It’s Decision Time for Millions Facing Spiking ACA Premiums

Open enrollment for ACA coverage kicks off this Saturday — and many shoppers are bracing for what could be the largest cost increase since the law was launched more than a decade ago.

More than 24 million Americans use the ACA marketplace to get health insurance. This year, a “perfect storm” of rising premiums and the planned expiration of enhanced subsidies is set to dramatically raise costs for middle‑class families across the country. CBS News

“If it comes down to paying for food, power and heat versus health insurance that you don’t know if you’ll need or not, it’s hard to continue to pay for that given how much of your budget it takes today,” says Stacie Dusetzina, a health‑policy professor at Vanderbilt University.

Here’s what you should know — and what you can do — as open enrollment begins.

🗓️ How Long Does ACA Open Enrollment Last?

• Coverage open‑enrollment generally runs from November 1 through January 15 in most states. Center on Budget and Policy Priorities
• Some states have longer or different periods:
  • Idaho began Oct. 15 and closes Dec. 15
  • Massachusetts: through Jan. 23
  • Virginia: through Jan. 30
  • California, New York, Rhode Island and Washington, D.C.: through Jan. 31
• To have coverage begin Jan. 1, you’ll generally need to enroll by December 15. Plans selected after Dec. 15 typically take effect Feb. 1.
• One major change: Until now, lower‑income people could apply outside the standard window. That option ends this year. KFF Health News

Why Are Premiums Going Up Next Year?

Two primary drivers are behind the rising costs:

1. Expiration of Enhanced Premium Tax Credits (ePTCs)
   • These were introduced in 2021 and expanded eligibility and subsidy amounts via the American Rescue Plan Act and the Inflation Reduction Act. KFF
   • Without them, people eligible for help will pay significantly more. For example: someone earning ~$35,000 could pay roughly $2,615 instead of ~$1,033 annually. KFF
   • On average, if the ePTCs expire, net premium payments for subsidized enrollee could more than double (~114% increase) next year. KFF
   • Also, the so‑called “subsidy cliff” returns in 2026 — individuals earning just above 400% of the federal poverty level (FPL) will lose eligibility entirely. healthinsurance.org
2. Insurers Raising Premiums
   • Many insurers are requesting large premium increases for 2026: median increase ~15‑18 % in many states. American Hospital Association
   • Additional cost pressures include expensive prescriptions, rising hospital costs, and tariffs driving up import prices of medical goods. KFF

Who Qualifies for the Enhanced Subsidies — and What Happens If They Expire?

• The enhanced tax credits expanded subsidy eligibility to people above 400% of FPL (roughly $78,800 for an individual in 2025) who previously would receive no help. KFF
• If the credits expire at year‑end 2025:
  • People above 400% of FPL could lose all subsidy eligibility.
  • Those still eligible will receive less assistance — meaning higher premiums and possibly higher deductibles/out‑of‑pocket costs. KFF
• Analysts estimate millions could drop coverage: e.g., the Congressional Budget Office projects enrollment falling from ~22.8 million in 2025 to ~18.9 million in 2026 if nothing changes. KFF Health News

What You Can Do Before You Enroll

• Compare plans early. Don’t just renew automatically. Premiums and subsidy amounts may change next year.
• Estimate your income carefully. If you earn near the subsidy threshold, small changes could affect eligibility.
• Consider plan tiers. Bronze plans cost less monthly but might have higher deductibles. If you’re in good health, that might make sense — but understand the trade‑off.
• Don’t drop coverage lightly. Insurance protects against unexpected big costs (hospital stays, surgeries). Going uninsured may save money short‑term but carries risk.
• Watch for state‑specific assistance programs. Some states may offer extra help or special open‑enrollment rules.
• Keep an eye on Congress. If lawmakers act to extend enhanced subsidies, it could change your cost dynamics mid‑stream.

Key Takeaways

• Open enrollment begins Nov. 1 and ends Jan. 15 (with state‑variations).
• Premiums are set to jump in 2026 — due to subsidy expirations and insurer rate hikes.
• Without action, many middle‑income Americans face steep cost increases or loss of coverage.
• Your best bet: compare plans, estimate income carefully, and don’t delay enrollment decisions.

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