The ACA Marketplace
The Affordable Care Act (ACA) Marketplace (also called the Health Insurance Marketplace, Exchange, or HealthCare.gov) is where individuals and families can shop for and purchase health insurance coverage. It is designed for people who don't get insurance through their job, aren't eligible for Medicare or Medicaid, and need to buy coverage on their own. The Marketplace offers a range of comprehensive health plans that cover essential services like doctor visits, hospital stays, prescription medications, preventive care, mental health services, and emergency care.
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What makes the Marketplace different from buying insurance directly from a company is that most people qualify for financial help — called premium tax credits — that lower their monthly costs (known as premiums) based on their income. This helps working families afford their health care coverage.
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Who Gets Coverage Through the ACA Marketplace in New Hampshire?
Tens of thousands of Granite Staters purchase their health insurance through the ACA Marketplace and receive premium tax credits to make their monthly premiums affordable.
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70,000
NH residents purchase health insurance through the ACA Marketplace
50,000
NH residents rely on premium tax credits, which make their monthly costs affordable
Small business owners and their employees who run local shops, restaurants, and service businesses.
Independent contractors and freelancers including electricians, plumbers, graphic designers, consultants, and tradespeople.
Part-time workers juggling multiple jobs in retail, hospitality, and service industries.
Self-employed professionals like photographers, writers, real estate agents, and home-based business owners.
Early retirees (people under 65) who are not yet eligible for Medicare.​
Seasonal workers in tourism, agriculture, and construction.
Gig economy workers including ride-share drivers, delivery drivers, and online sellers.​​​
Nonprofit employees working at some charitable organizations and community groups.
​These are our neighbors, coworkers, and community members who work hard but don't have access to employer-sponsored insurance. They include:
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These are people doing essential work in our communities, often without the security of employer-provided health benefits. The Marketplace gives them access to the same quality coverage that many people get through their jobs, with financial assistance to make it affordable.
What's Changing? Enhanced Premium Tax Credits Are Expiring.
Right now, Granite Staters who buy insurance through the Marketplace benefit from enhanced premium tax credits (ePTCs, also known as advanced premium tax credits) — extra financial help that Congress created to make health insurance more affordable during and after the pandemic. These credits were not included in the recent government funding agreement and are set to expire on December 31, 2025, unless Congress acts to extend them.
With ePTCs, the average Marketplace enrollee pays just $179 per month for coverage. Without them, that same person would pay an average of $636 per month — more than three times as much.
It's important to note that only the enhanced premium tax credits are expiring at the end of 2025. The original premium tax credits will remain in place.
?How Much Will Premiums Increase in NH
If Congress doesn't extend the enhanced credits, New Hampshire residents will face dramatic cost increases. People who are enrolling in the Marketplace right now are already seeing their premiums increase.
For many families, this means premiums could double or even triple. These increases could force thousands of Granite Staters to drop their coverage altogether because they simply can't afford it.​
To add to this, New Hampshire premiums are already rising for everyone by about 22% in 2026 due to uncertainty in the insurance market. Insurance companies are raising rates because they expect many people will drop their coverage when the ePTCs expire. This creates a vicious cycle — higher premiums lead to fewer enrollees, which leads to even higher premiums for those who remain.
Why This Matters for Small Businesses in NH
Small businesses are the backbone of New Hampshire's economy. According to the U.S. Small Business Administration, over 97% of New Hampshire businesses are small businesses — defined as having fewer than 500 employees. These businesses often rely on the ACA Marketplace to support their owners and workers.
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​Nationally, nearly half of all adults with ACA Marketplace coverage are small business owners, their employees, or self-employed workers. In New Hampshire, this means the Marketplace provides essential coverage for the entrepreneurs running our local shops and restaurants, the contractors building our homes, the freelancers supporting our businesses, and the part-time workers keeping our economy moving.
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Changes to the ACA Marketplace, including the expiration of ePTCs, will hurt small businesses:
Workforce Destabilization: The ACA Marketplace keeps employees healthy and productive — without affordable coverage, workers face higher costs or lose insurance, leading to absenteeism, turnover, and reduced productivity.
​Recruitment & Retention Disadvantage: Affordable health coverage is a critical competitive tool for small businesses to attract talent, and rolling back ePTCs makes it harder to compete with larger employers or retain workers who may leave for states with stronger protections.
Financial Strain: Since nearly half of adults with ACA Marketplace coverage are small business owners, employees, or self-employed, losing ePTCs disproportionality harms this group.
Local Economic Impact: With small businesses making up nearly 99% of all NH businesses and employing half the private workforce, weakening coverage will reduce consumer spending, weaken Main Street, and create ripple effects of higher uncompensated care costs and higher taxes for communities.
What Can You Do?
Are you a small business owner or employee, self-employed, or another worker who purchases health insurance for yourself or your employees through the ACA Marketplace? We want to hear from you! Share your story to show lawmakers why Congress needs to extend the enhanced premium tax credits that are set to expire at the end of 2025.
Resources
If you need assistance or would like additional information, here's where you can turn for help.
Get Free, Local Help from Trained Assistors and Navigators in NH
Navigating health insurance can be confusing, but resources are available. Certified enrollment assistors can provide free, unbiased help to New Hampshire residents. You can find local assistance at HealthCare.gov/find-assistance.
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Prepare to Apply Using the "My Marketplace Application Checklist"
When you apply for the ACA Marketplace, you'll need certain information and documents about you and your household. This could include your household size, social security number, employer and income information, and more. You can find a checklist here.
Preview 2026 Plans and Prices
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Open Enrollment for 2026 coverage runs from November 1, 2025, through January 15, 2026. During this time, you can shop for new plans and compare costs, see what financial assistance you qualify for, and enroll in coverage or switch to a different plan. Visit HealthCare.gov to get started.​​