As Premiums Soar and Congress Battles, Open Enrollment for ACA Health Insurance Is Underway

THURSDAY Nov. 6, 2025 (HealthDay News) — The open enrollment period for health insurance through the Affordable Care Act (ACA) began this week with what is expected to be the largest cost increase since Obamacare was enacted in 2010.

More than 24 million Americans who don’t have employer-sponsored health insurance get their coverage through the HealthCare.gov marketplace, and many will face significantly higher bills in 2026, reports NBC News.

Any U.S. citizen and some immigrants can sign up for ACA coverage through the marketplace; there is no income limit or pre-existing condition limitation, according to USA.gov.

But rising premiums and the anticipated expiration of enhanced subsidies — tax credits for many middle-class families put in place in 2021 — are driving much higher costs.

“Enhanced subsidies” are health premium tax credits that apply to most ACA members today. The credits are aimed at individuals earning up to $78,800 a year and families of four earning up to $163,200, whose premiums exceed roughly 8.5% of their income.

This is the main point of contention in the government shutdown as some lawmakers aim to restore the tax credits for the more than 22 million Americans who received them.

At the same time, insurers are raising their rates to cover the higher costs of prescription drugs, hospital care and increased demand for medical services.

With loss of the subsidies, some people could see their premiums increase by an average 114%, according to NBC News.

The situation is leading some Americans to consider going uninsured, a choice experts warn is highly risky.

“If it comes down to paying for food, power and heat versus health insurance that you don’t know if you’ll need or not, it’s hard to continue to pay for that given how much of your budget it takes today,” Stacie Dusetzina, a health policy professor at Vanderbilt University in Nashville, Tennessee, told NBC News.

If the tax credits expire, the Congressional Budget Office projects that 3.8 million people a year, on average, will drop their coverage over the next eight years.

“It’s a double whammy,” Cynthia Cox, director of the program on the ACA at the health policy research firm KFF, told NBC News. “People aren’t just losing the tax credits, but then they’re also paying this steep increase in what insurance companies are charging.”

Despite the government shutdown, open enrollment is underway online. People may sign up for ACA health insurance through Jan. 15 in most states.

• To ensure coverage begins Jan. 1, you must enroll by Dec. 15 in most states.

• Plans selected after Dec. 15 typically take effect Feb. 1.

More information

The official website for the marketplace is HealthCare.gov.

SOURCE: NBC News, Oct. 31,2025