President Trump announced in September 2026 that roughly 1 million Americans would receive one-time $500 refund checks tied to user fees collected from HealthCare.gov insurers during the Biden administration. These payments target a narrow slice of Affordable Care Act Marketplace enrollees: those who signed up in 2026 through HealthCare.gov without receiving premium tax credits. About 5% of all ACA Marketplace enrollees fall into this group, while the remaining 95% are excluded entirely. The checks are framed as refunds of surplus user fees, though the administration has offered little detail on how the flat $500 figure was calculated.
User Fees and How They Accumulated Over Time
User fees are charges that ACA Marketplaces impose on participating insurers to fund operations such as eligibility determinations, enrollment processing, information technology support, consumer outreach, and program integrity. Since 2017, the Department of Health and Human Services has collected these fees monthly from insurers offering plans on HealthCare.gov, including those operating through state-based exchanges using the federal platform. Insurers typically pass these fees into monthly premiums, with a large share ultimately covered by taxpayers through premium subsidies. In 2026, about 82% of premium dollars in HealthCare.gov states were paid by the advance premium tax credit.
HHS adjusts user fee rates annually based on projected operating costs, premiums, and enrollment figures. During fiscal years 2018 through 2020, the federal government collected more in user fee revenue than it spent, creating a surplus.
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The pattern shifted between fiscal years 2021 and 2023, when the federal government spent more in user fees than it collected. The Biden administration largely controlled spending during these years and increased funding for consumer assistance and outreach, raising that budget from $503 million in 2020 to $1.2 billion in 2023. Even as user fee rates declined, total revenue grew due to enrollment increases driven by enhanced premium tax credits. In fiscal years 2024 and 2025, spending more closely matched collections, though consumer outreach budgets dropped again in 2025 under the Biden administration, falling from $1.2 billion to $778 million.
The $500 checks are unlikely to fully offset the premium increases many recipients faced when enhanced tax credits expired heading into 2026. The checks are smaller than the premium increases most of these enrollees faced and are also smaller than the average premium increases expected in 2027. For most recipients, the $500 checks likely exceed the amount the recipients indirectly paid in total user fees this year.
Legal Authority and Administrative Discretion
The rulemaking process governing user fee rates requires public notice and comment. Proposed rates are published in the annual Notice of Benefit and Payment Parameters, finalized roughly nine months before each plan year begins. This timeline means most user fee policies in effect during the first two years of an administration were set by its predecessor. For example, the Obama administration established rates for plan years 2017 and 2018, the first Trump administration adjusted rates for 2019 and 2020, and the Biden administration modified rates for 2022 through 2026. Rapid shifts in consumer outreach spending, however, can occur outside this rulemaking cycle, allowing administrations to redirect funds annually through budgetary decisions.
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Spending Trends and Future Outlook
The first Trump administration reduced Navigator and enrollment assister funding from nearly $100 million in 2016 to about $20 million by 2020, while overall outreach spending fell from $806 million to $503 million.
User Fee Rate Adjustments and Rulemaking Timeline
The Federally Facilitated Marketplace (FFM) user fee rate has remained at or below 3.5% since the ACA Marketplace began in 2014, reaching a low of 1.5% in 2025. The first rate change occurred in Plan Year 2020, when the Trump administration lowered the rate from 3.5% to 3% citing operational efficiency and enrollment projections. User fees stayed constant through 2021 before the Trump administration reduced the 2022 rate to 2.25% in a final rule issued in January 2021.
The Biden administration later adjusted the 2022 rate to 2.75%, balancing lower projections against contract costs and premium growth. Rates held steady at 2.75% in 2023 before dropping to 2.2% in 2024 and 1.5% in 2025 under the Biden administration. For 2026, the rate was set at 2.5% after enhanced premium tax credits expired, and the Biden administration ultimately lowered the 2027 rate to 1.9%.
