ACA Marketplace: Understanding the Upcoming Insurance Hikes

October 28, 2025

Imagine logging in to renew your health-insurance plan this November and discovering your monthly premium has nearly doubled — all because Congress couldn’t agree to fund the tax credits that have quietly kept your coverage affordable. That’s the stark reality for millions of Americans enrolled in the health insurance marketplaces under the Affordable Care Act (ACA).

Under the ACA, individuals and families who do not get health insurance from an employer or through a public program can shop at a federal or state-based “Marketplace.” Insurers offer plans in metal tiers (Bronze, Silver, Gold)—with varying premiums, deductibles, and out-of-pocket costs. What keeps many of these plans affordable is the federal premium tax credit. If you qualify (mainly based on income as a share of the federal poverty level), you receive a subsidy that reduces the monthly premium you pay.

Because of this subsidy, many enrollees pay only a modest portion of what might otherwise cost thousands of dollars. The Kaiser Family Foundation (KFF) found that thanks to the enhanced tax credits, an individual making $28,000 “will pay no more than around 1 % ($325) of their annual income towards a benchmark plan.” The system ties a person’s share of premium costs to their income, and the subsidy covers the rest. This critical safeguard has kept coverage within reach for millions of lower-income Americans.

Why Subsidies Are in Danger of Expiring

The wrinkle: the enhanced subsidies many people now rely on are temporary unless Congress renews them. These enhancements were introduced by the American Rescue Plan Act in 2021 and extended under the Inflation Reduction Act of 2022. They expanded eligibility (including households earning more than 400% of the poverty level) and reduced out-of-pocket costs for individuals. But unless renewed by year’s end, they sunset at the end of 2025.

Even more urgent: insurers are already filing their proposed 2026 premiums, assuming no renewal of the enhanced tax credits. KFF reported that enrollee net premium payments could increase by 114 % on average—from about $888 in 2025 to about $1,904 in 2026—if the enhanced credits expire.

What People with Low Income Will Face

For low- and moderate-income Americans who depend on the marketplaces, the expiration of enhanced subsidies is more than theoretical—it’s a budget-breaker.

If subsidies are eliminated, many enrollees will see their monthly premium contributions skyrocket. KFF’s analysis shows that without the enhanced tax credits, average annual premium payments for subsidized enrollees would more than double. Some households will lose eligibility altogether. For people earning above 400 % of the poverty level, that subsidy cliff means they go from some assistance to none. KFF explains that “people with incomes over four times the poverty level will no longer be eligible for any financial assistance” if the enhanced credits expire.

The rate increases compound the effect: insurers are proposing median premium hikes of around 18 % for 2026. Those who are already barely making ends meet may find the new premiums impossible. One enrollee in Florida told Health News Florida that she’s already struggling to cover other rising costs. “The rent is going up. The water bill is going up,” said the Florida resident. “I cannot afford a premium hike.”

A missing subsidy cushion means not just higher premiums but a greater risk of losing coverage altogether. As Jason Levitis, Senior Fellow at the Urban Institute, explained, “If you have fewer subsidies, you’re going to have less health coverage and less health care.”

Why Enrollment Has Grown Recently

Enrollment in the marketplaces has surged in recent years, and the subsidy enhancements are a significant reason. Before the enhancement period, around 11 million people used the marketplace; now more than 24 million are enrolled.

Several factors have driven the growth. The enhanced tax credits increased eligibility and lowered what many paid, making coverage far more accessible. Improved outreach and usability—especially as state-based marketplaces matured—helped consumers find and keep plans more easily. At the same time, rising costs in employer-based coverage pushed more people to shop for plans individually. According to KFF, the enhancements cut annual premium payments by an estimated 44 % (about $705) for many subsidized enrollees. “The enhancements made it easier for millions of people to afford health coverage,” said Larry Levitt, Executive Vice President for Health Policy at KFF. “If they expire, we could see those gains wiped out almost overnight.”

In short, more help meant more people using the marketplace. The flip side is that less help could mean fewer people—and higher premiums for those who stay.

