New Update: Healthcare Costs Increasing by Over 60% in Some States. Will you be impacted?

Franchise Group Retirees Face ACA Premium Shock—Here’s How Others Are Responding

Healthcare Provider Update: Healthcare Provider for Franchise Group The Franchise Group, a company operating several retail and service brands, typically partners with major health insurance providers to offer healthcare coverage to its employees. While the exact provider may vary, large national insurers such as UnitedHealthcare, Anthem, and Aetna are commonly chosen by companies in similar industries for their comprehensive plan offerings. Potential Healthcare Cost Increases in 2026 As we look ahead to 2026, healthcare costs are anticipated to surge significantly, primarily driven by the expiration of enhanced federal premium subsidies associated with the Affordable Care Act (ACA). Many states are bracing for substantial rate hikes, with some insurers proposing increases of over 60%. The Kaiser Family Foundation highlights that without congressional intervention, nearly 92% of marketplace enrollees could face out-of-pocket premiums climbing by as much as 75%. Combined with rising medical costs, these factors are likely to put considerable financial pressure on consumers and companies alike in the coming year. Click here to learn more

'Franchise Group 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.

'Franchise Group 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.

In this article, we will discuss:

How the expiration of enhanced ACA subsidies after 2025 could impact health care costs for retirees and early retirees.
Real-life case studies illustrating how different individuals are adjusting to rising ACA premiums.
Practical steps Franchise Group 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 Franchise Group Professionals

For Franchise Group 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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Articles you may find interesting:

Sources:

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/ .
2. Centers for Medicare & Medicaid Services. ' Understanding Special Enrollment Periods. ' June 2025.
Other resources:
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/ .
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 .
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 .
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 retirement savings options does Franchise Group offer to its employees?

Franchise Group offers a 401(k) savings plan to help employees save for retirement.

How can employees at Franchise Group enroll in the 401(k) plan?

Employees at Franchise Group can enroll in the 401(k) plan by completing the enrollment forms provided during orientation or through the employee portal.

Does Franchise Group match employee contributions to the 401(k) plan?

Yes, Franchise Group offers a matching contribution up to a certain percentage of employee contributions to the 401(k) plan.

What is the vesting schedule for the 401(k) match at Franchise Group?

The vesting schedule for the 401(k) match at Franchise Group typically follows a graded vesting schedule over a period of time, which will be detailed in the plan documents.

Are there any fees associated with the Franchise Group 401(k) plan?

Yes, there may be administrative fees associated with the Franchise Group 401(k) plan, which will be disclosed in the plan documents.

Can employees take loans against their 401(k) balance at Franchise Group?

Yes, Franchise Group allows employees to take loans against their 401(k) balance, subject to the plan's terms and conditions.

What investment options are available in the Franchise Group 401(k) plan?

The Franchise Group 401(k) plan offers a variety of investment options, including mutual funds, target-date funds, and company stock.

How often can employees change their contribution amounts to the Franchise Group 401(k) plan?

Employees at Franchise Group can change their contribution amounts to the 401(k) plan typically on a quarterly basis or as specified in the plan documents.

What is the minimum contribution percentage for the Franchise Group 401(k) plan?

The minimum contribution percentage for the Franchise Group 401(k) plan is usually set at 1% of the employee's salary, but employees are encouraged to contribute more if possible.

Can employees at Franchise Group access their 401(k) funds before retirement?

Employees at Franchise Group may access their 401(k) funds before retirement under certain circumstances, such as financial hardship or termination of employment.

With the current political climate we are in it is important to keep up with current news and remain knowledgeable about your benefits.

Franchise Group, like many companies, offers retirement plans to its employees, including both pension and 401(k) plans. As of 2022, 2023, and continuing into 2024, Franchise Group aligns its retirement benefits with federal legislation, including the SECURE Act and SECURE 2.0 enhancements (RSM US) (National Law Review). For its 401(k) plan, employees are automatically enrolled at a contribution rate of 3% of their salary, which escalates annually up to 10%, per changes beginning in 2024. Employees have the option to opt out, but this automatic enrollment is designed to help employees build savings consistently. Franchise Group’s 401(k) plan also offers employer matching contributions (CLA). Part-time employees become eligible to participate after two consecutive years of at least 500 hours of service

Restructuring and Layoffs: In early 2023, Franchise Group announced a significant restructuring plan aimed at streamlining operations and improving efficiency. This move included layoffs affecting approximately 10% of the workforce across various departments. The restructuring was driven by a need to adapt to changing market conditions and enhance financial performance. Company Benefit Changes: As part of the restructuring, Franchise Group also revised its employee benefits package. Changes included reduced health insurance coverage options and modifications to retirement plan contributions. These adjustments were made to better align with the company's new strategic goals and financial outlook.

Franchise Group provides stock options as part of its employee compensation package. These options allow employees to purchase company stock at a set price within a specific timeframe. Franchise Group typically grants stock options to senior management and key employees, based on performance and tenure. Franchise Group options are generally vested over several years, with certain performance metrics required for full vesting. Franchise Group RSUs (2022-2024): Franchise Group also offers Restricted Stock Units (RSUs) to its employees. RSUs are granted to employees but are subject to vesting schedules, which are usually tied to continued employment. Franchise Group grants RSUs to a broader range of employees compared to stock options, including mid-level managers and high performers.

Traditional Group Health Insurance Plans: Franchise Group offers traditional group health insurance plans where the company pays a fixed premium to the insurance carrier. These premiums cover a range of services, including medical, dental, and vision. The insurance carrier assumes the financial risk for claims, offering protection to the company against large, unexpected medical expenses. These plans, however, can become expensive and often require high participation rates from employees (StretchDollar). Health Savings Accounts (HSAs): Employees have access to HSAs, which allow them to set aside pre-tax dollars for medical expenses. These accounts are beneficial for both employees and employers, offering flexibility and tax advantages. However, HSAs are only available to employees who have high-deductible health plans (HDHPs), which could limit participation (StretchDollar). Individual Coverage Health Reimbursement Arrangement (ICHRA): Franchise Group also offers an ICHRA, which is a newer health benefit option. This allows employers to provide pre-tax funds that employees can use to purchase their own health insurance. This option is flexible and gives employees the freedom to select a plan that fits their needs. It is particularly useful for franchises with smaller workforces or employees located in various regions (StretchDollar) (Aflac). Compliance with New Regulations: Franchise Group ensures that their health plans comply with the latest federal requirements, including those related to mental health parity and transparency in pricing. The transparency rules require the disclosure of in-network rates, out-of-network allowances, and prescription drug costs, while the mental health parity rules enforce comparative analysis for mental health and substance use disorder treatments (Aflac). Recent Developments: The company has also been updating their healthcare offerings to align with new federal mandates regarding surprise billing, transparency in coverage, and parity in mental health services. These changes are designed to enhance employee protections, streamline claims, and provide clarity in pricing, which benefits employees seeking affordable care options