Caught in the middle are insurance customers, many of whom are facing significant premium hikes that may prompt them to rethink their plans.
Sarah Collins, an expert in insurance from the Commonwealth Fund, mentioned, “It feels overwhelming, but exploring different options is crucial.”
Shoppers can respond as follows:
First deadline is in 6 weeks
Most shoppers have until January 15 to secure a plan for 2026, although those wanting coverage that begins on New Year’s Day must decide by December 15.
This period offers the best opportunity for individuals with private insurance to select a plan for the next year. As tracked by KFF, over 24 million people are projected to be enrolled in individual plans by 2025.
New plans can be purchased through state-established insurance markets, with the aid of income-based tax credits. The administration of former President Joe Biden expanded these tax credits during the pandemic, but they are set to expire this year unless Congress acts to extend them.
Additionally, shoppers can look for alternatives outside of these markets, which may sometimes be at lower prices but without tax credit assistance.
KFF reported that, on average, premiums are expected to rise by about 20% next year. The possible expiration of tax credits could more than double some customers’ coverage costs.
As long-term care expenses continue to climb, many Americans are worried about the surging insurance premiums. Insurers are anticipating that some healthy individuals, who may not have paid much in premiums for 2025, could opt out, influencing their pricing strategies.
Karan Rustagi, an actuary at Wakely Consulting Group who collaborates with insurance companies, explained that these price hikes are intended to compensate for potential revenue losses.
Even if Congress restores the enhanced tax credit prior to the enrollment deadline, rates may not change. Rustagi pointed out that it often takes weeks for insurers to finalize rates with regulators and update systems and customer documents.
Help can be difficult to find
This past February, the Centers for Medicare and Medicaid Services slashed funding by 90% for a federal program that assists individuals in finding insurance.
This funding cut will impact more than 20 states that depend on federal support for their health insurance markets. Kay Pestaina, Vice President at KFF, emphasized how crucial this help is for first-time shoppers, who need to accurately estimate their income for tax credit eligibility.
Estimating income can be especially challenging for seasonal workers or those with fluctuating salaries.
“One-on-one support is going to be very important,” Pestaina remarked. “It’s not something that’s straightforward.”
If navigators are unavailable, health insurance brokers or agents can provide assistance. They receive commissions from insurance companies, paid as a flat fee.
Shoppers can discover their options by exploring their state’s insurance markets. More information can be found at healthcare.gov.
Collins suggested starting there, instead of using search engines, which might lead to companies offering more limited short-term insurance options.
Joshua Brooker, an independent insurance agent in Lancaster, Pennsylvania, advised that the first step is to apply for tax credit assistance.
This process indicates if there’s any aid available. Assistance will renew automatically once the enhanced tax credit is extended.
“There’s no delay in submitting the initial application,” he noted.
Then, it’s essential to choose a plan. Consider not only premiums but also deductibles, the network of doctors and hospitals, and how your medications will be covered.
Don’t stall in hopes that the tax credit situation will be resolved; this might not occur during the registration phase. If it changes later, you can reassess your selection.
“There’s always a mulligan,” Brooker added.
Agents noticed that many people are delaying their insurance purchases, resulting in help being harder to find as deadlines approach.
“Every year, some folks wait until the last minute to enroll or miss the deadline entirely,” shared Sheila Teague, an insurance agent in Anchorage, Alaska. “Be sure you’re prepared.”
