Healthcare Premium Increases and Open Enrollment Insights
On September 16, 2025, at the Capitol in Washington, D.C., Senate Minority Leader Chuck Schumer (D-N.Y.) and U.S. Senator Jeanne Shaheen (D-N.H.) displayed a poster stating, “Premiums for the Affordable Care Act will increase by more than 75%” during a press conference encouraging Republicans to support the Affordable Care Act’s tax cuts bill.
Open enrollment is currently in progress for numerous employees, Medicare recipients, and individuals purchasing their own health insurance through Affordable Care Act plans, with many set to face substantial price hikes. If the enhanced subsidies end in 2025, healthcare costs could rise by an average of 114%, according to KFF, a nonpartisan health policy research organization. Approximately 22 million of the 24 million individuals participating in the ACA market, including many self-employed and small business workers, rely on these premium credits, which are a significant component of the ongoing government shutdown discussion.
Moreover, ACA insurers are predicted to raise next year’s premiums by an average of 26%. According to KFF, one of the contributing factors is the expectation that healthier individuals may drop their coverage when the enhanced subsidies expire.
Louise Norris, a health policy analyst at healthinsurance.org, mentioned, “What we don’t know for certain is whether the prices we see now will be the actual prices.” She added that if these subsidy enhancements are extended or adjusted, premiums could be different than anticipated.
Employer-sponsored health plans are also experiencing growth, though it is slightly less significant. KFF reports that around 165 million Americans, including employees and their dependents, are covered through their employers. Employee paycheck deductions for health insurance may rise by an average of 6.5% in 2026, marking the fastest increase in 15 years, according to global consulting firm Mercer.
Zach Teutsch, from Values Added Financial in Washington, D.C., pointed out that many people may overlook these changes since they often come as payroll deductions.
As expenses continue to climb, millions might have to make tough decisions about their health insurance options and how to afford them. Financial advisors and health policy analysts suggest several key steps to consider before selecting health insurance for 2026:
Review Your Medical Expenses from 2025
Before exploring your 2026 options, take stock of your out-of-pocket spending in 2025, including copays, medical bills, and prescriptions. Knowing your recent medical costs can offer insight into what you might expect to spend next year and help you determine the type of health insurance you need.
Compare All Available Plans for 2026
Even if your current insurance provider offers the same plans as this year, expect to see increases in premiums and deductibles, which might also fluctuate based on your health needs. Check which of your current providers remain “in-network” and understand coverage for out-of-network services.
If you have planned procedures or chronic conditions, you may want to consider a different plan for better cost management. Typically, employers present two payment structures: pay now (higher premium) or pay later (higher deductible), offering flexibility based on individual financial situations.
For ACA plans, individuals can compare their options through the federal market or state-specific websites.
Delay ACA Enrollment
If you are currently using the ACA Marketplace, hold off on signing up just yet. If the enhanced subsidy is extended or reworked, Norris emphasizes that you could end up paying less than expected. A reminder to review prices by late November will be beneficial, as enrollment deadlines approach for coverage starting January 1st.
Consider Your Health Needs
Experts advise against going without insurance. Hospital visits can lead to exorbitant bills, often exceeding six figures. Norris highlights that it’s one thing to negotiate a payment plan with a hospital, but quite another when facing a significant deductible after a major health incident.
For those who generally maintain good health, opting for a high-deductible plan—akin to the Bronze level in ACA plans—might help save money. This way, should a serious health issue arise, insurance will still be there. Some doctors may even refuse treatment without insurance.
Adding a direct primary care option on top of a Bronze plan can also provide additional benefits for those needing more frequent care. Although this usually incurs a monthly fee, it often covers basic visits and necessary services without contributing to a deductible.
Utilize FSAs and HSAs
If your employer offers a Health Flexible Spending Account (FSA), you can use the pre-tax contributions for qualifying medical expenses like copayments and deductibles. This not only reduces your taxable income but also allows you to pay for medical needs with pre-tax dollars.
Health Savings Accounts (HSAs) are another tax-advantaged option for covering medical costs, particularly for those with high-deductible plans. Unlike FSAs, HSAs allow for long-term savings. Recent legislation has also made access to HSAs more available through various marketplace health plans.
