Open enrollment for the Affordable Care Act kicks off this Saturday. This year, many expect the enrollment period to bring the biggest cost hikes since the law was first enacted over ten years ago.
Currently, over 24 million Americans have health insurance through the ACA, often referred to as Obamacare. By 2026, a combination of premium rises and the end of enhanced subsidies that have kept costs manageable for many middle-class families could lead to higher expenses for a lot of individuals. Some might even end up without any coverage.
“This is a precarious situation for many,” noted Stacey Dusetsina, a health policy professor at Vanderbilt University in Nashville, Tennessee. “When deciding how to allocate funds for essentials like food, utilities, and health insurance—especially when it feels optional—it becomes tough to balance everything within your budget.”
If you’re renewing your coverage or enrolling for the first time, here’s what you need to know about this open enrollment.
How long will ACA open enrollment last?
The open enrollment period for ACA coverage runs from November 1 to January 15 in most states.
However, some states have distinct schedules. For instance, Idaho’s registration period opens on October 15 and wraps up by December 15. Massachusetts will accept registrations until January 23, while Virginia goes until January 30, and states like California, New York, Rhode Island, and Washington, DC will continue until January 31.
If you’re aiming for coverage to start on January 1, you’ll need to enroll by December 15 in most places. Plans selected post-December 15 generally begin on February 1.
Previously this year, those with incomes up to roughly 150% of the federal poverty level—around $23,500 for individuals—could enroll in ACA insurance at any time. Unfortunately, that option has been discontinued.
Cynthia Cox, who leads the ACA program at KFF—a nonpartisan health policy research group—mentioned that this change took effect on August 25 after insurers raised concerns about individuals waiting until sick to get insurance or switching to more comprehensive plans that better cater to their sickness.
Additionally, the Trump administration revoked ACA coverage for DACA recipients, or Dreamers, those who were brought to the U.S. unlawfully as children. They had been eligible for coverage during the 2025 enrollment period, but that was overturned in August due to rule changes.
Why will my insurance premium go up next year?
Two major factors are pushing premiums up this coming year. First is the anticipated end of enhanced ACA subsidies, while the second is rising premiums implemented by insurance companies.
These enhanced subsidies, introduced in 2021, significantly lowered monthly premium costs for numerous middle-class Americans. This issue was highlighted during the recent government shutdown, with Democrats refusing to agree to reopen until these tax credits are extended.
Simultaneously, insurance providers are increasing premiums to align with escalating hospital and prescription drug costs, along with greater demand for medical services.
Recent analysis indicates that insurers are raising premiums by an average of 30% in states following the typical policies and 17% in those with their own markets.
“These hikes are the steepest since the ACA exchanges began,” shared Gideon Lukens, a senior fellow and director of research at the Center on Budget and Policy Priorities—a nonpartisan research organization. “However, it pales in comparison to the out-of-pocket increase due to the expiring enhancements.”
Taken together with the loss of enhanced subsidies, some consumers might find themselves paying an average of 114% more in their premiums, according to Cox.
“It’s a double whammy,” she noted. “People are not only losing their tax credits, but they’re also faced with these hefty price hikes from their insurers.”
Who is eligible for the enhanced subsidy?
Before 2021, only individuals with incomes up to 400% of the federal poverty level could qualify for ACA subsidies.
The enhanced subsidies raised the income threshold and opened eligibility for many more middle-class citizens. Those earning above 400% of the federal poverty level (about $78,800 for an individual) can still receive a tax credit if their premiums exceed roughly 8.5% of their income. The enhanced tax credits boosted overall financial aid.
“We label these as enhancements because they broaden eligibility and increase credits for everyone,” Lukens explained. “This led to remarkable enrollment figures.”
Government data shows around 22.3 million people (90% of those benefiting from the ACA) are currently receiving enhanced subsidies.
Art Caplan, who leads medical ethics at New York University’s Grossman School of Medicine, noted that many ACA enrollees are either small business owners or employees at small firms.
“This is a typical mom-and-pop store,” he remarked.
What happens when the enhanced subsidy expires?
According to the Congressional Budget Office, over the next eight years, approximately 3.8 million individuals are expected to drop their insurance annually and become uninsured.
Those who remain covered will probably see their costs more than double, Lukens warned.
“We’re heading back to a system with a benefit cliff. A 60-year-old couple would no longer receive assistance for their premiums, meaning they’d need to cover the full amount out of pocket,” he added.
For instance, a couple earning $85,000 could see their premiums surge from about $600 to roughly $2,600 monthly. Meanwhile, a family of four with an income around $130,000 might see their monthly premiums jump from approximately $920 to $1,900.
Can I still get help paying my insurance premiums?
Even if the tax credit expires, individuals earning less than four times the federal poverty level (around $62,600 for individuals and $128,600 for families of four) will still qualify for standard ACA subsidies.
However, the amount of assistance might be significantly decreased, resulting in higher premiums.
“They will still receive subsidies,” Cox mentioned. “It’s just less financial support.”
There are concerns about low-income individuals who previously qualified for plans without monthly premiums under enhanced subsidies losing that benefit. It’s predicted that around 1 million individuals in this low-income bracket might end up uninsured if enhancements are not continued.
Those who no longer qualify for tax credits could potentially find more affordable options by switching from silver to bronze plans. These bronze plans typically offer lower monthly premiums but come with higher deductibles. So, while you may pay less monthly, you’d face more out-of-pocket expenses before coverage kicks in.
Cox advised ensuring that your deductible is something you can realistically handle, particularly if you end up needing care.
“What does your deductible cover?” she posed. “There might be preventive services, doctor visits, and other necessities that don’t fall under it. So, check the details.”
Would it be cheaper to cut out health insurance altogether?
Some are contemplating the idea of saving money by opting not to purchase insurance.
However, experts caution against this. While paying cash might be manageable for small, routine expenses—such as X-rays or lab tests—health insurance is crucial for covering unexpected, high-cost events. A single hospital stay or surgery could result in expenses totaling tens of thousands of dollars or more.
“This is what happens when people are unable to afford insurance,” said Dr. Adam Gaffney, a critical care physician and assistant professor at Harvard Medical School. “Most people wouldn’t want to find themselves in such a position.”
Clinics known as federally qualified medical centers can provide low-cost primary care services to uninsured patients. While some doctors may be open to negotiating fees, they often require upfront payment, noted Michelle Johnson, executive director of the Tennessee Justice Center, a nonprofit that assists people facing medical bills.
Co-operative schemes for community-based self-insurance can offer lower premiums and more flexibility, Caplan explained. Nonetheless, they tend to lack ACA regulation and can result in significant medical expenses for their members.
