Open enrollment for Affordable Care Act health insurance begins November 1 in most states, and millions of Americans may face significant premium increases when they sign up for 2026 coverage.
The surge stems from uncertainty surrounding enhanced federal subsidies that help reduce insurance costs for lower- and middle-income consumers. Congress has yet to extend the program, which remains tied to the ongoing government shutdown.
“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, according to CNBC.
Roughly 22 million of the 24 million Americans enrolled in ACA marketplace plans rely on those enhanced premium tax credits, according to the Kaiser Family Foundation (KFF). Without them, average premiums could rise by 114% in 2026.
Health experts warn that losing the subsidies could lead to more uninsured and underinsured Americans. Many may be forced to choose between higher monthly premiums and reduced coverage. “That sticker shock could have significant ramifications for consumers’ finances and the choices they make about health coverage,” KFF reported in October.
While ACA marketplace participants represent a small portion of the total insured population, analysts say the financial impact could influence voter sentiment ahead of next year’s elections.
The open enrollment period runs through January 15; however, consumers must select a plan by December 15 to ensure coverage starts on January 1, 2026. Many enrollees — particularly early retirees and modest-income households — are bracing for steep rate hikes if Congress does not act soon.
The enhanced subsidies, first expanded under pandemic relief legislation, have helped stabilize ACA participation and affordability. If they lapse, insurers could face rising costs as healthier consumers drop out of the market, leading to even higher premiums in subsequent years.
For now, the millions who depend on subsidized ACA coverage remain in financial limbo, awaiting a decision from Congress that could determine the affordability of their healthcare for the coming year.