If you’re considering health insurance right now, you might be in for a surprise when you see the prices.
The Affordable Care Act’s health care marketplace opened on November 1, but with the enhanced premium tax credits that Congress approved having expired, many premiums have increased dramatically.
Without these credits, some people may find that their premiums have essentially doubled, leaving them wondering what to do next.
“This is perhaps the most disruptive public offering period since the marketplace first opened,” remarked Cynthia Cox, vice president and ACA program director at KFF.
These premium subsidies significantly helped lower health insurance costs for those who qualified. Since the ACA was enacted in 2010, individuals with incomes below 400% of the poverty level have received subsidies in the form of premium credits for marketplace insurance. But due to the coronavirus pandemic, the federal government extended subsidies to people above the income limits on a sliding scale and increased benefits for those below. Enhancement of insurance premium tax deduction.
According to a federal report from the Centers for Medicare and Medicaid Services, 84% of marketplace customers received premium tax credits to lower monthly health insurance costs in 2020, which rose to 92% last year.
The average monthly premium before tax credits in 2020 was $584, compared to $619 the following year. However, thanks to the credits, the average amount actually paid in premiums dropped from $162 to $113 between 2020 and 2025.
The enhanced tax credit originated from the American Rescue Plan Act in 2021 and was extended through 2022, just expiring at the end of September.
Democrats in Congress are pushing for an extension of these subsidies, stating they won’t pass a budget without it, while Republicans want to negotiate the subsidies after the budget has been passed. This deadlock has led to the longest government shutdown in history.
Experts advise that there’s no need for consumers to panic as Congress could still take action. Here are three steps marketplace shoppers should consider when looking for health care.
1. Take your time choosing a plan
It’s essential to familiarize yourself with all the options available, proceed thoughtfully, and stay informed.
The marketplace remains open in all states until at least December 15 for the upcoming year. While some states may have extended enrollment periods, it’s wise to consider early to mid-December as a crucial deadline, according to health policy analyst Louise Norris. health insurance.org.
Cox suggested that Thanksgiving could be a perfect time for shoppers to gather, review their budgets, and discuss options with family. This approach allows many to take a break while giving Congress additional time to make possible changes.
Norris pointed out three potential avenues for Congress:
1. No action – This would mean consumers pay the current premium prices listed online.
2. Possible extension – If extended, “most individuals would likely see significantly lower premiums in 2026,” she said.
3. Maybe a compromise – This scenario could extend the subsidy but require some changes.
“It’s challenging to predict how this will affect premiums since we don’t know the specifics, but it’s likely to be less expensive for some compared to current rates,” she added.
read more: Health subsidies are pivotal in the government shutdown debate. Who is affected when they cease?
Norris encouraged people to check their state markets to learn about plan options. Remember, even if plans are fixed, premiums could still decrease.
If you choose a plan but Congress extends premium subsidies, there’s no need to worry as plans can be altered during the open enrollment period.
Whether selecting a plan now or delaying, both Cox and Norris recommend staying alert for any changes.
“Another suggestion is to monitor this closely. Stay informed about the news regarding the extension of tax credits,” Cox said.
2. Seek professional assistance
Though finalizing plans might take until mid-December, Cox recommended reaching out to an agent, broker, or navigator sooner rather than later.
“They might be inundated this year. You can imagine around 20 million people seeking guidance,” she commented.
read more: AP-NORC poll indicates rising health care costs are concerning for most Americans.
Brokers and navigators are likely to be busy, so if you need assistance in understanding your options or selecting a plan, it’s best to reach out early.
“Many have experience in this field and can be trusted. Check their reviews or ask for recommendations from friends,” suggested Cox.
Moreover, this year, the Trump administration cut funding for Navigator, a nonprofit assisting people in understanding their plans for free. Among other services. In February, CMS indicated funding would drop from nearly $100 million to just $10 million.
Norris noted that while navigators help people understand their choices, only state-licensed brokers can provide advice or recommendations. Since brokers earn commissions, premium rates tend to be relatively stable across companies, which lessens concerns about potential biases towards specific plans.
Getting help is a “very good idea,” Norris emphasized, “especially if you’re worried about in-network doctors or need coverage for specific medications.”
If the range of options feels overwhelming, a broker or navigator could be quite beneficial.
3. Weigh your health and financial situation when selecting a plan
Cox noted that many marketplace insurance buyers are low-income and qualify for cost-sharing assistance, resulting in lower deductibles. This help is available only with silver plans, and while premiums may rise, deductibles usually remain manageable, making silver plans a strong choice.
Cox mentioned that a zero-premium Bronze plan could be appealing for those who are “truly healthy,” don’t require medications, and only need insurance as a safety net. However, she cautioned that the deductibles would be quite high.
“If they prioritize avoiding monthly costs, that option might work for them,” she indicated.
Norris added that all Bronze plans will feature a health savings account option next year. If Congress reinstates the pre-2021 “subsidy cliff,” those slightly above the threshold for premium tax credits might consider contributing to an HSA to lower their projected income.
clock: Why millions of Americans face rising health care costs
“For instance, if you anticipate earning $63,000 as a single person and discover you’re ineligible for subsidies, choosing a bronze plan and contributing $1,000 to an HSA could drop your income to $62,000, possibly making you eligible for significant subsidies,” Norris explained.
4. Regardless of insurance, plan on increasing your medical budget next year.
Even if Congress extends some or all of the enhanced premium tax credits, experts suggest that Americans should prepare to boost their health care spending budget, whether insurance comes through the marketplace or an employer.
This follows a change by the federal government that altered the methodology behind setting out-of-pocket maximums, which increases the cap on personal medical expenses from $9,200 in 2025 to $10,600 in the coming year.
However, not all plans have high out-of-pocket limits, Norris noted. It remains vital to evaluate options, especially if those expenses might exceed budget capabilities.
“Whether you maintain your current plan and pay more, or switch to a lower-premium plan with a higher deductible, it appears likely that you’ll incur increased health care costs next year,” Cox observed.
