ACA open enrollment starts Nov. 1 as enhanced subsidies in limbo
The US Capitol in Washington on October 27, 2025, weeks before the US government shutdown.
Kylie Cooper | Reuters
Open enrollment for health insurance purchased under the Affordable Care Act Market place It starts Nov. 1 in most states, but millions of people could face a financial surprise when they try to sign up.
That’s because the congressional stalemate over the extension of increased subsidies for insurance premiums continues with no end in sight.
Carolyn McClanahan, a physician and certified financial planner based in Jacksonville, Fla., said consumers are “going to face major sticker shock as prices increase.”
Experts say this sticker shock could have significant consequences for consumers’ finances and the choices they make about health insurance, contributing to an increase in the number of uninsured and underinsured consumers and higher premiums in the coming years.
Although the percentage of Americans with ACA marketplace health insurance is small, the share may be large enough. run into a close electionKFF reported in October.
ACA subsidies at center of government shutdown
During open enrollment, consumers choose their health plans for the upcoming year.
While open enrollment typically runs through January 15, there is a December 15 deadline to ensure coverage begins in early 2026.
However, potential enrollees remain in financial uncertainty.
Congress has yet to expand enhanced subsidies that make insurance premiums cheaper About 22 million of the 24 million Americans who purchase insurance through the ACA exchanges.
Without increased subsidies, recipients’ health premiums are expected to rise an average of 114% by 2026, according to KFF, a nonpartisan health policy research group.
Some enrollees, such as early retirees with modest incomes, face much larger increases, health experts said.
Increased subsidies are at the center of the federal government shutdown that began Oct. 1. This shutdown is already the second-longest in U.S. history, following the 35-day shutdown during President Donald Trump’s first term.
The increased subsidies, also known as enhanced premium tax credits, have been available since the Biden administration adopted them in 2021 and extended them in 2022. These subsidies are scheduled to expire at the end of 2025.
Democrats are pushing for an extension of subsidies as part of a deal to end the shutdown. Republicans have said they want to negotiate the subsidies separately.
More than half of ACA marketplace enrollees, 57%, live in Republican congressional districts, according to KFF analysis starting from the beginning of this month. This year, nearly 80% of all premium tax credits, or $115 billion, went to ACA marketplace enrollees in states won by President Trump in last year’s KFF election. to create.
There are 39 congressional districts where at least 10% of the population is enrolled in ACA marketplaces and where average 2024 premium payments would be double or more without increased subsidies. based on To KFF.
These districts are largely concentrated in states Trump won: 20 in Texas, seven in Florida and three in Georgia.
What does this mean for open enrollment?
Without a deal, many people trying to enroll in a health plan through the Affordable Care Act marketplace will face significantly higher premiums during open enrollment, said Cynthia Cox, vice president and manager of KFF’s ACA program.
Financial risks vary by factors such as household income, age, and state.
For example, annual premiums for the average 60-year-old couple earning $85,000 are projected to rise by more than $22,600 in 2026. based on To KFF.
It found that premiums for a 45-year-old earning $20,000 in a state that did not expand Medicaid would increase, on average, from $0 to $420 per year.
Cox said there are many potential impacts of congressional stalemate and consumers’ sticker shock during open enrollment.
Many people may choose not to sign up for coverage rather than pay higher premiums and therefore remain uninsured, Cox said.
Others, such as self-employed entrepreneurs and gig workers, may choose to find a more traditional job that offers employer-based health insurance so they don’t have to sign up for a marketplace plan, Cox said.
Some people may choose to buy lower-tier plans, where premiums are smaller up front but have much higher deductibles on the back end, meaning they’ll face a hefty bill if they have to use their insurance, Cox said.
If young, healthy people do not enroll, insurers will be left with a relatively older, less healthy population of enrollees; That would lead insurers to raise annual premiums even more in the future due to a higher-risk pool of enrollees, he said.
Experts said the damage could occur even if Congress eventually extends the increased subsidies.
“There’s a very good chance that people will log in on Nov. 1 and say, ‘Gosh, I can’t afford that premium,’ and then they won’t look back even if increased subsidies are enacted,” said Jonathan Burks, vice president for health and economic policy at the Bipartisan Policy Center.
What potential ACA enrollees need to do
That being the case, increased subsidies will expire.
Applicants enrolled in an ACA marketplace plan should choose their 2026 health insurance coverage with that in mind, Cox said. In other words, don’t choose a plan based on the expectation that Congress will expand increased subsidies, he said.
However, he advises registered people to pay close attention to the news. Cox said if Congress reaches a deal, enrollees should come back and look again because their options and costs may have changed.
“If it were me, I would probably mark my calendar to shop around Thanksgiving or early December,” Cox said. “We set the deadline for Dec. 15,” Cox said.
There’s definitely a very good chance that people will log in on November 1st and say, ‘Gosh, I can’t afford that premium.’
Jonathan Burks
vice president for health and economic policy at the Bipartisan Policy Center
Fortunately, the open enrollment period offers relative flexibility, Burks said.
Consumers can choose a plan during the open enrollment period and choose another plan later without consequences, he said.
“People shouldn’t feel the need to rush into decisions, and there’s no real cost to making a decision early. [then] circumstances are changing and they want to evaluate this decision before the open enrollment period ends,” Burks said.
Existing enrollees who take no action will be re-enrolled in the same or similar plan if the current plan is no longer available, experts said.
How to think about health insurance decisions?
Even consumers who are healthy and rarely see a doctor should have insurance, or even a high-deductible plan, in case a major unforeseen health event occurs, said McClanahan, founder of Life Planning Partners and a CNBC affiliate. Council of Financial Advisors.
Those with minor health problems, such as hypertension or diabetes, who see a doctor regularly may consider purchasing a high-deductible plan in the ACA market, which often includes lower upfront premiums, he said.
Pair this coverage directly with the primary care physician model. Such doctors charge a subscription fee for care (perhaps $150 or $200 a month), he said, and provide all basic primary care, such as basic lab tests and imaging services.
McClanahan said it would be best for those with serious illnesses who go to the doctor frequently to purchase a good health insurance plan with a wide network of doctors and, ideally, a lower deductible.
Of course, that could be challenging for households that lose out on increased subsidies, he said.