What’s at Stake

At the core of the current federal budget impasse (which led to the shutdown beginning October 1, 2025) is a fight over whether to extend the enhanced subsidies. Democrats insist that any funding deal must include the subsidy extension, arguing that letting them expire would cause a major affordability crisis. Republicans are pushing for reopening the government without tying the subsidy question directly to the budget deal, saying the issue should be negotiated separately.

From a consumer standpoint, the stakes are enormous. Without subsidy extensions, millions may lose assistance, face steep premium increases, or drop coverage altogether. KFF’s district-level data show that premiums would at least double in many parts of the country if the enhancements are not renewed. Rising premiums could also cause healthier enrollees to opt out, worsening the insurance risk pool and pushing rates even higher in subsequent years.

For families already squeezed by inflation and rising living costs, this would trigger an affordability crisis. “The cost of health insurance is never going to be low enough for a person who makes just above poverty to be able to afford it,” said Cynthia Cox, Director of KFF’s Program on the Affordable Care Act. “If you want that person to have health insurance, then there needs to be financial assistance.”

If Congress doesn’t act, many Americans will pay far more—or lose coverage altogether. As open enrollment begins, millions will face difficult choices about whether they can keep the coverage that has protected them for years, and whether Washington will act before the bills come due.

Insure You Know

Before you finalize your renewal or new plan selection, it may help to check out Insure You Know — a secure, central place where you can store and manage the critical information your family will need (insurance details, plan documents, contact numbers, and more). Taking a few minutes now to upload your coverage information ensures you’re ready for whatever changes lie ahead, and helps keep everything organized so you’re not scrambling when the numbers on your bill jump or the policy rules shift.

Kick Your Health Benefits into High Gear

December 1, 2022

As open enrollment season kicks into high gear, millions of people will have an opportunity to choose their 2023 health benefits.

Employers’ Healthcare Costs

Employers’ healthcare costs are rising, with large companies forecasting up to an 8 percent increase for 2023. The main difference with previous years will be higher prescription drug costs, which will jump 10 percent, the highest in the past decade.

Many companies will try to limit the share they pass along to their workers, as benefits are seen as a key attraction and retention tool in a tight job market. 

Employees’ Healthcare Costs

For 2022, annual family premiums for employer-sponsored health insurance averaged $22,463, up slightly from $22,221 in 2021, according to the 2022 benchmark KFF Employer Health Benefits Survey. On average, workers contributed $6,106 toward the cost of family premiums, with employers paying the rest. The average premium for single coverage was $7,911 (up from $7,739 in 2021), with employees paying $1,327 annually, according to the survey. Nine percent of covered workers, including 21 percent of covered workers at small firms, are in a plan with a worker contribution of $12,000 or more for family coverage.

While premium data for 2023 generally won’t be available until after the new year begins, workers may see larger increases than in recent years.

Triple-Tax Advantaged HSAs

Some tools can help you manage your healthcare costs. More than three-quarters of large employers offer Health Savings Accounts (HSAs) that offer triple tax advantages: money contributed is pre-tax, it grows on a tax-free basis, and then can be withdrawn tax-free to pay for qualifying medical expenses now or in the future, all the way through retirement.

You can contribute to an HSA only if you’re enrolled in a qualifying high-deductible health plan. Average annual premiums for workers enrolled in HSA plans are lower than the overall average, but workers shoulder higher costs until they meet their deductible. 

Employees can contribute up to $3,850 to their HSA for individual coverage for 2023, up from $3,650 this year; for family coverage, workers can contribute up to $7,750, up from $7,300 this year, per an announcement by the Internal Revenue Service. Catch-up contributions for those 55 and over remain $1,000.    

Many HSAs give account holders the option to invest a portion of their money in the stock market. But fewer than 10 percent do so, as opposed to leaving their money just sitting in cash. If you can afford to pay your medical bills through your regular cash flow, your HSA funds will likely grow over time in the market and can be used in retirement to pay for a range of qualifying medical expenses.

