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

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

Healthcare Provider Update: Healthcare Provider for Pfizer: Pfizer does not operate as a traditional healthcare provider, but it is a major pharmaceutical company that provides a wide range of medications and vaccines. For healthcare services, Pfizer collaborates with various healthcare organizations, insurers, and providers to distribute its products and support health initiatives. Potential Healthcare Cost Increases in 2026: The healthcare landscape is bracing for significant cost escalations in 2026, driven by a convergence of factors, including the anticipated expiration of enhanced ACA premium subsidies and rising medical costs. Insurers are expected to request steep premium increases, some exceeding 60%, as they cope with surging hospital and prescription drug expenses. Moreover, without congressional action to extend these subsidies, many consumers could see their out-of-pocket costs rise dramatically-some estimates suggest increases of over 75%-making access to affordable healthcare a critical concern for millions. Click here to learn more

'Pfizer 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.

'Pfizer 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 Pfizer 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 Pfizer Professionals

For Pfizer 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 Pfizer, Inc. approach the management of its Consolidated Pension Plan to ensure the financial stability and long-term sustainability of the benefits promised to its employees? Furthermore, what strategies does Pfizer, Inc. employ to communicate the importance of this plan to its workforce, and how does it equip employees with the knowledge needed to understand their benefits effectively?

Pfizer, Inc. manages its Consolidated Pension Plan with a strong focus on financial stability and long-term sustainability by working with key financial partners like Fidelity Investments for recordkeeping and Northern Trust Company for trustee services(Pfizer_3-9-2015_Pfizer_…). The company ensures proper investment strategies and regular reviews to meet the pension obligations and maintain the health of the fund. To communicate the importance of the pension plan, Pfizer uses various channels to educate employees about their benefits, including workshops, internal communication, and retirement planning tools, ensuring that all employees have a clear understanding of their benefits.

In what ways does Pfizer, Inc. ensure compliance with the latest IRS regulations concerning pension plans, and how frequently does it review and update its pension plan policies to align with changing laws? Additionally, what role does the Pension Plan Administrator play in overseeing these compliance efforts within Pfizer, Inc.?

Pfizer, Inc. stays in compliance with IRS regulations regarding pension plans by frequently reviewing and updating its policies to reflect legal changes. The Pension Plan Administrator at Pfizer plays a vital role in overseeing compliance efforts, ensuring that the company adheres to evolving tax laws and regulations. Regular internal audits and legal consultations help Pfizer maintain the necessary compliance measures(Pfizer_3-9-2015_Pfizer_…).

How does Pfizer, Inc. determine the eligibility criteria for employees to participate in its defined benefit pension plan, and what factors are considered when calculating pension benefits? Furthermore, how does Pfizer, Inc. ensure transparency in communicating these criteria and calculations to its employees?

Eligibility for Pfizer’s defined benefit pension plan is determined by factors such as years of service and employee classification. When calculating pension benefits, Pfizer considers age, salary history, and service duration. The company ensures transparency by providing clear documentation and personalized benefit statements to employees, helping them understand the criteria and calculations affecting their retirement benefits(Pfizer_3-9-2015_Pfizer_…).

What are the potential tax implications for employees of Pfizer, Inc. who choose to retire early and how does this intersect with the company's pension plan offerings? Additionally, what resources does Pfizer, Inc. provide to assist employees in understanding their options and the long-term impact of early retirement on their pension plans?

Employees of Pfizer, Inc. who opt for early retirement may face tax implications such as penalties for early withdrawals or reduced pension payouts. Pfizer provides educational resources, including financial planning tools and access to retirement advisors, to help employees navigate the long-term impacts of early retirement decisions. These resources ensure employees can make informed decisions about their retirement plans(Pfizer_3-9-2015_Pfizer_…).

Can you outline the process that Pfizer, Inc. has in place for employees to appeal decisions related to their pension benefits? What steps are involved, and how does Pfizer, Inc. ensure that this process is accessible and fair to all employees who may wish to challenge a decision regarding their pensions?

Pfizer, Inc. offers a structured process for employees to appeal pension benefit decisions. This process includes filing a formal complaint, undergoing a review by the Benefits Administration team, and potentially escalating to higher management if needed. Pfizer ensures this process is accessible and fair, providing employees with clear guidance on how to challenge pension-related decisions(Pfizer_3-9-2015_Pfizer_…).

How does Pfizer, Inc. integrate career counseling and financial planning resources into the retirement process for employees? Furthermore, what initiatives does Pfizer, Inc. undertake to educate its employees about preparing for retirement beyond the financial aspects, ensuring a holistic approach to the transition into retirement?

Pfizer integrates career counseling and financial planning into its retirement process by offering resources such as access to financial advisors, retirement workshops, and online tools. These initiatives help employees plan for retirement comprehensively, covering not just financial aspects but also lifestyle adjustments and post-retirement career considerations(Pfizer_3-9-2015_Pfizer_…).

What specific benefits does Pfizer, Inc. offer to employees who are nearing retirement age, and how do these benefits differ from those provided to younger employees? Additionally, how does Pfizer, Inc. communicate and promote these benefits to ensure that eligible employees take full advantage of what is available to them as they approach retirement?

Pfizer, Inc. provides specific benefits for employees nearing retirement, such as catch-up contributions to retirement plans and access to enhanced financial counseling. These benefits are communicated through targeted retirement seminars and direct communications to ensure that eligible employees understand the advantages available to them as they approach retirement(Pfizer_3-9-2015_Pfizer_…).

How does Pfizer, Inc. address issues related to underfunding of its pension plan, if applicable, and what measures are taken to mitigate potential risks? What plans does Pfizer, Inc. have in place to ensure that it can meet its pension obligations even in challenging financial environments?

If Pfizer, Inc. faces any underfunding issues in its pension plan, the company takes proactive steps to address the problem by increasing contributions or adjusting plan investment strategies. Pfizer has contingency plans in place to ensure it can meet pension obligations even in financially challenging environments(Pfizer_3-9-2015_Pfizer_…).

In 2024, what key changes to the pension plan within Pfizer, Inc. can employees expect, particularly concerning contribution limits and retirement planning strategies? How does Pfizer, Inc. communicate these changes to its employees to ensure that they are well-informed and able to adjust their retirement planning effectively?

In 2024, Pfizer employees can expect updates to the pension plan concerning contribution limits and retirement strategies, in line with IRS changes. The company communicates these updates through newsletters, online portals, and direct emails to ensure employees stay informed and can adjust their retirement planning accordingly(Pfizer_3-9-2015_Pfizer_…).

If employees at Pfizer, Inc. have questions about their retirement benefits, what is the best way for them to contact the company? Are there specific resources, such as a dedicated help desk, online portal, or contact persons within the Benefits Administration team, that Pfizer, Inc. recommends for providing assistance and further information regarding retirement benefits?

Employees at Pfizer, Inc. who have questions about their retirement benefits can contact the Benefits Administration team directly at the contact details provided. Additionally, Pfizer offers online portals and dedicated help desks, making it easy for employees to get assistance with any retirement-related inquiries(Pfizer_3-9-2015_Pfizer_…).

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

Pfizer provides both a traditional defined benefit pension plan and a defined contribution 401(k) plan. The defined benefit plan includes a cash balance component, where benefits grow based on years of service and compensation, with interest credits added annually. The 401(k) plan offers company matching contributions and various investment options such as target-date funds and mutual funds. Pfizer also provides financial planning resources and tools to help employees manage their retirement savings.

Pfizer provides both RSUs and stock options to employees. RSUs vest over time, providing shares, while stock options allow employees to buy shares at a set price.