Millions face 'huge sticker shock' when ACA open enrollment starts Nov. 1

https://www.cnbc.com/2025/10/31/aca-open-enrollment-starts-enhanced-
subsidies.html

Open enrollment for health insurance bought on the Affordable Care Act 
marketplace starts Nov. 1 in most states — but millions of people may get 
a financial surprise when they try to sign up.

That’s because a congressional deadlock tied to the extension of enhanced 
subsidies for insurance premiums has continued with no end in sight.

Consumers are “going to get huge sticker shock, because prices are going 
up,” said Carolyn McClanahan, a physician and certified financial planner 
based in Jacksonville, Florida.

That sticker shock could have significant ramifications for consumers’ 
finances and the choices they make about health coverage, experts say, 
contributing to a higher population of uninsured and underinsured 
consumers and soaring premiums in years to come.

While the percentage of Americans who have ACA marketplace health 
insurance is small, the share could be large enough to swing a close 
election, KFF reported in October.

ACA subsidies at the heart of the government shutdown
During open enrollment, consumers pick their health plans for the coming 
year.

While open enrollment generally lasts through Jan. 15, there’s a Dec. 15 
deadline to ensure coverage starts at the beginning of 2026.

However, prospective enrollees are in financial limbo.

Congress has yet to extend the enhanced subsidies that make insurance 
premiums cheaper for about 22 million of the 24 million Americans who buy 
insurance over the ACA exchanges.

Recipients’ health premiums are set to increase by 114% in 2026, on 
average, without the enhanced subsidies, according to KFF, a nonpartisan 
health policy research group.

Certain enrollees, such as early retirees with modest incomes, face much 
larger increases, health experts said.

The enhanced subsidies are at the heart of the federal government shutdown 
that started Oct. 1. The shutdown is already the second-longest in U.S. 
history, behind a 35-day shutdown during President Donald Trump’s first 
term.

The enhanced subsidies, also known as enhanced premium tax credits, have 
been available since the Biden administration passed them in 2021 and 
extended them in 2022. They are scheduled to expire at the end of 2025.

Democrats are pushing to extend the subsidies as part of a deal to end the 
shutdown. Republicans have said they want to negotiate the subsidies 
separately.

More than half, 57%, of ACA marketplace enrollees live in Republican 
congressional districts, according to a KFF analysis from earlier this 
month. This year, about 80% of all premium tax credits, or $115 billion, 
went to ACA marketplace enrollees in states won by President Trump in last 
year’s election, KFF found.

There are 39 congressional districts where at least 10% of the population 
is enrolled in the ACA marketplaces and where, had it not been for 
enhanced subsidies, their 2024 average premium payments would have been 
double or more, according to KFF.

These districts are largely concentrated in Trump-won states: The bulk, 
20, are in Texas, with another seven in Florida and three in Georgia.

What this means for open enrollment
Absent a deal, many people who try to enroll in a health plan via the 
Affordable Care Act marketplace will see significantly higher premiums 
during open enrollment, said Cynthia Cox, vice president and director of 
the ACA program at KFF.

The financial stakes vary according to factors such as household income, 
age and state.

For example, the average 60-year-old couple making $85,000 would see their 
annual premiums increase more than $22,600 in 2026, according to KFF.

A 45-year-old earning $20,000 in a state that didn’t expand Medicaid would 
see premiums rise from $0 to $420 per year, on average, it found.

There are many potential implications to the congressional impasse and 
consumers’ sticker shock during open enrollment, Cox said.

Many people may opt not to sign up for coverage rather than pay higher 
premiums, and therefore would be uninsured, Cox said.

Others, such as self-employed entrepreneurs and gig workers, may choose to 
try 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 opt to buy lower-tier plans that come with smaller upfront 
premiums but much higher deductibles on the back end, meaning they’d be on 
the hook for a hefty bill if they need to use their insurance, Cox said.

If young, healthy people don’t enroll, insurers would be left with a 
relatively older, less healthy population of enrollees — likely leading 
insurers to raise their annual premiums even more in the future due to the 
pool of higher-risk enrollees, she said.

The damage may be done, even if Congress does eventually extend the 
enhanced subsidies, experts said.

“There’s certainly a very real possibility that people will log on Nov. 1 
and say, ‘Gosh, I can’t afford that premium,’ and they don’t come back to 
look again even if there were a subsequent enactment of enhanced 
subsidies,” said Jonathan Burks, executive vice president of health and 
economic policy at the Bipartisan Policy Center.

What prospective ACA enrollees should do
As things stand, enhanced subsidies will expire.

Prospective enrollees in an ACA marketplace plan should pick their 2026 
health insurance coverage with this in mind, Cox said. In other words, 
don’t pick a plan based on the expectation that Congress will extend the 
enhanced subsidies, she said.

However, she recommends enrollees pay close attention to the news. If 
Congress reaches a deal, enrollees should come back and look again, 
because their options and costs may have changed, Cox said.

“If it were me, I’d probably make a note on my calendar to shop over 
Thanksgiving or in early December,” with an eye to the Dec. 15 deadline, 
Cox said.

Luckily, the open enrollment period offers relative flexibility, Burks 
said.

Consumers can pick a plan and select another plan later within the open 
enrollment period without consequence, he said.

“People shouldn’t feel the need to rush into a decision, nor is there a 
real cost if they make a decision early on, [then] circumstances change 
and they want to evaluate that decision before the end of the open 
enrollment period,” Burks said.

Current enrollees who take no action will be reenrolled into the same plan 
or a similar one if the current plan is no longer available, experts said.

How to think through health insurance decisions
Even consumers who are healthy and rarely go to a doctor should have 
insurance, even a plan with a high deductible, in case there’s a major 
unforeseen health event, said McClanahan, the founder of Life Planning 
Partners and a member of CNBC’s Financial Advisor Council.

Those with minor health issues such as hypertension or diabetes and who 
see a doctor regularly can consider buying a high-deductible plan — which 
generally carry lower upfront premiums — on the ACA marketplace, she said.

Pair that coverage with a direct primary care physician model. Such 
doctors charge a subscription for care — maybe $150 or $200 a month — and 
provide all basic primary care such as basic laboratory tests and imaging 
services, she said.

Those with serious illnesses who go to the doctor frequently would be best 
suited by buying a good health insurance plan with a broad network of 
doctors and, ideally, a lower deductible, McClanahan said.

Of course, this may be challenging for households that lose enhanced 
subsidies, she said.


-- 
November 5, 2024 - Congratulations President Donald Trump.  We look 
forward to America being great again.

We live in a time where intelligent people are being silenced so that 
stupid people won't be offended.

Every day is an IQ test. Some pass, some, not so much.

Thank you for cleaning up the disasters of the 2008-2017, 2020-2024 Obama 
/ Biden / Harris fiascos, President Trump.

Under Barack Obama's leadership, the United States of America became the 
The World According To Garp.  Obama sold out heterosexuals for Hollywood 
queer liberal democrat donors.