HSAs  are portable and remain with the owner through plan and job changes. If you are no longer enrolled in a qualifying high-deductible health plan, you can no longer contribute to your account, but you can still tap it to pay qualifying medical costs. Flexible-spending accounts (FSAs), by contrast, are linked to a particular employer; unlike HSA funds, money in an FSA must be spent down or forfeited within a certain period.

Health Insurance Plans under the Affordable Care Act

Outside of the employer market, open enrollment began on November 1 on Healthcare.gov for individual and family health insurance plans under the Affordable Care Act. In most states, open enrollment ends on January 15, although you must enroll by December 15 if you want coverage to begin on January 1. The Inflation Reduction Act extended the enhanced premium subsidies for ACA enrollees through 2025; for many, that may offset the moderate average increases expected to premiums.

Impact of Rising Drug Costs

There are two main reasons drug costs are rising: First, pharmaceutical companies are introducing better, but more expensive drugs for several important conditions. In most years, total drug cost would be tempered by other brand name drugs that were being replaced by generics, but in 2023, there will be fewer of these than usual.

Second, pharmaceutical companies are raising the prices they charge to private health insurance plans because they anticipate having to lower the prices they charge to Medicare. The recent Inflation Reduction Act allows Medicare to negotiate drug prices for the first time. Currently, only 10 drugs are on the negotiation list, but these are widely used. The list will rise to 20 drugs in the future.

The “No Surprises” Act

The “No Surprises” Act that went into effect in January 2022 is having its intended effect of lowering surprise out-of-network charges to patients who get emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers.

InsureYouKnow.org

After you determine your healthcare insurance coverage for 2023, file your decisions at insureyouknow.org. Keep aware of government mandates that can affect your healthcare expenses for prescription drugs, out-of-network charges, changes in Medicare, increases in premiums, and your HSA and FSA contributions and withdrawals.

Ensure Your Health Care Coverage

November 15, 2020

Changing your calendar to the month of November signals the need to review your health insurance coverage for the coming year. If you don’t have health insurance coverage through an employer, you’ll need to buy it yourself if you want coverage in 2021.

The Affordable Care Act (ACA) (also known as Obamacare), enacted in March 2010, called for the creation of a health insurance exchange in each state, with three primary goals:

• Make affordable health insurance available to more people. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100 percent and 400 percent of the federal poverty level.
• Expand the Medicaid program to cover all adults with income below 138 percent of the federal poverty level.
• Support innovative medical care delivery methods designed to lower the costs of health care in general.

In the article, “Insurance Coverage after Job Loss—The Importance of the ACA during the Covid-Associated Recession,” published on October 22 in The New England Journal of Medicine, the authors state, “The ACA, having created several new options for health insurance unrelated to employment, will protect many recently unemployed people and their families from losing coverage.” The article also emphasizes, “The very virus that has brought about record unemployment levels is the same agent that makes health insurance—and the new options created under the ACA—more important than ever.

Open Enrollment for 2021

In every state, open enrollment for ACA-compliant 2021 health coverage for individuals and families started on November 1 and, in most states, will end on December 15, 2020. This deadline applies to the 36 states that use HealthCare.gov and it also may apply in some of the states that run their own exchanges.

You can enroll for a health insurance plan online, over the phone, or in-person. When you enroll in a plan through the exchange, you need to have the following information on hand for each enrollee:

• Name, address, email address, Social Security number, birthdate, and citizenship status.
• Household size and income if you’re planning to apply for premium subsidies or cost-sharing reductions. A wide range of documentation can be used to prove your income, including pay stubs, W2s, or your most recent tax return.
• Coverage details and premium for any employer-sponsored plan that’s available to your household (regardless of whether you’re enrolled in that plan or have declined it).
• Payment information that the insurer will be able to use to charge your premiums.
• Your doctors’ names and zip codes, so that you can check to make sure they’re in-network with the health plans you’re considering.
• A list of medications taken by anyone who will be covered under the policy. Each insurance plan has its own formulary so you’ll want to check to see which one will best cover the medications you need.
• If you want to enroll in a catastrophic plan and you’re 30 years old or older, you’ll need a hardship exemption (note that premium subsidies cannot be used with catastrophic plans, so these are generally only a good idea if you don’t qualify for a premium subsidy, but can meet the requirements for a hardship exemption).

