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

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

Healthcare Provider Update: Healthcare Provider for MetLife: MetLife partners with a variety of healthcare providers and networks to deliver its health insurance products. These generally include extensive networks of hospitals, physicians, and specialists under the MetLife brand, often incorporating regional healthcare systems to ensure members have access to a broad range of services. Specific providers may vary based on the plan and location chosen by the member. Potential Healthcare Cost Increases for 2026: As healthcare costs continue to rise, projections indicate that premiums for Affordable Care Act (ACA) plans could increase sharply in 2026, with the median hike estimated at 18%-the largest seen since 2018. This surge is fueled by factors such as escalating medical expenses, the looming expiration of enhanced federal premium subsidies, and recent aggressive rate hikes from major insurers like MetLife. Without these subsidies, many enrollees could face even steeper out-of-pocket costs, potentially exceeding 75%, underscoring the urgent need for consumers to prepare financially for the upcoming changes. Click here to learn more

'MetLife 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.

'MetLife 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 MetLife 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 MetLife Professionals

For MetLife 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:

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 .

How does the MetLife Retirement Plan structure benefits differently for salaried versus commissioned employees, and what specific factors go into calculating the retirement benefits for each type of employee as detailed in the MetLife plan documents?

Salaried vs. Commissioned Employees: MetLife structures benefits for salaried employees based on their base salary and Annual Variable Incentive Plan, while commissioned employees' benefits are calculated using 42% of commissions from Company proprietary products and services. The benefit formula takes into account eligible pay, Social Security Wage Base, and credited service(MetLife_Retirement_Plan…).

For employees considering early retirement from MetLife, what factors should they weigh in terms of financial security and expected benefits, and how does the MetLife plan accommodate early retirement for participants who may be eligible?

Early Retirement Considerations: Employees considering early retirement should weigh the reduction in benefits due to early retirement factors. Eligibility requires at least 15 years of service and being at least 55 years old. Early retirement benefits are reduced according to specific factors based on age and service(MetLife_Retirement_Plan…)(MetLife_Retirement_Plan…).

What are the implications of the recent changes to the MetLife Retirement Plan regarding the freeze on the Traditional Formula benefits, and how does this impact employees who have been accruing benefits under this system?

Changes to Traditional Formula Benefits: The Traditional Formula was frozen as of December 31, 2022. All future benefit accruals are under the Personal Retirement Account (PRA) formula, which impacts those who were accruing under the Traditional Formula by transitioning them to the PRA(MetLife_Retirement_Plan…).

How does MetLife ensure that employees are fully informed of their rights under the Employee Retirement Income Security Act (ERISA), and what resources does the company provide for employees to understand their pension benefits?

ERISA Rights and Resources: MetLife ensures employees are informed of their ERISA rights through plan documents, the MetLife HR Global Compensation and Benefits Department, and the Retirement Benefits Service Center. Participants can access detailed plan information, their benefits, and contact the plan administrator for legal issues(MetLife_Retirement_Plan…).

In the event of resignation or transitioning to another role within MetLife, what provisions does the retirement plan offer regarding preserved benefits, and how can employees navigate this process to secure their retirement funds?

Preserved Benefits after Resignation: Employees leaving MetLife retain preserved benefits if vested. These benefits can be claimed at retirement age, and employees can opt for different forms of payment, including lump sums or annuities, depending on the value of their preserved benefits(MetLife_Retirement_Plan…).

What measures are in place for employees at MetLife to reach out for support and clarification about their retirement benefits, and how can they utilize those resources effectively to address any concerns they might have?

Support for Retirement Benefit Queries: Employees can seek support through the Retirement Benefits Service Center or the online portal. These resources provide answers to any queries about benefits and can be used to resolve discrepancies in benefit calculations or account information(MetLife_Retirement_Plan…).

As MetLife employees, what strategies can individuals implement to maximize their pension benefits throughout their careers, including understanding the impact of factors like final average pay and years of credited service?

Maximizing Pension Benefits: Employees can maximize pension benefits by understanding the impact of final average pay, credited service, and the Social Security Wage Base. Maintaining consistent employment and maximizing eligible pay are key strategies for increasing retirement benefits(MetLife_Retirement_Plan…).

Can you explain the eligibility criteria for participation in the MetLife Retirement Plan and how an employee can determine their eligible pay throughout the duration of their employment with the company?

Eligibility for MetLife Retirement Plan: To participate in the plan, employees must complete at least one year of service with 1,000 hours and be 21 years old. Eligible pay is determined by the employee's base salary or a percentage of commissions for commissioned employees(MetLife_Retirement_Plan…).

What steps should MetLife employees take if they notice discrepancies or unusual activity in their retirement accounts, and what resources are available to assist them in resolving these issues?

Addressing Discrepancies in Accounts: If employees notice discrepancies, they should contact the Retirement Benefits Service Center immediately. There are procedures in place for filing claims, and employees must report errors within a reasonable timeframe(MetLife_Retirement_Plan…).

How can MetLife employees obtain further information about their pension rights and benefits, and what specific documentation or communication channels should they utilize to ensure they have accurate and comprehensive information? These questions are designed to assist employees in navigating their retirement benefits with MetLife.

Obtaining Further Information: Employees can access comprehensive information on their pension rights and benefits through the online portal or by contacting the plan administrator. The portal provides personalized benefit details, and written requests can be submitted for official plan documents(MetLife_Retirement_Plan…).

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

MetLife is a leading global provider of insurance, annuities, and employee benefit programs, serving millions of customers worldwide.

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