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

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'Sempra 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.

'Sempra 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 Sempra 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 Sempra Professionals

For Sempra 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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