Congressional Stalemate Creates Chaos for Obamacare Shoppers

This year’s Obamacare open enrollment period, which began Nov. 1 in most states, is fraught with uncertainty and confusion for the more than 24 million people who shop for health insurance on the Affordable Care Act’s federal and state marketplaces.

Even with the enrollment season underway, the fate of enhanced premium tax credits that make coverage more affordable for 92% of policyholders remains up in the air, with the prospect of significantly higher premiums looming.

But there are steps market buyers can take to ensure they’re making the right choices for the plan year ahead.

1. Understand how we got here

In 2021, as part of a covid relief package, the ACA premium tax credits were enhanced to reduce costs for previously eligible individuals and expand eligibility to individuals with incomes above 400% of the federal poverty level (equivalent to approximately $63,000 for an individual in 2025). But those improvements, which were extended into 2022, will expire at the end of 2025 unless Congress acts.

The debate over whether to extend them again has been at the center of a political battle between Republicans and Democrats in Congress, a fight at the heart of the government shutdown for a month now.

The financial implications for many registrants in the market are enormous. According to KFF, a nonprofit health news organization that includes KFF Health News, average premiums paid for subsidized enrollees are expected to more than double if the enhanced tax credits expire.

“The longer this goes on, the more damage is done,” said Cynthia Cox, vice president and director of the ACA program at KFF. “If someone logs in on November 1 and sees their bonus double, they may be gone.”

That would be a mistake, market experts agree. What is clear, however, is that buyers need to be careful and informed.

2. Follow the news

It can be frustrating to follow the machinations of the Capitol on a daily basis. But it may be your best source of up-to-date information. Congress could strike a deal to extend the enhanced subsidies at any time in the coming days, weeks or months – or not. Either way, it could affect your enrollment decision. So, be careful.

Don’t rely on the market or your insurer to tell you what you should expect to pay. “Many state markets have fallen behind” in sending consumers net premium notices, which take into account premium tax credits, said Sabrina Corlette, co-director of the Center on Health Insurance Reforms at Georgetown University.

The federal government does not send notices to enrollees regarding plan premiums for the upcoming year for the 28 federally facilitated marketplaces. For 2026, it was clarified that health plans could also choose not to do this.

3. Update your account information

Log in to your Marketplace account and update your income, household size, and any other details that have changed.

This year, it is especially important to provide an accurate estimate of your anticipated income for 2026.

A provision of H.R. 1, sometimes called the One Big Beautiful Bill Act, eliminated caps on what many people were required to pay back if they underestimated their projected income and received more premium assistance than they should have. Next year, people will have to repay the entire excess amount.

In recent years, it has been possible to put your ACA insurance “on autopilot,” with automatic re-enrollment in your current plan or similar. Given the uncertainty surrounding bonuses, this is not a good year to do this, enrollment specialists say.

This is especially true for people who, without a deal in Congress, will no longer be eligible for subsidies next year, particularly those whose incomes exceed 400% of the federal poverty level.

4. Shop based on sticker prices

When people see their projected premiums, assuming Congress has not reached an agreement to extend the enhanced credits, many will be shocked.

Health insurance premiums on marketplaces are expected to increase by an average of 26% next year, according to KFF. This is the largest rate increase since 2018.

So far, people have been largely protected from these increases thanks to enhanced tax subsidies that benefit almost all enrollees. Here’s how it works: Most people with ACA marketplace plans are responsible for paying part of their premium based on a sliding income scale, and the government pays the rest.

According to a KFF analysis, if the enhanced credits are not renewed, a family of four with an income of $75,000, for example, will be responsible for paying $5,865 in annual premiums for a benchmark silver plan in 2026, more than double the $2,498 they will pay if they are renewed.

When evaluating a plan, focus on the listed price. If it’s not affordable without the enhanced tax credits, it’s not a good buy.

“People have to make a decision based on what’s in front of them,” Cox said.

If you can’t afford the sticker price without the enhanced credits, consider enrolling in a less generous plan with a lower premium but a higher deductible, Cox said. Bronze plans must offer comprehensive coverage, including free preventative care coverage, and may cover certain doctor visits before the deductible.

“In most cases, it makes more sense to have a bronze plan than to be uninsured,” she said.

The Trump administration is promoting catastrophic plans as a more affordable option for people facing financial hardship, including those who do not qualify for subsidies because their income is either less than 100% or more than 400% of the federal poverty level.

Similar to Bronze plans, catastrophic plans cover a package of essential health benefits, provide free preventive care, and must cover at least three doctor visits before people meet their deductible. But catastrophic plan deductibles are the highest of all plan types on the market: $10,600 for individuals and $21,200 for families in 2026.

“They’re expensive for what they cover,” said Jennifer Sullivan, director of health coverage access at the Center on Budget and Policy Priorities, noting that premiums can cost several hundred dollars.

5. Come back, check and recheck

If you’re dismayed by high prices on your first pass, “don’t close the computer and decide there are no options for you,” Sullivan said. “Congress could still act and things could change dramatically.”

Lawmakers could reinstate the enhanced premium tax credits until the end of the year, or later.

In the majority of states, including the 28 that use the federal government’s centralized marketplace, open enrollment lasts until January 15. There are also other key dates to remember.

In most states, people must sign up by December 15 for coverage starting January 1 and by January 15 for coverage starting February 1, although some states have later deadlines.

6. Wait to pay your premium

Premium payments are typically due before the plan goes into effect, although marketplaces and insurers have the ability to extend deadlines, Corlette said.

For example, they could give people more time to make a first payment. “We’ve seen it in the past. State officials and insurance companies have been creative in trying to keep people covered,” she said.

But if there is a last-minute deal and a person has already paid their premium for January coverage and received a lower tax credit than the deal provided, they should still be able to take the higher credit.

“There are ways to make people whole,” Corlette said, although it’s unclear how that might happen during this enrollment period.