The Trump administration began sending one-time $500 payments to Affordable Care Act marketplace enrollees in 30 different states, describing the payments as refunds for excessive fees that it says consumers paid through higher insurance premiums.

Nearly 1 million Americans are expected to qualify, and the payments are aimed at individuals who purchase ACA coverage through the federal Healthcare.gov platform and receive no federal subsidies. The checks are coming just weeks before the November midterm elections, when health care affordability is a major concern among voters.

Here’s what to know on whether President Trump’s $500 payment will meaningfully reduce health care costs.

How Much Difference Will $500 Make?

At the end of 2025, Congress let enhanced ACA premium tax credits expire, driving up healthcare costs for millions of Americans. According to KFF’s analysis of 2026 marketplace data, the average monthly premium payment after tax credits rose from $113 in 2025 to $178, indicating a 58% increase. However, for those without subsidies, the average monthly benchmark premium—the second-lowest-cost silver plan for a 40-year-old—is currently $625 nationally. Of note, average marketplace deductibles also increased by 37%, to $3,786 per person, which is the amount an individual has to pay before insurance coverage kicks in.

Thus, for most Americans receiving the $500 check who are part of the ACA marketplace and receive no federal subsidies, the amount will not cover a full month’s premium for the average enrollee. Although the $500 could provide some short-term assistance in covering the majority of a monthly insurance premium, it is a one-time payment, not a reduction in the underlying insurance premium, deductible or cost of medical treatment.

Healthcare monthly premiums are only one part of healthcare spending. Individuals still can face out-of-pocket costs, prescription costs as well as deductibles.

Who Benefits, And Who Is Left Out?

Checks will only be given to ACA marketplace enrollees in 30 states who have not received federal subsidies. Some households with multiple eligible individuals may receive more than one payment. Americans with employer sponsored coverage, those who receive insurance through state-run marketplaces or those that receive any federal subsidies will not qualify under the announced criteria by the Trump administration.

This means that many lower and middle-income Americans receiving ACA assistance and some who dropped coverage because they could not afford it will not directly benefit. There are currently over 19 million Americans enrolled in the ACA marketplace, and more than 18 million of whom will not receive a check from the Trump administration.

What Could Make Healthcare More Affordable?

Although a one-time refund could help with some immediate expenses, several policy options could provide more sustained relief. These include restoring the tax credits that Congress let expire last year, which would decrease the cost of monthly premiums for millions of Americans in the ACA marketplace. In addition, limiting out-of-pocket costs and reducing prescription drug costs and hospital costs through increased healthy competition could significantly reduce the amount Americans pay for healthcare.

President Trump’s $500 checks could provide limited, temporary relief to nearly 1 million Americans. However, the payments do not directly address the broader forces driving premiums, deductibles and prescription costs upward. More than half of Americans cannot afford healthcare and prescription costs according to Gallup research . Healthcare affordability will continue to be a pivotal issue in the upcoming midterm elections.