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

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Healthcare Provider Update: Maximus, known for its administration of government health programs, primarily collaborates with state and federal health services. It provides administrative services for Medicaid, Medicare, and health care reform initiatives, which play a critical role in ensuring access to healthcare coverage for millions. Looking ahead to 2026, healthcare costs are anticipated to surge, significantly impacting consumers reliant on the Affordable Care Act (ACA) marketplace. As many states prepare for premium increases that could reach as high as 66%, the expiration of enhanced federal subsidies is expected to exacerbate financial burdens for enrollees, with nearly 92% of them facing potential out-of-pocket premium hikes exceeding 75%. This combination of factors is creating a challenging landscape for healthcare affordability, compelling individuals to take proactive steps in managing their healthcare expenditures. Click here to learn more

'Maximus 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.

'Maximus 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:

  1. How the expiration of enhanced ACA subsidies after 2025 could impact health care costs for retirees and early retirees.

  2. Real-life case studies illustrating how different individuals are adjusting to rising ACA premiums.

  3. Practical steps Maximus 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 Maximus Professionals

For Maximus 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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What is the 401(k) plan offered by Maximus?

The 401(k) plan offered by Maximus is a retirement savings plan that allows employees to save a portion of their paycheck before taxes are taken out.

How can I enroll in the Maximus 401(k) plan?

You can enroll in the Maximus 401(k) plan by completing the enrollment form available through the HR portal or by contacting the HR department for assistance.

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

Yes, Maximus offers a matching contribution to employee 401(k) plans, which helps to enhance your retirement savings.

What is the maximum contribution limit for the Maximus 401(k) plan?

The maximum contribution limit for the Maximus 401(k) plan is set annually by the IRS, and you can check the latest limits on the IRS website or through Maximus’s HR resources.

Can I change my contribution percentage to the Maximus 401(k) plan?

Yes, you can change your contribution percentage to the Maximus 401(k) plan at any time by submitting a request through the HR portal.

When can I start withdrawing from my Maximus 401(k) plan?

You can start withdrawing from your Maximus 401(k) plan at age 59½, or earlier under certain circumstances such as financial hardship.

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

Yes, there may be administrative fees associated with the Maximus 401(k) plan, which are outlined in the plan documents provided to employees.

Does Maximus provide investment options within the 401(k) plan?

Yes, Maximus provides a variety of investment options within the 401(k) plan, allowing employees to choose based on their risk tolerance and retirement goals.

How often can I change my investment allocations in the Maximus 401(k) plan?

Employees can change their investment allocations in the Maximus 401(k) plan as often as they wish, subject to the plan's guidelines.

What happens to my Maximus 401(k) plan if I leave the company?

If you leave Maximus, you have several options regarding your 401(k) plan, including rolling it over to another retirement account, cashing it out, or leaving it with Maximus.

With the current political climate we are in it is important to keep up with current news and remain knowledgeable about your benefits.
Plan Name: Maximus Pension Plan Years of Service and Age Qualification: Employees are generally eligible for the Maximus Pension Plan after completing 5 years of service and reaching age 65. Pension Formula: The pension is calculated based on a formula that includes years of service and average compensation. Specifics are detailed in the plan document. Plan Name: Maximus 401(k) Plan Who Qualifies: All full-time employees are eligible to participate in the Maximus 401(k) Plan after completing 30 days of service. 401(k) Details: Employees can contribute a percentage of their salary, with the company offering a matching contribution up to 4%.
In response to decreased demand for its services and the need to streamline operations, Maximus announced a plan to cut approximately 1,000 positions globally. This move is part of a broader strategy to reduce costs and enhance operational efficiency. The layoffs are expected to impact various departments, including customer support and IT services.
Maximus offers stock options and RSUs to its employees as part of its compensation package. These are typically available to senior management and key employees based on performance and tenure. The specific types of stock options and RSUs include non-qualified stock options (NSOs) and time-vested RSUs.
2023: Maximus has been actively expanding its mental health and telehealth services as part of its benefits package. There has been an increased emphasis on comprehensive care that includes mental health support and preventive services. 2024: The company has introduced new wellness initiatives, including more flexible health plans and enhanced coverage options for chronic conditions
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