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

'TIAA 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.

'TIAA 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 TIAA 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 TIAA Professionals

For TIAA 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 TIAA-CREF's current approach to retirement benefits reflect the changing landscape of retiree health care support, and what implications does this have for employees planning for their retirement? How can TIAA-CREF employees leverage available resources to ensure that they are maximizing their retirement readiness?

TIAA-CREF is adapting to the evolving landscape of retiree health care by integrating defined contribution retirement and health care plans, thereby increasing benefits while maintaining cost control. This shift is crucial for employees planning for retirement as it allows for more predictable and sustainable benefits management. Employees should leverage TIAA-CREF’s educational resources, online tools, and direct consultation with wealth advisors to maximize their retirement readiness, ensuring they understand how to optimize their savings and benefits.

In what ways has the transition from traditional defined benefit plans to defined contribution plans impacted TIAA-CREF employees in terms of financial security during retirement? What strategies can employees employ to manage their defined contribution savings effectively to ensure they meet their retirement needs?

The transition from defined benefit plans to defined contribution plans at TIAA-CREF has significant implications for financial security during retirement, potentially increasing the responsibility on employees to manage their retirement savings. Employees can enhance their financial security by taking advantage of TIAA-CREF's automatic enrollment, lifestyle funds, and matching contributions strategies. Additionally, they should consider utilizing financial planning services offered by TIAA-CREF to effectively manage and plan their retirement savings.

TIAA-CREF promotes a robust wellness program alongside its retirement benefits. How can the wellness initiatives offered by TIAA-CREF contribute to an employee's overall preparation for retirement? What measures should employees take to integrate wellness into their retirement planning?

TIAA-CREF’s wellness programs are integral to helping employees prepare for retirement by promoting physical and financial well-being. Engaging in these wellness initiatives can lead to reduced long-term health care costs and improve overall health, which is vital for a secure retirement. Employees should actively participate in these programs and integrate wellness into their retirement planning to ensure they remain healthy and financially prepared for their post-working years.

As employees approach retirement, understanding health care costs becomes essential. What resources does TIAA-CREF provide to help employees estimate their future health care expenses, and why is it crucial for employees to factor these costs into their retirement planning?

TIAA-CREF provides several resources to help employees estimate future health care expenses, which is essential for comprehensive retirement planning. Utilizing tools like health savings accounts and retirement health savings plans can aid employees in planning for these costs effectively. Understanding the specifics of Medicare and supplemental insurance options available through TIAA-CREF can also help employees make informed decisions about their health care in retirement.

Facing the challenges of an aging workforce and rising health care costs, how is TIAA-CREF adapting its retiree health care strategies to remain sustainable? What can current employees learn from these changes as they prepare for their future?

Facing an aging workforce and rising health care costs, TIAA-CREF is adapting its strategies by shifting towards health reimbursement arrangements (HRAs) and providing access to Medicare Advantage plans through private exchanges. These changes help sustain the financial viability of retiree health benefits. Employees should stay informed about these shifts and plan accordingly to utilize the evolving benefits effectively as they prepare for retirement.

The retirement health savings plan (RHSP) at TIAA-CREF offers unique benefits. How does this plan specifically support employees in managing their health care costs post-retirement, and what should employees consider when contributing to this plan while employed?

TIAA-CREF’s RHSP offers unique benefits by allowing employees to save for health care costs with tax advantages. Understanding and contributing to this plan during their employment can significantly aid employees in managing health care expenses post-retirement. Employees should consider maximizing their contributions to take full advantage of TIAA-CREF’s matching offerings and the tax-free growth of these assets.

TIAA-CREF has moved towards providing financial support for retirees through health reimbursement arrangements (HRAs) instead of traditional retiree health benefits. What should TIAA-CREF employees know about the HRA structure, and how can they plan to utilize these funds effectively to cover medical expenses in retirement?

TIAA-CREF’s move to provide financial support through HRAs instead of traditional health benefits requires employees to understand the structure and benefits of HRAs. Planning how to use these funds effectively, including covering medical expenses and insurance premiums in retirement, is crucial. Employees should educate themselves about the terms and optimal uses of their HRA to maximize its value for their retirement health care needs.

Considering recent changes in accounting standards like FAS 106, how has TIAA-CREF adjusted its benefits structure? How can employees understand the implications of these standards when it comes to their retiree benefits and overall financial planning?

With changes in accounting standards like FAS 106 affecting the reporting and funding of retiree benefits, TIAA-CREF has adjusted its benefits structure accordingly. Employees need to understand these changes and their implications on their retiree benefits to plan their finances and retiree benefits more effectively. Awareness of these accounting standards and proactive engagement with HR can help employees navigate these changes.

The rising costs of health care naturally impact retirement planning. How is TIAA-CREF preparing its employees to navigate these rising costs in their retirement? What proactive steps should employees take to mitigate health care costs during their retirement years?

TIAA-CREF is preparing employees for rising health care costs by providing tools and resources to estimate and manage these expenses effectively. Employees should proactively use these resources and consider increasing their health savings contributions to mitigate the impact of medical inflation on their retirement savings.

If TIAA-CREF employees have further questions or need detailed information regarding their retirement benefits, what is the best way to contact TIAA-CREF for assistance? What resources are available through TIAA-CREF's communication channels to ensure employees have comprehensive support during their retirement planning process?

For TIAA-CREF employees seeking further assistance or detailed information regarding their retirement benefits, contacting TIAA-CREF through their dedicated support channels, including customer service lines and online portals, is advisable. Utilizing workshops, webinars, and one-on-one advisement can also provide comprehensive support and guidance in navigating retirement planning effectively.