Coverage Effective January 1

In almost all cases, your coverage will take effect on January 1, 2021 if you sign up during the open enrollment window in the fall of 2020. If you’re already enrolled in an individual-market plan and you’re picking a different plan during open enrollment, your current plan will end on December 31 and your new plan will take effect seamlessly on January 1 if you continue to pay your premiums.

December Deadline Limitations

If you don’t enroll in an ACA-compliant health insurance plan by the end of open enrollment on December 15 in most states, your buying options may be limited for the coming year. Open enrollment won’t come around again until November 2021, with coverage effective January 1, 2022. Exceptions include:

• Medicaid and CHIP enrollment are available year-round for those who qualify. If your income drops to a Medicaid-eligible level later in the year, you’ll be able to enroll at that point. Similarly, if you’re on Medicaid and your income increases to a level that makes you ineligible for Medicaid, you’ll have an opportunity to switch to a private plan at that point, with the loss of your Medicaid plan serving as the qualifying event that triggers a special enrollment period.
• Native Americans can enroll year-round in in plans through special provisions in the ACA that apply to Native Americans.
• If you have a qualifying event during the year, you’ll have access to a special enrollment period. Qualifying events include marriage (if at least one spouse already had coverage prior to the marriage), the birth or adoption of a child, loss of other minimum essential coverage, or a permanent move to a new geographical area where the available health plans are different from what was available in your prior location (if you already had coverage prior to your move).     

You can access a guide to all of the qualifying events that trigger special enrollment periods in the individual market including details about the specific rules that apply to each of them.

No Federal Penalty but Some States Levy Tax Penalties

There is no federal government penalty for being uninsured in 2021 but four states (Massachusetts, New Jersey, California, and Rhode Island) and Washington, DC, impose tax penalties for not having health insurance.

For More Information About ACA-Healthcare Coverage

Follow these steps:

• Get a quotation at healthinsurance.org. 
• ‘Window shop’ anonymously on your state exchange (if you’re in Washington, DC, or one of the 14 states that run their own exchanges) or HealthCare.gov’s plan browsing page if you’re in one of the other 36 states.
• Consult with a trained advisor by setting up an appointment with a navigator or broker in your area who will be able to help you sort through the available options and figure out which one will best meet your needs.
• Talk with your health care providers if you’re considering a policy change during open enrollment. You’ll want to know which provider networks include your doctors, and whether any network changes are planned for the coming year.

Auto-Renewal for Existing ACA-Compliant Health Plan

If you’re already enrolled in an ACA-compliant health plan through your state’s marketplace, you can probably let your plan automatically renew for 2021. Auto-renewal is an option for nearly all exchange enrollees, although Pennsylvania and New Jersey have transitioned away from HealthCare.gov and are using their own new enrollment platforms instead. Residents in those states need to pay close attention to notifications they receive from the marketplace with instructions on how to renew coverage or select a new plan for 2021.

But, relying on auto-renewal for ACA-compliant insurance coverage may not be in your best interest. No matter how much you like your current plan, it pays to shop around during open enrollment and see if a plan change is worth your while because:

• In most states, you won’t be able to pick a new plan after your coverage is auto-renewed. 
• Your subsidy amount will generally change from one year to the next. If your subsidy gets smaller, auto-renewal could result in higher premiums next year. 
• If you receive a subsidy, auto-renewal could be risky even if the subsidy amount isn’t declining. This FAQ explains details that you may encounter if you let your individual health insurance plan automatically renew.
• If your plan is being discontinued, auto-renewal will result in the exchange or your insurer picking a new plan for you. 
• Auto-renewal might result in a missed opportunity for a better value. 

You might still decide that renewing your current plan is the best option for 2021. But, it’s definitely better to actively make that decision rather than letting your plan auto-renew without considering other available options.

After you have squared away your health care coverage for 2021, you can record all the decisions you make, enrollment forms you submit, and confirmations you receive at InsureYouKnow.org. By doing that, you’ll be able to review your health insurance coverage commitments in November 2021 in preparation for 2022.