Photo: HealthCare.gov
When open enrollment begins on Nov. 1 for Affordable Care Act health insurance, consumers may face sticker shock and not just those who formerly qualified for premium tax credits.
The Centers for Medicare and Medicaid Services released ACA prices on Thursday. Prices showed a 30% increase in states using the federal marketplace and a 17% hike in states running their own marketplaces, according to KFF. This averages out to a 26% increase for 2026, KFF said.
Prices are based on the second-lowest cost plan in the silver metal tier.
These increases do not include the effects of the expiring premium tax credits at the end of this year, which could further increase out-of-pocket costs, according to AJMC, the American Journal for Managed Care.
ACA consumers who qualified for enhanced subsidies are expected to pay more when these tax credits expire at the end of the year. Premium tax credits were enhanced in 2021 due to the COVID-19 pandemic. Standard tax credits will still exist in 2026.
Partisan arguments over keeping the enhanced tax credits are holding up an agreement on a spending bill, with the government shutdown now in its fourth week.
WHY THIS MATTERS
Without the enhanced premium tax credits, out-of-pocket premiums are expected to increase drastically, according to KFF.
KFF estimates that subsidized enrollees' out-of-pocket premium payments on average will be 114% higher without the premium credits.
This may lead to some ACA beneficiaries dropping their plans and going without coverage, which impacts hospital finances when uninsured patients become sick enough to head to the ER.
CMS said the average marketplace premium after tax credits is projected to be $50 per month for the lowest cost plan in 2026. This represents a $13 increase from 2025, but remains $20 less expensive than the monthly premium after tax credits in 2020, CMS said.
THE LARGER TREND
ACA open enrollment begins on Nov. 1 and runs until Jan. 15, 2026.
Email the writer: SMorse@himss.org