The Obamacare open enrollment period kicked off last Saturday in most states, and sadly, uncertainty continues to loom over the 24 million individuals relying on the Affordable Care Act (ACA) marketplaces for health insurance.
This year’s enrollment process is becoming quite complicated, mainly because of a standoff in Congress regarding the expiration of important tax credits that have greatly lowered coverage costs. With the federal government in an ongoing shutdown that has lasted for a month, the Republican-controlled House and Senate are opposing the Democrats, who are advocating for the extension of these enhanced subsidies as a condition for reopening.
While reports indicate that most current enrollees will still qualify for some federal tax credits, many could face escalating monthly premiums without the extra financial support, leading to overwhelming anxiety about affordability. Some individuals may even find themselves ineligible for subsidies altogether or receiving less assistance than before, leaving the fate of affordable coverage for 92% of enrollees hanging in the balance.
However, all is not lost; experts suggest that there are proactive steps marketplace shoppers can take to navigate this tumultuous landscape and make informed decisions for the upcoming plan year. By staying informed and comparing options carefully, consumers can better position themselves to find the right coverage amidst this year’s challenges.
Here are five suggestions from authorities who cover healthcare policy and government spending to help you get started.
Shop, Shop, Shop
When it comes to choosing your health insurance for next year, lower subsidies aren’t the only thing to keep in mind; the underlying costs of plans are also on the rise.
It’s tempting to just hit that automatic renewal button on your current coverage, but that could be a costly mistake. Before you lock in your plan, it’s wise to explore your options. Consulting with a licensed broker can provide you with personalized insights. And don’t forget to check out the resources available on the marketplace website – these can help you navigate the sometimes overwhelming choices out there.
If you’re considering signing up through healthcare.gov, remember that you have until December 15 to enroll in a plan that kicks in on January 1. For those who miss that deadline, the final date to enroll for coverage that starts on February 1 is January 15. Keep in mind that different state marketplaces might have their own deadlines, so it’s important to stay informed.
“People should really look and see what they are facing, what their options are,” Justin Giovannelli, a health researcher at the Center on Health Insurance Reforms at Georgetown University, told The Times. “There’s no reason to delay that.”
Giovannelli also advises staying informed about the news. If Congress approves an extension of the subsidies, you will have the opportunity to modify your selection during the open enrollment period.
Change Your Account Details and Don’t Auto-enroll
Log in to your marketplace account and update your income, household size, and any other information that has changed.
This year, it’s very important to give a correct estimate of your expected income for 2026.
A rule in HR 1, often called the One Big Beautiful Bill Act, removed limits on how much some people had to pay back if they guessed their income too low and got more premium help than they were supposed to. Starting next year, people will have to pay back the full extra amount.
In recent years, you could automatically renew your ACA insurance in your current or a similar plan. However, due to the uncertainty about premiums, experts advise against doing that this year.
This is particularly critical for individuals who will lose their eligibility for subsidies next year if Congress does not reach a new agreement, particularly those whose incomes exceed 400% of the federal poverty level.
Buy Sticker Prices
As the government shutdown wears on, many individuals and families will face a dire reality when they see their projected health insurance premiums for next year, especially if the enhanced credits aren’t extended.
According to the Kaiser Family Foundation (KFF), average marketplace premiums are set to soar by about 26%, marking the largest increase since 2018. Until now, the enhanced premium tax subsidies have offered a financial cushion, keeping costs manageable for most enrollees.
Here’s the deal: under the ACA, individuals pay a portion of their premiums based on income, while the government covers the rest. However, if these enhanced credits are allowed to expire, the financial burden will shift dramatically.
For instance, a family of four earning $75,000 could see their annual premium costs skyrocket from $2,498 to a staggering $5,865 for a benchmark silver plan in 2026 – more than double the current amount. Without renewed support, many could find themselves facing consequential financial strain, forcing them to reevaluate their healthcare options and possibly compromising their access to necessary medical care.
When looking at a plan, pay attention to the price. If you can’t afford it without the extra tax credits, then it’s not a good purchase.
If you think the cost of a health insurance plan is too high without extra financial help, it might be a good idea to look at a less expensive plan that has a lower monthly payment but a higher deductible, according to Cynthia Cox, a vice president and the director of the Program on the ACA at KFF in an interview with NPR.
She explains that, for example, Bronze plans offer solid coverage, including free preventive care, which means you can get services like vaccinations and screenings without paying anything. Additionally, you might still be able to see certain doctors before you hit your deductible, which can help you manage your health costs better. Choosing this type of plan can make healthcare more affordable while still giving you access to important services, even if it requires some careful planning with your overall healthcare spending.
“People need to make a decision based on what is in front of them,” she said. “In most cases, it makes more sense to have a bronze plan than to be uninsured,”
In addition, you may still be able to access certain doctor visits before reaching your deductible, giving you some breathing room when it comes to managing your health expenses. By opting for this kind of plan, you can make healthcare more affordable while still ensuring that you have access to essential services, even if it means being a bit more strategic about your overall healthcare spending.
The Trump administration has been encouraging people to consider catastrophic plans as a cheaper choice for those struggling financially, including individuals who earn too little or too much to receive subsidies.
Like bronze plans, catastrophic plans include a basic set of essential health benefits, offer free preventive care and cover at least three doctor visits before the deductible kicks in. However, catastrophic plan deductibles are the highest among all marketplace plans: $10,600 for individuals and $21,200 for families in 2026.
“They are expensive relative to what they cover,” said Jennifer Sullivan, who is in charge of health coverage access at the Center on Budget and Policy Priorities. She mentioned that premiums can be several hundred dollars.
Come Back, Look it Over and Then Look it Over Again
If you feel frustrated by high prices when you first look, “don’t slam the computer shut and decide that there are no options for you,” advises Sullivan. “Congress might still act and things might change radically.”
Lawmakers might reinstate the additional premium tax credits before the end of the year or even later.
It’s worth repeating that it’s essential to remember the key dates:
In most states, including the 28 that utilize the federal marketplace, open enrollment is available until January 15.
In most states, individuals must sign up by Dec. 15 for coverage that starts on Jan. 1, and by Jan. 15 for coverage beginning on Feb. 1. However, some states may have different deadlines.
Hold off on Paying Your Premium
Premium payments typically need to be made before a health insurance plan kicks in, but there’s some leeway from marketplaces and insurers when it comes to deadlines, as noted by Sabrina Collette, a co-director of Georgetown University’s Center on Health Insurance Reforms.
For instance, they might give folks a little extra time to make that crucial first payment.
“We’ve seen that in the past. State officials and insurance companies have gotten creative to try and keep people in coverage,” she said. Plus, if there happens to be a last-minute deal and someone has already forked over their premium for January coverage, they won’t be left in the lurch. Even if they ended up with a lower tax credit than what the new deal offers, they should still qualify for the higher credit. This flexibility really helps to ease the financial strain on individuals, making it a bit easier to navigate the often confusing world of health insurance.
