ACA Open Enrollment Opens With Premiums Up and Subsidies at Risk

Open enrollment for Affordable Care Act coverage began Nov. 1, and shoppers are seeing the largest proposed premium increases since 2018, with the enhanced federal subsidies that held down costs scheduled to expire on Dec. 31. In most states people have until Jan. 15 to sign up, and those who want coverage to start Jan. 1 generally must enroll by Dec. 15, NBC News reported.

The median rate increase insurers proposed for 2026 is 18 percent, more than double last year’s 7 percent median, according to KFF, a nonprofit health policy research group, based on filings by 312 insurers in all 50 states and the District of Columbia. Insurers cited rising costs and the expected expiration of the enhanced credits. More than 24 million people now get coverage through the ACA marketplaces, KFF and NBC both reported.

The larger effect comes from the credits themselves. Congress enacted the enhanced subsidies in 2021. They increased the help available to lower-income enrollees and removed the old cutoff at 400 percent of the poverty level, so that people with higher incomes could qualify if the benchmark plan cost more than about 8.5 percent of their income, NBC reported. KFF estimated that if the credits expire, the average subsidized enrollee’s annual premium payments would rise 114 percent, from $888 in 2025 to $1,904 in 2026, an increase of $1,016.

Averages hide wide differences. KFF gave the example of a 60-year-old couple earning $85,000, whose premiums would rise by more than $22,600 in 2026 because they would lose the credit entirely and the benchmark plan would take about a quarter of their income instead of 8.5 percent.

“It’s a double whammy,” Cynthia Cox of KFF told NBC, referring to higher sticker prices combined with the loss of aid. She added that most people would still receive a subsidy, “just less financial help.” Stacie Dusetzina, a health policy professor at Vanderbilt University, called it a “high risk situation for people.”

The dispute has become part of the standoff that has closed much of the federal government since Oct. 1. NBC reported that Democrats have said they will not vote to reopen the government unless the tax credits are extended.

Idaho’s enrollment period runs Oct. 15 to Dec. 15, and Massachusetts, Virginia, California, New York, Rhode Island and the District of Columbia allow sign-ups into late January, NBC reported.