Millions of Americans who bought insurance under the Affordable Care Act still have until 2026 to sign up. But rising insurance premiums and the expiration of expanded tax subsidies have led to larger-than-expected costs.
Concerned shoppers, wondering if there is anything they can do, are consulting with insurance brokers or speaking with ACA marketplace call centers.
“We're hearing from people with complex medical conditions who don't think they can survive if they don't have access to care,” said Audrey Morse Gasteyer, executive director of the Massachusetts Health Connector, the state's insurance marketplace.
And some are considering looking beyond the ACA for more affordable options. But this requires caution.
Congress is unlikely to extend the increased subsidies until the end of the year. Late Wednesday, the House passed a package favored by conservatives that doesn't address subsidies and is largely considered dead on arrival in the Senate. However, earlier on Wednesday, four moderate Republicans joined Democrats to sign petition for dismissal force a vote (probably in January) on a three-year extension. The Senate and President Donald Trump would also have to approve the measure, but if extended, subsidies could apply retroactively.
Meanwhile, the deadline to choose a health insurance plan is quickly approaching. The official end of open enrollment is set for January 15, and coverage will begin on February 1. In most states, it is too late to sign up for coverage after January 1st.
Here are five considerations in the decision-making process:
1. Short-term plans: “You must be healthy”
Some ACA buyers may consider short-term insurance plans sold outside of government markets or that are steered towards plans by insurance brokers. Be careful.
Short-term plans are just insurance, originally designed as temporary coverage in case you change jobs or go to school. They can look a lot like traditional insurance, with deductibles, copays, and participating hospital and physician networks. However, they are not ACA compliant and are not available on official ACA marketplaces.
They are often less expensive than ACA plans. But they cover less. For example, unlike ACA plans, they can impose annual and lifetime limits on benefit amounts. The vast majority do not cover maternity services. Some may not cover prescription drugs.
Short-term plans require applicants to fill out a medical questionnaire, and insurers may exclude coverage or cancel the policy retroactively for those with pre-existing conditions. In addition, depending on the terms of the particular plan, a person who develops a disease during the insurance period may not be accepted for renewal.
Additionally, short-term plans are not required to cover health care costs. Checklist of Key ACA Benefitssuch as prophylaxis, hospitalization or emergency care.
The plans' shortcomings, which critics say are sometimes misrepresented, have prompted Democrats to call them “junk insurance.” The Trump administration says they are suitable for some people and is seeking to make them more widely available.
“We recommend it when it makes sense,” said Joshua Brooker, an insurance broker in Pennsylvania. “But if you're going to sign up for short-term insurance, you need to know what boxes aren't checked.”
“They're not for everyone. You have to be healthy,” said Ronnell Nolan, president and CEO of the trade group Health Agents of America.
And they are only available in 36 states. according to KFF dataa nonprofit health information organization that includes KFF Health News. In some states, such as California, they are prohibited. Others set strict limits.
2. Beware of Incomplete Coverage
There are other types of health insurance offered by sales brokers or other organizations.
One kind, called a compensation plandesigned to supplement a traditional health insurance plan through deductibles or copayments.
These plans also do not have to meet ACA coverage rules. They typically pay a flat dollar amount—say, a few hundred dollars a day—for a hospital stay or a smaller amount for a doctor's visit. Typically these payments do not cover the full cost and the policyholder pays the rest. They usually also require consumers to fill out medical forms detailing any pre-existing conditions.
Another type, a faith-based exchange plan, pools participants' money to cover their medical bills. According to the Commonwealth Fund, a foundation that supports health research and improvements to the health care system, plans are not required to maintain any specific amount of financial reserves, and participants are not guaranteed that the plans will pay their health care expenses.
Since the passage of the ACA, exchange plans have expanded beyond religious communities. Like short-term plans, they cost less than ACA plans but do not have to follow ACA rules.
They are not considered insurance, and some of them were accused of fraud government regulators.
“Yes, it’s cheaper, and yes, it does help some people,” Nolan said. “But you need to understand what this plan does. This will be my last resort.”
3. Consider a “bronze” or “catastrophic” plan, but be mindful of deductibles.
For those who want to stay with ACA plans, the lowest premiums are typically in categories labeled “catastrophic” or “bronze.”
Jessica Altman, executive director of the California ACA exchange, said her state has seen an increase in enrollment in bronze-level plans. They have lower premiums but high annual deductibles—the amount a customer must spend before most coverage kicks in. Franchises for bronze plans the national average is about $7,500According to KFF data.
Another option, new for 2026, is expanded eligibility for catastrophic plans that were previously only available to people under 30 years of age. As the name suggests, they are designed for people who want health insurance for a catastrophic health condition, such as cancer or injuries from a car accident, and the plans can have deductibles up to the ACA's annual out-of-pocket limit—$10,600 for an individual or $21,200 for a family.
But now people are losing subsidies due to the expiration of the extended tax benefits may also qualify for these plans. However, they may not be available in all regions.
Lauren Jenkins, a broker in Oklahoma, said some of her clients who made less than $25,000 this year qualified for very low-cost or no-cost plans with enhanced subsidies. However, next year the cost could rise to $100 or more per month for a silver plan, which is a step up from bronze.
So she shows them bronze plans to reduce monthly costs. “But now they'll have to pay a deductible of $6,000, $7,000 or $10,000,” Jenkins said. “For people making just $25,000 a year, this would be detrimental.”
Both bronze and catastrophic plans can be linked to health savings accounts that can be used for save money without taxes for medical expenses. They are more popular among higher income families.
4. Another plan may have lower premiums.
You can pay for your purchases. Some people may be able to find a lower premium by switching to a different plan, even one offered by the same insurer. There are also different levels of coverage, from bronze to platinum, where premiums also vary. Brooker said that in some places, gold plans are cheaper than silver plans, although that seems counterintuitive.
Additionally, some people who run their own business but only have one employee may qualify for a group plan rather than an individual policy. Sometimes they can be cheaper.
Not every state allows it, Nolan said. But for example, Nolan said, she has a client whose only employee is his wife, so she's going to see if they can get a group plan at lower rates.
“It might work for them,” she said.
ACA rates for plans for small groups (fewer than 50 employees) vary by region and are not always cheaper than individual coverage, Brooker said.
“Where the rates are better is almost universal,” he said.
5. Other traffic rules
Insurance experts urge people not to wait until the last minute to at least take preliminary steps. Buyers can go to the official federal or state marketplace website and fill out or update an application with their required income and other information needed to determine what's in store for them in the 2026 plan.
For example, even without Congressional intervention, subsidies will not disappear completely. However, they will be smaller, and there is an income cap – a threshold for households earning more than four times the poverty level, which will be $62,600 for an individual and $84,600 for a couple in 2026.
When shopping, consumers should ensure they land on the official ACA website, as there are similar products that may not offer ACA compliant plans. Healthcare.gov is the official federal website. From here, people can find websites serving the 20 states, plus the District of Columbia, that have their own ACA exchanges.
Government websites can also direct consumers to licensed brokers and other advisers who can help with the application.
And a reminder: Consumers also need to pay the first month's premium for coverage to take effect.
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