Open enrollment for 2026 health insurance through the Affordable Care Act started November 1, and the news isn’t good for your wallet. Premiums jumped an average of 26% compared to last year. Worse? Without action from Congress, that increase could hit 114%—more than double what you paid in 2025.
About 24 million Americans currently rely on ACA marketplace plans. If you’re one of them, you’re facing a tight deadline and serious financial uncertainty. The government shutdown is stalling negotiations to extend premium tax credits that expire December 31, 2025. Without those subsidies, most people simply can’t afford coverage.
Here’s what you need to know before the December 15 deadline to get coverage starting January 1, 2026. Scripps News reported on the urgent situation facing millions of enrollees.
Why Are 2026 ACA Premiums Rising 26%?
Three factors explain the surge:
- Major insurers exiting markets. Companies like CVS Health’s Aetna pulled out of several ACA marketplaces, reducing competition. Fewer insurers mean higher prices—basic economics.
- Rising healthcare costs across the board. Hospital services, prescription drugs, and specialty care all cost more in 2025 than 2024. Insurers pass those increases to consumers through premium hikes.
- Market uncertainty from policy debates. When insurers can’t predict subsidy availability, they price in extra risk. That caution shows up as higher premiums.
The 26% average increase assumes current subsidies remain in place. But those subsidies expire in 37 days unless Congress acts. The government shutdown makes that extension increasingly unlikely before year-end.
114% Premium Jump: The Math Without Subsidies
Let’s break down what “114% increase” actually means for your budget.
| Current Monthly Premium (with subsidies) | 2026 Premium (without subsidies) | Annual Cost Increase |
|---|---|---|
| $150 | $321 | $2,052 more per year |
| $300 | $642 | $4,104 more per year |
| $450 | $963 | $6,156 more per year |
These numbers come from Kaiser Family Foundation analysis of marketplace premium data. For a family of four currently paying $600 monthly with subsidies, losing those credits means jumping to around $1,284 per month. That’s an extra $8,208 annually—more than most families can absorb.
Middle-income families earning 150-400% of federal poverty level face the steepest increases. You make too much to qualify for Medicaid but not enough to comfortably afford full-price insurance. Premium tax credits were specifically designed to bridge that gap.
December 15 Deadline: What Happens If You Miss It
Two critical dates determine your 2026 coverage:
- December 15, 2025: Last day to enroll for coverage starting January 1, 2026. Miss this, and you’re uninsured for at least January.
- January 15, 2026: Final enrollment deadline for any 2026 coverage. After this, you need a qualifying life event (job loss, marriage, birth) to enroll outside open enrollment.
Why does the December 15 deadline matter so much? If you wait until January 15 to enroll, your coverage doesn’t start until February 1. That’s a full month without insurance. One emergency room visit in January could cost you $5,000-15,000 out of pocket.
Plus, if Congress extends subsidies in late December (still possible despite the shutdown), you want to be already enrolled to benefit immediately. Retroactive subsidy application can take months to process.
How the Government Shutdown Affects Your Premiums
The shutdown creates a perfect storm of problems:
First, negotiations to extend premium tax credits stopped when federal agencies closed. Congressional budget talks require staff analysis, cost projections, and compromise language—all impossible during a shutdown. Every day without progress pushes the December 31 subsidy expiration closer.
Second, uncertainty forces insurers to maintain higher premiums. They can’t price 2026 plans assuming subsidy extensions that might not happen. When HealthCare.gov calculates your premium, it shows worst-case pricing unless subsidies get renewed.
Third, consumer confusion leads to delayed enrollment. Many people are waiting to see if Congress acts before committing to a plan. But that waiting game risks missing the December 15 deadline entirely.
The political math is brutal. Democrats want subsidy extension. Republicans want spending cuts. Neither side is budging during the shutdown. Your health insurance hangs in the balance of this stalemate.
3 Steps to Take Before December 15
1. Check your current premium estimate now.
Visit HealthCare.gov and run the calculator with your 2025 income information. You’ll see two premium estimates: one assuming subsidies continue, one assuming they expire. This shows your financial risk clearly.
The Kaiser Family Foundation’s subsidy calculator also lets you enter your ZIP code for location-specific estimates. Premiums vary significantly by state and county.
2. Enroll by December 15 even if subsidy status is uncertain.
Don’t gamble on Congress acting before year-end. Enroll now at the subsidized rate. If subsidies expire, you can:
- Switch to a cheaper plan during a special enrollment period (policy change qualifies you)
- Drop coverage and pay the gap-coverage penalty (still cheaper than months uninsured)
- Keep the plan if you can afford the higher premium
Having coverage starting January 1 beats scrambling in late December or going uninsured in January.
