Open enrollment for Affordable Care Act (ACA) health plans runs November 1 through January 15, 2026. Consumers should review options carefully: experts expect higher monthly premiums, larger out-of-pocket costs, reduced eligibility for marketplace coverage, and fewer enrollment-assistance resources.
Why costs may rise
– Enhanced premium tax credits (subsidies) that have helped most enrollees are scheduled to expire at the end of 2025 unless Congress renews them. The federal government shutdown and budget disputes have increased uncertainty.
– Kaiser Family Foundation (KFF) estimates that without the subsidies, annual premiums for individuals could rise by several hundred to more than a thousand dollars, and family premiums could increase by thousands.
– Insurers are also raising rates due to higher healthcare costs; KFF projects a median insurer premium increase of about 18%.
– Examples from Georgetown’s Center on Health Insurance Reforms: a family of four in New Hampshire earning $50,000 could see premiums rise from $9 to $186 per month; two retirees in Wisconsin with income of $85,000 could see premiums jump from $602 to $2,144; a 28-year-old in Oregon earning $25,000 could see premiums go from $8 to $97.
Out-of-pocket limits
– Reported 2026 increases include individual out-of-pocket maximums rising from $9,200 in 2025 to about $10,600 in 2026, and family limits from $18,400 to about $21,200.
– Higher premiums and higher out-of-pocket caps make careful plan comparison more important; eHealth reports potential average savings of about $2,000 per year by shopping with a licensed agent.
Eligibility and enrollment assistance
– Uncertainty over subsidies may discourage enrollment. The Trump administration reduced funding for ACA navigators in many states, which may cut consumer help.
– New CMS rules removed a monthly special enrollment period for people with projected incomes at or below 150% of the federal poverty level and tightened income verification for premium subsidies.
– Some carriers may exit ACA marketplaces; Aetna has announced it will not participate in 2026 in some areas.
Short-term plans are not a simple solution
– Short-term, limited-duration plans (sold in many states) are often marketed as cheaper alternatives, but they:
– Do not qualify for subsidies.
– May deny coverage for pre-existing conditions.
– Often carry very high deductibles (sometimes up to $25,000).
– Frequently exclude mental health, substance use treatment, immunizations, and maternity care.
– Are not required to allow automatic renewal, leaving consumers exposed if they become ill.
– Federal enforcement of consumer protections for these plans may be limited.
Potential impacts if subsidies lapse
– The Commonwealth Fund estimates up to 5 million Americans could lose ACA coverage in 2026 without renewed subsidies; CBO projections and other analyses also foresee increases in the uninsured.
– Reduced enrollment could shrink insured pools, raise costs further, lead some people to delay preventive care, and result in job losses and lower state and local tax revenue according to projections.
What consumers should do
– Review and compare plans during open enrollment (Nov 1–Jan 15). If you miss open enrollment you generally must wait for a qualifying life event to enroll.
– Don’t assume your current plan is the best option for 2026; premiums and cost-sharing can change.
– Consider using licensed agents or brokers to compare options; shopping can yield meaningful savings.
– Confirm plan details: premiums, deductibles, out-of-pocket maximums, covered benefits (including the 10 essential health benefits), and provider networks.
– Pay premiums on time to avoid losing coverage.
Background
– The ACA, enacted in 2010, expanded access to coverage, prohibited denial for pre-existing conditions, and aimed to make insurance more affordable. In 2025, over 24 million Americans were enrolled through the ACA marketplaces, the highest single-year total to date.
Key dates and basics
– Open enrollment: November 1–January 15 for 2026 coverage.
– Sign up at healthcare.gov or your state marketplace. Most ACA plans cover essential benefits and may qualify for premium and cost-sharing assistance for eligible enrollees.
– Compare plans carefully and verify eligibility for subsidies before selecting coverage for 2026.
