Open enrollment for Affordable Care Act marketplace plans starts November 1, 2025. But millions of Americans may face sticker shock when they shop for coverage.
Why? Enhanced premium subsidies that kept costs manageable haven’t been renewed—and the ongoing government shutdown means they might not load into enrollment systems before the deadline. ABC News reports that Democrats demand subsidy extension as a condition to end the shutdown, now stretching past its tenth day.
The numbers look ugly. Without renewal, average premiums for subsidized enrollees could jump from $888 in 2025 to $1,904 in 2026—a 114% increase, according to the Kaiser Family Foundation.
That’s not a typo. Your monthly premium could more than double in three weeks.
Why ACA Subsidies Became a Political Flashpoint
Melinda Buntin, professor at Johns Hopkins Bloomberg School of Public Health, explained the stakes to ABC News: “The thing at the very top of the list is these subsidies because they are so salient and they will directly affect the pocketbooks of so many millions of Americans.”
Congressional Democrats want two things:
- Extension of enhanced marketplace premium tax credits that temporarily lowered costs for people buying individual health insurance through federal and state exchanges.
- Making those subsidies permanent instead of requiring annual renewal fights that create exactly this kind of uncertainty.
Republicans haven’t publicly committed to either demand. The shutdown drags on. And open enrollment ticks closer.
Here’s what makes this especially messy: Even if Congress passes subsidy renewal tomorrow, insurers need time to update enrollment systems. Professor Buntin warned: “If open enrollment begins and these subsidies are not approved and loaded into the enrollment systems, people are likely to see their premiums go up.”
Translation? Technical logistics matter as much as political will right now.
The Congressional Budget Office Projects Steep Premium Hikes
The Congressional Budget Office crunched numbers on what happens if subsidies lapse. Their analysis shows gross benchmark premiums increasing by 4.3% in 2026 and 7.7% in 2027 for marketplace plans.
That sounds almost manageable—until you realize those percentages apply to unsubsidized premiums. The real consumer impact hits harder.
Kaiser Family Foundation dug deeper into what actual enrollees would pay out of pocket. Their September 2025 analysis found subsidized consumers would face that massive 114% jump: $888 monthly in 2025 becomes $1,904 in 2026.
| Year | Average Monthly Premium (Subsidized Enrollees) | Change from 2025 |
|---|---|---|
| 2025 | $888 | Baseline |
| 2026 (without renewal) | $1,904 | +114% |
For a family of four, that increase translates to roughly $12,000 more per year in health insurance costs. Most household budgets can’t absorb that kind of hit.
Who Gets Hurt Most by the Subsidy Impasse?
Not everyone on ACA marketplace plans receives subsidies. You qualify for premium tax credits based on household income relative to the federal poverty level.
Enhanced subsidies expanded eligibility upward. Middle-income families who previously earned “too much” for help suddenly qualified. Self-employed workers, early retirees, and gig economy workers—groups with higher-than-average marketplace enrollment—benefited significantly.
Three groups face the biggest financial impact from subsidy expiration:
- Households earning between 400% and 600% of federal poverty level would lose subsidies entirely. For a family of four in 2025, that’s roughly $120,000 to $180,000 annual income—solidly middle class in most metro areas, not wealthy by any stretch.
- People aged 50-64 (pre-Medicare) pay higher premiums due to age-based pricing. Without subsidies, their costs could exceed $2,500 monthly for an individual plan.
- Residents of high-cost insurance markets like Wyoming, West Virginia, and rural areas where provider competition is limited and base premiums already run high.
Roughly 15 million Americans purchase individual coverage through ACA marketplaces. Kaiser estimates about 3.8 million would become newly uninsured if subsidies disappear and premiums spike.
Should You Delay Enrollment or Buy Coverage Now?
Open enrollment runs from November 1, 2025, through January 15, 2026, for most states (some extend longer). You’re probably wondering: Should I wait to see if Congress renews subsidies?
Bad idea.
Here’s why waiting backfires:
- You risk going uninsured. If you miss the enrollment window and subsidies never materialize, you’re stuck without coverage until next year’s open enrollment. Medical emergencies don’t wait for political resolutions.
- Coverage starts later. Plans selected by December 15 take effect January 1, 2026. Wait until January, and your coverage doesn’t kick in until February 1 at earliest.
- Retroactive adjustments work in your favor. If Congress renews subsidies after you’ve enrolled, insurers credit your account retroactively. You won’t lose money by enrolling early.
What you should do: Enroll as soon as marketplace systems open November 1. If subsidies get approved later, you’ll see refunds or premium reductions automatically.
Shopping tip: Run multiple scenarios. Calculate costs with and without subsidies to understand your worst-case monthly expense. Then budget for the higher number while hoping for the lower one.
What Happens if Subsidies Never Get Renewed?
Let’s game out the nightmare scenario where political gridlock extends indefinitely and enhanced subsidies simply expire.
