6 things to know about ACA health plans this open enrollment : Shots

This year's Obamacare open enrollment period, which begins Saturday in most states, is fraught with uncertainty and confusion for more than 24 million people who purchase health insurance through the federal and state Affordable Care Act marketplaces.

The fate of expanded premium tax breaks that make insurance more affordable for 92% enrolled remains in limbo with the prospect of significant Higher premiums are looming.

But there are steps that marketplace buyers can take to ensure they make the right choice for the upcoming plan year.

1. Understand how we got here

In 2021, as part of the COVID-era relief package, the ACA premium tax break was expanded to lower costs for previously eligible people and expand eligibility to people with incomes above 400% of the federal poverty level (which is about $63,000 per person in 2025). But those improvements that were extended into 2022 will expire at the end of 2025, unless Congress acts.

The debate over whether to extend them again is at the center of a political battle of wills between Republicans and Democrats in Congress, a fight at the heart of a month-old battle. government shutdown.

The financial implications for many market participants are enormous. Average out-of-pocket payments for subsidized enrollees are projected to more than double if the expanded tax credits expire, according to KFF, a nonprofit health information organization that includes KFF Health News.

“The longer this goes on, the more damage will be done,” he said. Cynthia CoxVice President and Director of the ACA Program at KFF. “If someone logs in on November 1 and sees their premium has doubled, they might just leave.”

That would be a mistake, market experts agree. What is clear, however, is that buyers should be careful and informed.

2. Follow the news

Keeping track of the day-to-day machinations on Capitol Hill can be frustrating. But it may be your best source of up-to-date information. Congress could reach an agreement to extend the increased subsidies any time over the next few days, weeks or months—or not. Either way, it may influence your decision to enroll. So, pay attention.

Don't count on the market or your insurance company to tell you how much you should expect. “Many state marketplaces have experienced delays” in sending consumers net premium notices that take into account premium tax credits, he said. Sabrina Corlettco-director of the Center for Health Insurance Reform at Georgetown University.

The federal government is not sending members notices about next year's premiums. 28 with the assistance of the federal government markets. 2026 says health plans may also don't choose To.

3. Update your account information and do not automatically register.

Log into your marketplace account and update your income, family size, and any other details that have changed.

This year, it's especially important to provide an accurate estimate of your expected income for 2026.

H.R. 1, sometimes called One big beautiful bill law, removed capital letters about what many people had to pay out if they underestimated their projected income and received more coverage than they should have. Next year, people will have to repay the entire excess amount.

Over the past few years, it has become possible to put your ACA insurance on autopilot with automatic re-enrolment on your current or similar plan. Given the uncertainty around insurance premiums, this is not the best year for that, student recruiters say.

This is especially true for people who, without an agreement from Congress, will no longer qualify for subsidies next year, especially those whose incomes exceed 400% of the federal poverty level.

4. Shop at sticker prices.

When people see the projected premiums, assuming Congress has not reached an agreement to extend the extended credits, many will be shocked.

Marketplace health insurance premiums are expected to rise an average of 26% next year. according to KFF data. This is the largest rate increase since 2018.

Until now, people have been largely protected from this increase thanks to the expanded premium tax subsidies that nearly all enrollees receive. Here's how it works: Most people with ACA marketplace plans are responsible for paying a portion of the premiums based on a sliding income scale, and the government pays the rest.

According to KFF's analysis, if the expanded credits are not extended, for example, a family of four with an income of $75,000 will be held responsible for paying $5,865 in annual premiums for the benchmark silver plan in 2026—more than double the $2,498 he would pay if he renewed.

When evaluating a plan, use the listed price as a guide. If it's not possible without extended tax benefits, it's not a good buy.

“People have to make decisions based on what’s in front of them,” Cox said.

“If you can't afford the sticker price without extended credits, consider enrolling in a less generous plan with a lower premium but a higher deductible,” Cox said. Bronze plans must provide comprehensive coverage, including free preventive care, and may cover some doctor visits before meeting your deductible.

“In most cases, having a bronze plan makes more sense than being uninsured,” she said.

The Trump administration is promoting catastrophic plans as a more affordable option for people who face financial hardship, including those who do not qualify for subsidies because their incomes are less than 100% or more than 400% of the federal poverty level.

Like bronze plans, catastrophic plans cover a range of essential health care services, provide free preventive care, and must cover at least three doctor visits before people reach their deductible. But the catastrophic plan deductible is the highest of all market plan types: $10,600 for individuals and $21,200 for families in 2026.

“They are expensive compared to what they cover,” said Jennifer Sullivandirector of health insurance access at the Center on Budget and Policy Priorities, noting that premiums can cost several hundred dollars.

5. Go back, check and recheck

If you're alarmed by premium prices on your first pass, “don't slam the computer shut and decide you have no options,” Sullivan said. “Congress may still act and things could change radically.”

Lawmakers could reinstate the expanded tax breaks on premiums until the end of the year or later.

Most states, including 28 that use the federal government's centralized marketplace, will have open enrollment through Jan. 15. There are other important dates to keep in mind.

In most states people must register by December 15 for coverage beginning on January 1, and by January 15 for coverage beginning on February 1, although some states have later deadlines.

6. Wait until you pay your premium.

Premium payments typically must be made before the plan goes into effect, although markets and insurers have the option to extend the deadline, Corlett said.

For example, they might give people extra time to make their first payment. “We've seen this in the past. Government officials and insurance companies have gotten creative in trying to keep people covered,” she said.

But if the deal is done at the last minute and someone has already paid the premium for January coverage and received a lower tax credit than the deal provides, they should still be able to get a higher credit.

“There are ways to make people whole,” Corlett said, although it’s unclear how that might happen during this recruiting period.

KFF health news is a national news service that produces in-depth journalism on health issues and is one of the primary operating programs in KFF.