young and healthy—do I even need full coverage?”
Profile: An independent contractor in their 20s with minimal expected medical use.
What changed: Premiums for mid- and high-tier plans nearly quadrupled.
Decision pressure: Choosing between a high-deductible Bronze HSA plan and catastrophic coverage.
Our response: We modeled three options—a Bronze HSA-eligible plan, a mid-tier plan, and catastrophic coverage. The Bronze HSA option offered the best mix of lower premiums and long-term tax benefits. Monthly automated HSA contributions build a future medical fund that can later be used for qualified health care expenses or Medicare premiums (excluding Medigap) after age 65.
Five Steps to Take Before You Enroll
1. Evaluate your total annual cost, not just the premium. Factor in deductibles, copays, and the possibility of reaching your out-of-pocket maximum.
2. Manage your MAGI carefully. ACA subsidies depend on income. Coordinate Roth conversions, capital gains, and IRA withdrawals strategically.
3. Verify your doctor and prescription coverage. Always confirm your plan’s provider network and formulary before enrolling.
4. Maintain a medical reserve fund. Hold six to 12 months of premiums plus a portion of your maximum out-of-pocket in cash or short-term Treasuries.
5. Finalize your plan by December 15. Open Enrollment for 2026 coverage ends on December 15, with plans effective January 1.
If Affordability Is a Concern
Choosing to go without insurance can expose you to serious financial strain in case of illness or accident. Consider the most affordable Bronze plan that still meets ACA minimum coverage requirements. If your income decreases during the year, you may become eligible for Medicaid or CHIP and qualify for a Special Enrollment Period. 2
How The Retirement Group Supports Eli Lilly Professionals
For Eli Lilly employees approaching or already in retirement, the intersection of rising health care costs and income planning can be complex. The Retirement Group focuses on helping clients navigate ACA subsidy rules, tax-efficient withdrawal strategies, and health care cost planning during retirement transitions.
To speak with an advisor about aligning your retirement income and health care planning, call (800) 900-5867 today.
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Sources:
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1. Cox, Cynthia, et al. “ACA Marketplace Premium Payments Would More Than Double on Average Next Year if Enhanced Premium Tax Credits Expire.” Kaiser Family Foundation (KFF) , 2025, pp. n.p., https://www.kff.org/affordable-care-act/aca-marketplace-premium-payments-would-more-than-double-on-average-next-year-if-enhanced-premium-tax-credits-expire/ .
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2. Centers for Medicare & Medicaid Services. ' Understanding Special Enrollment Periods. ' June 2025.
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Other resources:
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1. “When Can You Get Health Insurance? | Dates & Deadlines.” HealthCare.gov , U.S. Centers for Medicare & Medicaid Services, n.d., https://www.healthcare.gov/quick-guide/dates-and-deadlines/ .
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2. Publication 969: Health Savings Accounts and Other Tax-Favoured Health Plans. Internal Revenue Service, 2024, pp. 8–9, https://www.irs.gov/pub/irs-pdf/p969.pdf .
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3. “Silver vs. Bronze Plan Selection: Cost-Comparison Scenarios.” Centers for Medicare & Medicaid Services (CMS) , 23 Dec. 2024, pp. 1–3, https://www.cms.gov/files/document/silver-vs-bronze-cost-comparison-scenario-resource.pdf .
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4. Murphy, Tom. “Expect Health Insurance Prices to Rise Next Year, Brokers Say.” AP News , Associated Press, 24 Aug. 2025, https://apnews.com/article/health-insurance-drug-costs-2026-rates-c4d865ec09c7088ecc6b55dc520f3566 .
What is the 401(k) plan offered by Eli Lilly?
The 401(k) plan at Eli Lilly is a retirement savings plan that allows employees to save a portion of their salary on a tax-deferred basis.
How does Eli Lilly match employee contributions to the 401(k) plan?
Eli Lilly offers a matching contribution up to a certain percentage of the employee's salary, which helps to boost retirement savings.
Can employees at Eli Lilly choose how their 401(k) contributions are invested?
Yes, employees at Eli Lilly can select from a variety of investment options for their 401(k) contributions, including stocks, bonds, and mutual funds.
What is the eligibility requirement for Eli Lilly's 401(k) plan?
Employees at Eli Lilly are typically eligible to participate in the 401(k) plan after completing a specific period of employment, usually within the first year.
How can Eli Lilly employees enroll in the 401(k) plan?
Eli Lilly employees can enroll in the 401(k) plan through the company’s online benefits portal or by contacting the HR department for assistance.
What are the contribution limits for Eli Lilly's 401(k) plan?
The contribution limits for Eli Lilly's 401(k) plan are set according to IRS guidelines, which can change annually. Employees should refer to the latest IRS limits for specifics.
Does Eli Lilly offer a Roth 401(k) option?
Yes, Eli Lilly provides a Roth 401(k) option that allows employees to make after-tax contributions, which can grow tax-free.
What happens to my Eli Lilly 401(k) if I leave the company?
If you leave Eli Lilly, you have several options for your 401(k), including rolling it over to another retirement account, cashing it out, or leaving it in the Eli Lilly plan if allowed.