Marketplace enrollment would crater. CBO projects millions dropping coverage due to unaffordability. That creates a death spiral risk: As healthy people exit, the remaining insurance pool gets sicker and more expensive, driving premiums even higher.
Insurers might pull out of certain markets entirely. Why participate in exchanges where enrollment collapses and risk profiles worsen? Several carriers already operate on thin margins in rural counties.
States could step in with their own subsidy programs, but that requires legislative action and budget allocation. The Commonwealth Fund has documented state-level efforts to stabilize individual markets, but most states lack the fiscal capacity to replace federal subsidies dollar-for-dollar.
Hospitals would see increased uncompensated care. When people can’t afford insurance, they still get sick. Emergency rooms can’t turn away patients, so providers absorb costs—which eventually get passed to everyone through higher prices.
The math gets uglier the longer you look at it.
Political Dynamics Behind the Subsidy Standoff
Why won’t Republicans budge on subsidy extension?
Three factors explain the resistance:
- Fiscal hawks oppose long-term entitlement expansion without corresponding spending cuts elsewhere. Making subsidies permanent adds roughly $335 billion to the federal deficit over 10 years, per CBO estimates.
- Philosophical opposition to ACA itself remains strong among conservative Republicans who view the law as government overreach into private insurance markets.
- Negotiating leverage matters during shutdown talks. Republicans may demand concessions on unrelated priorities (border security, spending caps) in exchange for subsidy renewal.
Democrats counter that subsidies save money overall by reducing uncompensated care, improving preventive health outcomes, and stabilizing individual insurance markets. But those arguments haven’t moved enough votes.
The political stalemate might break through one of three paths: a clean subsidy extension with bipartisan support, subsidy renewal attached to broader budget legislation, or temporary extension that kicks the fight down the road six months.
None of those solutions help consumers shopping for coverage on November 1.
Frequently Asked Questions
Will my ACA premium really double in 2026 without subsidy renewal?
It depends on your income and current subsidy level. Kaiser Family Foundation found subsidized enrollees would see average premiums jump 114% from $888 to $1,904 monthly. But individual impact varies. Someone receiving maximum subsidies could see larger percentage increases, while those with minimal subsidies might face smaller hikes. Calculate your specific situation using marketplace estimator tools at Healthcare.gov.
Should I wait to enroll until Congress renews subsidies?
No. Enroll during open enrollment starting November 1. If subsidies get renewed after you’ve signed up, insurers will retroactively adjust your premiums and issue refunds for overpayments. Waiting risks missing the enrollment window entirely, leaving you uninsured if political negotiations drag on. Coverage gaps can’t be fixed mid-year except through qualifying life events.
What income levels lose subsidies completely if renewal fails?
Enhanced subsidies currently extend eligibility beyond 400% of federal poverty level. Without renewal, anyone earning above that threshold loses all premium assistance. For 2025, that’s approximately $60,240 for individuals or $124,800 for a family of four. Previously ineligible households would suddenly face full unsubsidized premiums, potentially $15,000–$25,000 annually for family coverage depending on location and age.
Can states create their own subsidies if federal ones expire?
Technically yes, but most won’t. States would need to pass legislation and allocate budget funds—difficult during fiscal constraints. A few states like California, Massachusetts, and New Jersey operate supplemental subsidy programs, but these enhance federal subsidies rather than replace them entirely. Expecting all 50 states to backfill $335 billion in federal assistance isn’t realistic. Residents in states without action would face full premium increases.
How long could the government shutdown delay subsidy loading into enrollment systems?
Insurance industry experts estimate 2-3 weeks minimum to update enrollment platforms after congressional approval. That’s optimistic. Complex system integration, multi-state coordination, and insurer readiness all take time. With open enrollment starting November 1 and the shutdown already past 10 days, even immediate subsidy renewal might not prevent initial enrollment showing higher premiums. Retroactive corrections would follow, but first impressions matter—some consumers might not enroll after seeing inflated prices.
What This Means for Your Coverage Decision
The subsidy impasse creates uncertainty, but don’t let political dysfunction derail your health insurance planning.
Three actions protect you regardless of how negotiations unfold:
First: Mark November 1 on your calendar and enroll promptly. Early enrollment guarantees January 1 coverage start and positions you for retroactive subsidy adjustments if Congress acts later.
Second: Budget for worst-case premiums. Calculate what you’d pay without subsidies, then set aside that amount monthly. If subsidies materialize, you’ve built emergency savings. If not, you’re covered.
Third: Explore alternatives now. Short-term health plans, health sharing ministries, and high-deductible options with health savings accounts won’t work for everyone, but they might bridge coverage gaps cheaper than full ACA plans if subsidies disappear.
The political battle over subsidy renewal will eventually resolve—either through compromise, public pressure, or sheer exhaustion. But that resolution might come too late for November 1 enrollment.
Your health and financial security can’t wait for Washington to function. Plan accordingly.