Millions encounter ‘massive price surprise’ as ACA open enrollment begins on Nov. 1

Open enrollment for health insurance acquired through the Affordable Care Act marketplace commences on Nov. 1 in the majority of states — yet millions may encounter unexpected costs when attempting to enroll.

This dilemma arises from a legislative deadlock regarding the extension of enhanced subsidies for insurance premiums, which shows no signs of resolution.

Carolyn McClanahan, a physician and certified financial planner in Jacksonville, Florida, stated, “Consumers are going to experience significant sticker shock, as prices are escalating.”

Experts warn that this sticker shock could severely impact consumers’ financial situations and their decisions regarding health coverage, leading to a rise in uninsured and underinsured individuals and increasing premiums in the future.

While the fraction of Americans covered under ACA marketplace plans is relatively low, it is substantial enough to influence close elections, as reported by KFF in October.

During open enrollment, individuals select their health plans for the upcoming year.

Open enrollment typically continues until Jan. 15, but a cutoff of Dec. 15 is in place to guarantee coverage begins at the start of 2026.

Nevertheless, prospective enrollees find themselves in a precarious financial situation.

Congress has yet to renew the enhanced subsidies that reduce insurance premiums for approximately 22 million out of the 24 million Americans purchasing insurance via ACA exchanges.

According to KFF, a nonpartisan health policy research group, without these enhanced subsidies, health premiums for recipients are projected to spike by 114% in 2026, on average.

Experts highlighted that specific enrollees, such as early retirees with lower incomes, could experience even more substantial increases.

The enhanced subsidies lie at the core of the federal government shutdown that commenced on Oct. 1. This shutdown is now the second-longest in U.S. history, falling behind a 35-day shutdown during President Donald Trump’s first term.

The enhanced subsidies, also referred to as enhanced premium tax credits, have been accessible since their implementation by the Biden administration in 2021 and were extended in 2022. They are set to expire at the close of 2025.

Democrats are advocating for the continuation of these subsidies as a component of negotiations to conclude the shutdown. Contrarily, Republicans have expressed a desire to discuss the subsidies independently.

According to a KFF evaluation from earlier this month, over half, specifically 57%, of ACA marketplace enrollees reside in Republican-held congressional districts. This year, around 80% of all premium tax credits, equating to $115 billion, were allocated to ACA marketplace enrollees in states that President Trump won last election, as KFF determined.

There are 39 congressional districts where a minimum of 10% of the population is enrolled in ACA marketplaces, and where, in the absence of enhanced subsidies, their 2024 average premium payments would have been doubled or more, as KFF reported.

These districts are predominantly located in states won by Trump: 20 are in Texas, followed by seven in Florida and three in Georgia.

If no agreement is reached, many individuals attempting to enroll in a health plan through the Affordable Care Act marketplace will encounter greatly inflated premiums during open enrollment, stated Cynthia Cox, vice president and director of the ACA program at KFF.

The financial implications differ based on criteria such as household income, age, and state.

For instance, a couple aged 60 earning $85,000 could see their annual premiums rise by over $22,600 in 2026, as reported by KFF.

A 45-year-old earning $20,000 in a state that did not expand Medicaid would witness premiums escalate from $0 to an average of $420 annually, it was found.

Numerous potential consequences arise from the congressional stalemate and consumers’ sticker shock during open enrollment, according to Cox.

Many individuals may decide against enrolling due to elevated premiums, resulting in them being uninsured, she noted.

Others, including self-employed individuals and gig workers, might seek more traditional employment that provides employer-sponsored health insurance to avoid ACA marketplace enrollment, she added.

Additionally, some may opt for lower-tier plans with reduced upfront premiums but significantly higher deductibles, meaning they could face substantial bills if they need to utilize their insurance, according to Cox.

Should younger, healthier individuals refrain from enrollment, insurers may end up with an older, less healthy pool of members — arguably compelling them to further escalate annual premiums in the future due to the prevalence of higher-risk enrollees, she conveyed.

The damage may already be inflicted, even if Congress ultimately prolongs the enhanced subsidies, experts cautioned.

Jonathan Burks, executive vice president of health and economic policy at the Bipartisan Policy Center, remarked, “There’s certainly a very real possibility that individuals will log on Nov. 1 and exclaim, ‘Wow, I can’t afford that premium,’ and they may not return to reassess even if enhanced subsidies are later enacted.”

At this juncture, it appears that enhanced subsidies will cease to exist.

Individuals considering an ACA marketplace plan should select their 2026 health insurance with this in mind, according to Cox. In other words, do not choose a plan based on the assumption that Congress will renew the enhanced subsidies, she advised.

Nonetheless, she encourages enrollees to stay informed through the news. If Congress reaches an agreement, enrollees should revisit their options and costs as they may have changed, Cox remarked.

“If I were in this situation, I’d probably note on my calendar to review options around Thanksgiving or early December,” keeping the Dec. 15 cut-off in mind, she suggested.

Fortunately, the open enrollment season provides a degree of flexibility, Burks noted.

Consumers can select a plan and later choose another without repercussions during the open enrollment window, he explained.

“There is no need for people to hurry into making a decision, nor do they incur real costs if they decide early and subsequently wish to reassess before the end of open enrollment,” Burks added.

Current enrollees failing to take any action will be automatically reenrolled in the same or a comparable plan if their current plan is unavailable, experts indicated.

Even individuals in good health who seldom visit a doctor should secure insurance, even a plan with a high deductible, in case of unexpected health incidents, emphasized McClanahan, founder of Life Planning Partners and a member of CNBC’s Financial Advisor Council.

Those with minor health concerns like hypertension or diabetes who have regular check-ups ought to consider high-deductible plans — which generally have lower upfront costs — through the ACA marketplace, she suggested.

It’s advisable to pair that insurance with a direct primary care physician model. Such physicians charge a monthly fee — approximately $150 to $200 — which covers all standard primary care, including basic lab tests and imaging, she stated.

Individuals with severe health conditions requiring frequent medical visits would benefit most from acquiring a comprehensive health insurance plan that encompasses a wide network of physicians and, ideally, a lower deductible, McClanahan advised.

However, this might prove challenging for families who lose enhanced subsidies, she acknowledged.