Millions encounter significant price surprises when ACA open enrollment begins on November 1.

The open enrollment period for health insurance through the Affordable Care Act starts on November 1 in most states, but many may face unexpected costs when trying to register.

This is largely due to ongoing Congressional deadlock regarding the renewal and expansion of insurance premium subsidies, with no resolution in sight.

“Individuals are in for quite a shock since prices are on the rise,” cautioned Carolyn McClanahan, a physician and certified financial planner from Jacksonville, Florida.

This potential sticker shock could heavily influence consumers’ financial situations and health insurance decisions, possibly resulting in more people being uninsured or underinsured, along with increasing premiums in the future.

Though only a small portion of Americans utilize the ACA Marketplace for health insurance, the impact of this group might be substantial enough to sway close elections, as indicated by KFF.

During open enrollment, consumers will choose their health plans for the upcoming year.

This enrollment period usually extends until January 15, but there’s a crucial December 15 deadline for coverage to start at the beginning of 2026.

Unfortunately, many potential enrollees find themselves in a tough financial spot.

Congress hasn’t yet renewed the expanded subsidies that help lower premiums. About 22 million out of 24 million Americans acquire insurance via the ACA exchanges.

Without these enhanced subsidies, health insurance premiums are projected to rise by an average of 114% in 2026, according to KFF, a nonpartisan health policy research organization.

Experts warn that lower-income participants, especially early retirees, could experience even steeper increases.

The enhanced subsidies are central to the government shutdown, which commenced on October 1st and is now one of the longest in U.S. history, second only to the 35-day shutdown during President Trump’s first term.

These subsidies, also referred to as the Enhanced Premium Tax Credit, were established under the Biden administration in 2021 and extended into 2022, but are set to lapse at the end of 2025.

Democrats are pushing for these subsidies to be included in discussions to resolve the shutdown, while Republicans prefer to negotiate them separately.

Cynthia Cox, vice president and ACA program director at KFF, noted that without a consensus, many individuals looking for health insurance through ACA marketplaces might face significantly higher premiums during the enrollment phase.

Financial outcomes will differ based on various factors like household income and age. For instance, a 60-year-old couple earning around $85,000 could see their yearly premiums soar by more than $22,600 in 2026.

For a 45-year-old with a $20,000 income in a non-Medicaid expansion state, premiums might jump from $0 to $420 annually.

Cox highlighted that the gridlock in Congress could lead to serious consequences for consumers during this enrollment period.

Many may opt to go without insurance rather than face higher premiums, likely leaving them underinsured.

Entrepreneurs, gig workers, and others might start seeking traditional jobs that provide employer-sponsored health insurance to avoid enrolling in marketplace plans.

Cox also noted that some individuals might choose lower-tier options with reduced upfront costs but significantly higher deductibles, which could lead to hefty bills later on.

If younger, healthier individuals skip enrollment, insurers may be left with older, less healthy members, which could cause a rise in premiums over time.

Experts warn that even if Congress does eventually extend the enhanced subsidies, there might still be fallout.

“It’s very possible that come November 1, people will log in and realize they can’t afford their premiums. And even if the subsidies get extended later, they might not come back,” stated Jonathan Birx, executive vice president of health and economic policy at the Bipartisan Policy Center.

If conditions remain unchanged, the enhanced subsidies will lapse.

Those thinking of signing up for an ACA Marketplace plan should consider this when selecting coverage for 2026. In other words, it might not be wise to pick a plan based on the hope that Congress will extend the subsidies, she advised.

However, it’s crucial for enrollees to stay informed. If Congress reaches a deal, they will need to revisit their options and costs, as these could change.

“If I were in their shoes, I’d probably mark my calendar to shop around during Thanksgiving or early December,” Cox suggested, especially with the looming December 15 deadline.

Birx mentioned that the open enrollment period offers some flexibility. Consumers can select a plan without penalties if they decide to switch as the period progresses.

“People don’t need to rush their choices. Making decisions early won’t negatively impact them,” he added, suggesting that circumstances may evolve before the enrollment period closes.

Experts mentioned that those currently enrolled who take no action will simply be renewed into the same or a similar plan, should their current one become unavailable.

McClanahan, the founder of Life Planning Partners, advised even healthy individuals, who seldom visit doctors, to get insurance—perhaps a high-deductible plan—just for emergencies. People with minor health concerns, like diabetes, could look at high-deductible plans on the ACA Marketplace, which generally have lower initial premiums.

She suggests combining this with a direct primary care model, where patients might pay around $150 or $200 monthly for primary care, including basic tests and imaging services.

Those with serious conditions needing regular medical attention should aim for comprehensive insurance with a wide network and low deductible, though this might be challenging for those losing access to enhanced subsidies.