Beginning Saturday, Americans will be able to log into the federal Affordable Care Act exchange and choose their insurance plans for next year.
Nov. 1. has been a key date in the shutdown fight, as Democrats have long argued that if the enhanced federal subsidies aren’t renewed by that point, the impact on consumers will be dramatic. Millions of people will see major price hikes on their plans.
Here’s what to know ahead of open enrollment:
Premiums are rising despite extended subsidies
Insurers’ rates were submitted and finalized earlier this year, so premiums are locked in, and any deal to extend the enhanced tax credits won’t change those rates.
According to a KFF analysis, 2026 premiums are set to increase 18 percent on average.
The Washington Post, citing internal administration documents, reported the average ObamaCare premiums for the most popular midlevel “Silver” plan will increase 30 percent.
Insurers have cited the expiration of the enhanced tax credits as one reason why premiums are rising, because they anticipate healthy people dropping coverage if it’s too expensive. That would leave a smaller and sicker group of people, who are ultimately more expensive for the insurance company to cover.
But the expected end to enhanced subsidies is not the only reason costs have increased.
Insurers have also cited higher drug prices and hospital costs, as well as overall medical inflation. According to Jessica Altman, executive director of Covered California, higher health costs account for 7 percent to 8 percent of the state’s average 10 percent premium increase.
Premiums for private employer-sponsored plans are spiking for many of the same reasons — people are using their insurance more; labor costs are growing; and drug prices are high, especially for popular GLP-1s.
A shutdown deal to extend subsidies could blunt the financial hit
An extension of the subsidies won’t change premium rates, but most consumers only care about how much they contribute out-of-pocket.
No matter what the average premium increase is, people are going to be paying dramatically higher amounts if the enhanced subsidies are not renewed.
For instance, Covered California’s Altman said the amount people pay each month will rise on average by 97 percent next year.
According to KFF, 22 million subsidized enrollees will see an average out-of-pocket premium increase of 114 percent in 2026.
Most people enrolled in Affordable Care Act plans are eligible for financial assistance, so they are not paying full price. Even if the extra subsidies expire at the end of the year, a majority of enrollees will still be eligible for assistance to lower their monthly premium costs.
But the enhanced premiums made insurance much more affordable. For those at the poverty line — earning between $15,000 to $20,000 a year — instead of contributing between 2 percent and 3 percent of their income, they were eligible for “zero premiums” plans.
Someone earning $28,000 this year pays about $27 per month for a benchmark plan. Without the enhanced tax credit, that would jump to more than $130 per month in 2026.
“The bottom line is that over 90 percent of marketplace enrollees are currently getting enhanced premium tax credits, which have reduced the amount of their income that they’re expected to contribute to premiums,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms (CHIR) at Georgetown University.
If Congress doesn’t extend the tax credits, that level of contribution “is going to be much, much higher, up and down the income scale,” Corlette said.
Trump administration has done little outreach
By the end of October, almost all state-based exchanges will have sent notices to current enrollees informing them of higher premiums and reduced tax credits.
But the Trump administration this year told insurers on the federal exchange that including premium information in their notices to consumers is voluntary.
As a result, many enrollees won’t know about premium increases unless they log into their HealthCare.gov accounts; people who auto-enroll in plans may not find out until they receive their first bill.
Less than a week away from open enrollment, the administration has also not yet opened the HealthCare.gov window-shopping period. For each of the past eight years, the Centers for Medicare and Medicaid Services (CMS) has launched Affordable Care Act (ACA) window-shopping on either Oct. 25 or 26.
Senate Democrats on Monday called on the Trump administration to “stop hiding” premium increases and open window shopping immediately.
“The over 24 million Americans relying on the ACA Marketplace for health coverage need clear information from CMS and their health insurance plans, and they need it now,” they wrote in a letter to CMS Administrator Mehmet Oz.
The administration also slashed funding by 90 percent for federal navigators who help consumers enroll in plans.
The Trump administration similarly cut ACA navigator funding every year during his first term and cut advertising to HealthCare.gov by 90 percent. When enrollments dropped, the administration said it was evidence the law was failing.
Impacts of subsidy loss will vary by states
Some states will fare worse than others. Window-shopping periods have already begun in more than a dozen states. The prices that customers are logging on to see are telling.
KFF identified five congressional districts in Wyoming, West Virginia, Connecticut and Illinois where a 60-year-old couple making $85,000 would see the largest increases in their monthly premiums, ranging from 535 percent to nearly 700 percent.
Gideon Lukens, director of research and data analysis on the health policy team for the Center on Budget and Policy Priorities, gave The Hill the example of a 60-year-old couple and said, “The average increase for that same example couple is typically over $20,000 annually.”
Whether a state has opted to adopt Medicaid expansion, another provision of the ACA, will factor in to how the loss of subsidies will affect states. People in nonexpansion states who are ineligible for Medicaid coverage were particularly reliant on the ACA tax credits and won’t have the added safety net to fall back on.
The majority of states and Washington, D.C., have already chosen to expand Medicaid, leaving only 10 states that haven’t adopted expansion: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.
