As the Affordable Care Act (ACA) open enrollment period kicks off on November 1, 2025, millions of Americans are bracing for a wave of uncertainty and sticker shock. For the more than 24 million people who buy their health insurance through federal and state ACA marketplaces, this year’s enrollment comes with the highest premium hikes in years and the looming expiration of enhanced premium tax credits that have made coverage affordable for most enrollees.
These enhanced tax credits, first introduced as part of a COVID-era relief package in 2021 and extended in 2022, expanded eligibility to those with incomes above 400% of the federal poverty level—about $63,000 for an individual in 2025. According to KFF Health News, these subsidies have kept out-of-pocket premium costs manageable for 92% of marketplace enrollees. But unless Congress acts before the end of 2025, the credits will vanish, sending premiums soaring for millions.
The financial impact could be dramatic. KFF, a nonprofit health information organization, projects that average out-of-pocket premiums for subsidized enrollees could more than double if the enhanced credits expire. For a family of four earning $75,000, annual premiums for a benchmark silver plan could jump from $2,498 to $5,865 in 2026. Health insurance premiums on the marketplaces are expected to increase by an average of 26% next year—the steepest hike since 2018.
The situation is especially dire in states like Florida, which boasts the largest number of ACA recipients nationwide. According to the Centers for Medicare and Medicaid Services, about 4.7 million Floridians rely on the ACA marketplace for coverage. Scott Darius, executive director of Florida Voices for Health, told WUSF that premiums in Florida are expected to rise between 20% and 40% in 2026. "What every insurer pointed to, in large part, for their increase, was the fact that they did not expect Congress to reauthorize the premium tax credits," Darius explained. As a result, he anticipates that about 1.4 million Floridians—nearly 30% of enrollees—could be priced out of coverage entirely.
Ohioans aren’t faring much better. According to new marketplace data from KFF researchers, the roughly 583,000 Ohioans who purchase ACA insurance will see premiums increase by 13% to 17% in 2026. For a 40-year-old, monthly premiums in Ohio will be $400 for a bronze plan (up $47), $513 for silver (up $76), and $548 for gold (up $72). Nearly 90% of Ohio’s ACA enrollees receive subsidies, but those subsidies are set to shrink or disappear if Congress doesn’t intervene.
The political battle over the fate of these subsidies is fierce. Democrats in the U.S. Senate have refused to back a federal spending package unless Republicans agree to extend the expiring subsidies, a standoff that’s contributed to a 29-day government shutdown as of October 31, 2025. The enhanced subsidy’s expiration is a central issue in the budget impasse, with high stakes for millions of Americans.
For many, the prospect of losing affordable coverage is more than just numbers on a spreadsheet—it’s a gut-wrenching reality. Lisa Ferrigno, a violinist and part-time Disney cast member in Winter Park, Florida, told WUSF she’s been forced to reconsider her options after seeing her "bare-bones, bronze plan" more than double in price. "It’s not going to be a situation of going without health insurance, because I would never do that," Ferrigno said. "I just feel like I don't have any choices." She added, "It’s kind of stark. It’s not like, ‘Oh, it went up 20%.’ It’s like, ‘Oh, it went up 200%.’"
Experts warn that as premiums rise, healthier people are more likely to drop their coverage, leaving a "sicker risk pool" behind. "That just goes to make health insurance more expensive—not just for people enrolled in ACA plans, but as we’re seeing, for everyone, in every kind of insurance market," Darius noted. The cycle could drive costs even higher, compounding the crisis.
Marketplace advisors across the country are urging consumers to stay vigilant and proactive. Cynthia Cox, vice president and director of the Program on the ACA at KFF, told LAist, "The longer this goes on, the more damage is done. If someone logs on Nov. 1 and sees their premium doubling, they might just walk away." But she and others caution against giving up. Shoppers are advised to carefully update their income and household information, avoid auto-enrollment, and shop based on the actual sticker price of plans—not just the subsidized cost.
Catastrophic plans, which have the highest deductibles ($10,600 for individuals and $21,200 for families in 2026), are being promoted as a last-resort option for those who can’t afford standard plans. However, Jennifer Sullivan of the Center on Budget and Policy Priorities warned LAist that "they are expensive relative to what they cover," and their high out-of-pocket costs may leave many without meaningful protection.
Consumers are also encouraged to track developments in Congress closely. Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms, pointed out that many state marketplaces have delayed sending notices about net premiums because of the uncertainty. The federal government, which oversees 28 state marketplaces, does not send enrollees notices about upcoming plan premiums. For 2026, health plans may also choose not to send such notices, adding to the confusion.
Open enrollment in most states runs until January 15, 2026. To secure coverage starting January 1, shoppers must enroll by December 15, 2025; enrollment by January 15 secures coverage starting February 1. Premium payments are generally due before coverage starts, but some insurers may offer flexibility, especially if Congress acts at the last minute to restore subsidies. Corlette reassured LAist, "There are ways to make people whole," even if payments have already been made under less favorable terms, though the process remains unclear for this cycle.
In the meantime, healthcare advocates like Darius are urging people to prioritize their needs, shop early, and seek out trusted help. "Knowing that costs have gone up, you may have to make other plans and arrangements to really get exactly what you need," he advised.
For millions of Americans, the next few months will be a test of endurance, adaptability, and hope. As Congress debates and premiums climb, the choices facing families and individuals are as tough—and as consequential—as ever.