Are there any fees associated with Eli Lilly's 401(k) plan?
Yes, there may be administrative fees or investment-related fees associated with Eli Lilly's 401(k) plan, which are disclosed in the plan documents.
How often can I change my contribution amount to the Eli Lilly 401(k) plan?
Employees at Eli Lilly can typically change their contribution amounts at any time, subject to the plan's rules and guidelines.
With the current political climate we are in it is important to keep up with current news and remain knowledgeable about your benefits.
Eli Lilly offers comprehensive employee retirement benefits, including both pension plans and 401(k) plans. The Lilly Pension Plan is a Defined Benefit (DB) plan, where the pension is determined by an employee's earnings and years of service at the company. This pension plan has been updated over the years, with specific attention to tax and regulatory changes. Employees qualify based on their length of service and meet eligibility requirements outlined in Eli Lilly’s internal documents. The Lilly Pension Plan uses a final average pay formula to calculate the pension, meaning the pension is based on an employee's earnings during their final years of employment (SEC.gov).
Eli Lilly also provides a 401(k) plan known as The Lilly Employee 401(k) Plan. This plan was established to help employees save for retirement, incorporating both employer contributions and employee savings. As of January 1, 2006, it was amended to include an Employee Stock Ownership Plan (ESOP) within the 401(k). Eligibility for the 401(k) plan includes all regular, full-time employees of Eli Lilly, as well as its subsidiaries and affiliates (SEC.gov). The company matches contributions and offers vesting schedules based on years of service. For instance, employees become fully vested after completing five years of service, as outlined in their official documentation (SEC.gov).
The pension and 401(k) plan information for Eli Lilly has been extensively documented in their official filings with the SEC, where the detailed structure of the plans is outlined, including the qualifications for participation and vesting. Specific sections such as those covering mergers and eligibility requirements for different types of employees, including those under subsidiary plans, are found in their formal pension and 401(k) documentation (SEC.gov) (SEC.gov).
Restructuring and Layoffs: In 2023, Eli Lilly announced significant restructuring efforts, including the reduction of 3,500 jobs globally. This move is part of their strategy to save $500 million annually, with half of the savings aimed at product launches and R&D efforts. The layoffs are primarily focused on early retirement programs, site closures in New Jersey and Shanghai, and the consolidation of manufacturing locations (FiercePharma).
This news is critical to address due to the current economic climate, where inflationary pressures and cost-cutting measures are widespread. The political environment also affects the pharmaceutical industry, making it crucial to track how companies like Eli Lilly adjust their workforce to stay competitive (FiercePharma).
Eli Lilly provides its employees with both stock options and Restricted Stock Units (RSUs) as part of its long-term incentive compensation. These RSUs are issued to employees and are subject to a vesting schedule, typically staggered over a period of time such as one, two, or three years. The goal is to retain employees by ensuring they receive full ownership of the stock only after they have fulfilled a specified period of service with the company (BusinessOwnerAdvisor).
Stock options at Eli Lilly grant employees the opportunity to purchase company stock at a predetermined price, typically at the market value on the grant date. These options often vest over several years, with employees being able to exercise them once they are vested. RSUs, on the other hand, provide employees with company shares once they are fully vested, and these shares are taxed as ordinary income at the time of vesting. Employees are responsible for deciding whether to sell the shares immediately or hold onto them, which involves considering factors like tax implications and portfolio diversification (Eli Lilly and Company) (Eli Lilly and Company).
RSUs and stock options at Eli Lilly are available to a broad group of employees, typically those in management and other key roles. The availability of these stock-based compensation forms reflects Eli Lilly's commitment to aligning employee incentives with company performance, and they play a crucial role in employee retention (BusinessOwnerAdvisor).
Eli Lilly has been making significant strides in its healthcare offerings, particularly through the launch of its digital platform, LillyDirect. This platform focuses on providing support for patients with chronic illnesses such as obesity, diabetes, and migraines. By enabling patients to access telehealth services and facilitating direct home delivery of certain medications, Eli Lilly has made healthcare more accessible and streamlined for patients dealing with these conditions. Additionally, LillyDirect offers educational resources and digital pharmacy solutions, making it easier for patients to refill prescriptions and receive medications at home. This initiative is crucial as it caters to a growing need for convenient healthcare, especially in light of the current economic pressures and the healthcare industry's shift towards digital solutions (PYMNTS.com) (PYMNTS.com).
In the broader context of Eli Lilly's healthcare initiatives, the company's focus on digital healthcare aligns with current trends in healthcare delivery. The importance of platforms like LillyDirect is underscored by the economic and political pressures on the healthcare system, particularly as patients seek cost-effective and accessible treatments. Moreover, the growing political discourse around healthcare reform, coupled with tax implications for pharmaceutical benefits, further highlights the relevance of Lilly's approach. By offering services such as telehealth and home delivery, Eli Lilly is positioning itself at the forefront of healthcare innovation, which is critical for ensuring patient satisfaction in a competitive market (PYMNTS.com) (HealthCare ME&A Magazine).
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