The Affordable Care Act (ACA) health insurance market is set to open for enrollment on November 1st (Saturday) in the United States. The latest data shows that insurance companies are expected to increase premiums by 26%, but the actual premium increase paid by most policyholders may be even higher.
According to the non-profit healthcare policy research organization, the Kaiser Family Foundation (KFF), on October 28th, health insurance companies on the ACA marketplace are expected to raise premiums by an average of 26%. For individuals purchasing insurance for the 2026 fiscal year in state insurance markets, premiums will increase by 17%. For enrollees using the federally run Healthcare.gov platform, the average premium increase is even higher at 30%.
KFF reports that the factors behind the premium increase include higher hospital costs and more people using a weight loss drug called GLP-1.
The 26% increase refers to the rise in fees charged by insurance companies, which in most cases is not the amount actually paid by policyholders. Currently, out of the 24 million Americans purchasing insurance through the ACA marketplace, 22 million receive tax credits. The actual amount these subsidized policyholders pay is not the full premium charged by the insurance company, but rather a subsidized amount calculated based on a formula established by Congress, proportional to household income.
KFF analysis indicates that if the ACA’s Enhanced Premium Tax Credits policy expires, most policyholders will face even greater cost increases. The average premium for roughly 22 million individuals receiving tax credits could rise by 114%. For early retirees with limited incomes and lower-middle-class families, they may face larger premium hikes.
Cynthia Cox, the Vice President of KFF, pointed out, “Many people may find the premium increase too burdensome when they enroll.”
The federal government’s shutdown since October 1st centers around the Enhanced Premium Tax Credits. This shutdown has become the second-longest in U.S. history, trailing only the 35-day shutdown during President Trump’s first term.
Enhanced Premium Tax Credits, also known as Enhanced Premium Tax Deductions, were implemented by the Biden administration in 2021 and have been in effect since, with an original expiration set for the end of 2025. Democrats hope to include an extension of the subsidies in the agreement to end the shutdown, while Republicans prefer standalone negotiations on the subsidy issue.
Cox analyzed that if the subsidies are cut off, many self-employed individuals and freelancers may be forced to seek jobs with employer-sponsored health insurance to avoid paying expensive premiums out of pocket.
She stated that some may turn to insurance plans with lower premiums but higher deductibles, potentially increasing the risk of higher out-of-pocket medical expenses in the future.
She pointed out that if young and healthy individuals refrain from enrolling, insurance companies may face an aging and less healthy enrollee pool, which could lead to further premium increases due to an increase in high-risk policyholders.
The enrollment period for the 2026 ACA begins on November 1st and runs until January 15, 2026. To have insurance effective at the beginning of next year, enrollment must be completed by December 15th.
Experts recommend that enrollees evaluate insurance plans based on current policies, not assuming that Congress will extend the subsidies. If an agreement is reached by Congress, they should reconsider insurance plans promptly, as previous choices and costs may have changed.
Cox said, “If it were me, I would start looking at insurance plans around Thanksgiving or early December.” She emphasized that there is flexibility during the enrollment period, allowing enrollees to switch plans within the deadline without incurring any losses.
Carolyn McClanahan, founder of Life Planning Partners, advises even healthy individuals to maintain basic health coverage to guard against unforeseen serious illnesses. She suggests opting for high deductible plans and combining them with a Direct Primary Care model to save on costs.
She noted that for those with severe illnesses requiring frequent medical visits, purchasing a comprehensive health insurance plan covering a wide scope, a well-established network of doctors, and ideally lower deductibles, is the best choice.
With the continued congressional shutdown, uncertainty in the U.S. health insurance market is increasing. The future direction of ACA subsidies not only affects the health security of tens of millions of policyholders but may also become a political issue leading up to the 2026 midterm elections.