3. Document everything for potential subsidy claims.
If Congress extends subsidies retroactively (they’ve done this before), you’ll need proof of:
- Enrollment dates
- Premium payments made
- Income documentation
- Plan selection confirmations
Keep digital copies of all HealthCare.gov communications. Retroactive subsidy applications require detailed paperwork.
Who Gets Hit Hardest by Premium Increases
Not everyone faces the same financial impact.
Most vulnerable: Middle-income self-employed and gig workers. You don’t get employer coverage and earn too much for Medicaid. The 150-400% poverty level income range ($40,000-107,000 for a family of four) relies most heavily on premium tax credits. Without subsidies, insurance becomes unaffordable, forcing you to go uninsured or drain savings.
Also severely affected: Early retirees (ages 50-64). You’re not yet eligible for Medicare but face the highest premiums due to age. A 60-year-old currently paying $400 monthly with subsidies could see premiums jump to $880 without them. That’s $5,760 extra annually on a fixed income.
Somewhat protected: Lower-income enrollees. If you earn under 150% of poverty level, you likely qualified for enhanced cost-sharing reductions that aren’t affected by premium tax credit expiration. Your out-of-pocket costs stay lower even if headline premiums rise.
Unaffected: Employer-sponsored coverage holders. If you get insurance through work, ACA marketplace changes don’t touch you. You’re about 160 million Americans watching this debate without direct impact.
Frequently Asked Questions
What happens to my current ACA plan in 2026 if I don’t re-enroll?
Your 2025 plan automatically ends December 31, 2025. You must actively re-enroll during open enrollment (Nov 1 – Jan 15) to have any coverage in 2026. Many insurers auto-renew you into a similar plan, but that renewal uses 2026 pricing—which means the 26% average increase applies even without action. However, you might find a cheaper plan by shopping around on HealthCare.gov rather than accepting auto-renewal.
Can I change my ACA plan mid-year if Congress extends subsidies in March or April?
Yes, but only through a special enrollment period triggered by “changes affecting coverage eligibility.” If Congress retroactively extends subsidies and you’re currently paying full price, that policy change qualifies you for a special enrollment window (typically 60 days from the law’s effective date). You could then switch to a plan that better fits your new subsidized budget. Check HealthCare.gov for official special enrollment announcements.
How do I calculate if I can afford ACA coverage without subsidies?
Use the HealthCare.gov plan comparison tool and toggle the subsidy estimate to zero. This shows full-price premiums for your ZIP code and age. A general rule: health insurance shouldn’t exceed 10-12% of your gross monthly income to remain sustainable. For a household earning $5,000 monthly, that’s a maximum $500-600 premium budget. Anything higher forces tough choices between coverage and other necessities.
Should I choose a high-deductible plan to save on premiums if subsidies expire?
It depends on your health status and savings. High-deductible plans (HDHPs) with Health Savings Accounts can cut premiums by 30-40%, which helps if subsidies disappear. But you’ll pay the first $3,000-7,000 of medical costs out of pocket before insurance kicks in. This works if you’re healthy and can afford unexpected bills. Risky if you have chronic conditions or can’t cover a $5,000 emergency room visit. Run the math: monthly premium savings × 12 months vs. your typical annual medical spending.
What states are least affected by ACA premium increases?
States with robust insurer competition and strong state-level premium regulations see smaller increases. Massachusetts, California, and New York maintain multiple insurers per marketplace, which keeps premiums more stable through competition. Rural states with only 1-2 insurers (like Wyoming, Mississippi, Oklahoma) face steeper hikes because lack of competition allows higher pricing. Check your state’s insurance department website for local marketplace data—premium changes vary wildly by location.
Bottom Line: Act Before December 15
You can’t control Congressional negotiations or the government shutdown timeline. You can control your enrollment decision.
The December 15 deadline gives you 44 days from November 1 to secure coverage starting January 1, 2026. Waiting for political clarity risks missing that window entirely. Even if premiums jump to the 114% increase without subsidies, having coverage beats going uninsured and facing catastrophic medical bills.
Start at HealthCare.gov today. Run the numbers with and without subsidies. Pick a plan you can afford in the worst-case scenario. If Congress extends subsidies later, you benefit retroactively. If they don’t, you’re already covered.
Don’t let political dysfunction leave you uninsured.