Open enrollment for Affordable Care Act (ACA) plans runs November 1 through January 15, 2026. Experts urge consumers to review options carefully: monthly premiums, out-of-pocket costs and eligibility rules are changing, and there may be fewer enrollment-assistance resources available.
Why costs may rise
– Enhanced premium tax credits (the subsidies that lowered premiums for many enrollees) are scheduled to expire at the end of 2025 unless Congress renews them. Ongoing budget disputes and a federal government shutdown have added uncertainty.
– The Kaiser Family Foundation (KFF) estimates that without those subsidies, individual annual premiums could rise by several hundred to more than a thousand dollars, and family premiums could increase by thousands.
– Insurers are also requesting higher rates because of rising health-care costs; KFF projects a median insurer premium increase around 18%.
– Illustrative examples from Georgetown’s Center on Health Insurance Reforms: a family of four in New Hampshire making $50,000 could see premiums jump from $9 to $186 per month; two retirees in Wisconsin with $85,000 income could go from $602 to $2,144; a 28-year-old in Oregon earning $25,000 might move from $8 to $97 per month.
Out-of-pocket limits and plan costs
– Reported 2026 increases include individual out-of-pocket maximums rising from about $9,200 in 2025 to roughly $10,600 in 2026, and family caps from $18,400 to about $21,200.
– Higher premiums and higher out-of-pocket limits make careful plan comparison more important. eHealth reports that shopping with a licensed agent could save people an average of roughly $2,000 per year.
Eligibility, enrollment help, and marketplace changes
– Uncertainty over subsidy availability may discourage enrollment. Funding reductions for ACA navigators under the previous administration have already cut consumer assistance in many states.
– 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 certain markets; for example, Aetna announced it will not participate in some areas for 2026, reducing choices in affected locales.
Short-term plans are not a simple fix
– Short-term, limited-duration plans are often marketed as cheaper alternatives, but they have important limitations:
– They do not qualify for ACA subsidies.
– They may deny coverage for pre-existing conditions.
– They frequently carry very high deductibles (sometimes up to $25,000) and exclude many services.
– Common exclusions include mental health and substance-use treatment, immunizations, and maternity care.
– They are not guaranteed to auto-renew, leaving people exposed if they get sick.
– Federal enforcement of consumer protections for these plans may be limited.
Potential effects if subsidies lapse
– The Commonwealth Fund estimates that up to 5 million Americans could lose ACA coverage in 2026 if enhanced subsidies are not renewed. Other analyses, including CBO projections, also anticipate increases in the uninsured.
– Fewer enrollees could shrink risk pools and push premiums higher, prompt some people to delay preventive care, and reduce state and local tax revenues and employment tied to the marketplace, according to projections.
What consumers should do now
– Mark the dates: open enrollment runs November 1–January 15. If you miss this window, you generally must wait for a qualifying life event to enroll.
– Don’t assume your current plan remains the best choice for 2026. Review premiums, deductibles, out-of-pocket maximums, covered benefits (including the 10 essential health benefits), and provider networks.
– Compare plans at healthcare.gov or your state marketplace, and verify whether you qualify for premium or cost-sharing assistance before selecting coverage.
– Consider working with licensed agents or brokers; shopping around can yield meaningful savings for many consumers.
– Pay premiums on time to avoid losing coverage, and keep documentation to support income and eligibility if verification rules apply.
Background and basics
– The ACA, enacted in 2010, expanded access to coverage, prohibited denial for pre-existing conditions, and aimed to make insurance more affordable. In 2025, more than 24 million Americans were enrolled through the ACA marketplaces—the highest single-year total to date.
– Key reminder: open enrollment for 2026 coverage is November 1–January 15. Sign up or compare plans at healthcare.gov or your state marketplace and confirm eligibility for subsidies before finalizing a plan.
