4 Tips for Navigating Higher ACA Health Care Premiums

If you’re shopping for health insurance right now, you’ve probably experienced a case of sticker shock.

Open enrollment for health care marketplaces under the Affordable Care Act began Nov. 1, and some premiums have risen dramatically because of the expiration of enhanced tax credits approved by Congress.

Without those credits, some Americans may find that their premium rates have doubled, and they may feel unsure about how to move forward.

“This will likely be the most chaotic open enrollment period since the markets first launched,” said Cynthia Cox, vice president and ACA program director at KFF.

These premium subsidies have helped significantly reduce the cost of health insurance for those who qualify. Since the ACA was created in 2010, people with incomes of 400% of the poverty level or less have received subsidized help to pay for health coverage in the marketplace in the form of premium tax credits. But in response to the coronavirus pandemic, the federal government has allowed people above that income threshold to receive benefits on a sliding scale — and increased the amount it will contribute for those below it — through enhanced premium tax credits.

According to a federal report from the Center for Medicare and Medicaid Services, in 2020, 84% of Marketplace customers received advance payments from premium tax credits to lower their monthly health insurance bills. That jumped to 92% last year.

Compare the average cost of a monthly premium before tax breaks in 2020 at $584, versus $619 last year. But with the credits, the average amount customers paid in premiums fell between 2020 and 2025, from $162 to $113.

The enhanced tax credits were originally created under the American Rescue Plan Act in 2021 and extended through this year in 2022, but they just expired at the end of the fiscal year on September 30.

Democrats in Congress called for extending the expanded support, refusing to pass a government budget without it. Republicans say they want to pass the budget and then negotiate support. This impasse has led to a continuing government shutdown, now the longest in history.

Experts say consumers shouldn’t panic, as Congress could still take action. Here are three steps market shoppers should follow when searching for health care on the market.

1. Don’t rush to choose a plan now

Know all your options, give yourself time, and be flexible and vigilant.

The marketplaces opened on November 1 and remain open in all states through at least December 15 for health coverage starting in the new year. Some states have extended enrollment periods, but thinking of early to mid-December as a deadline is a good idea for most people, said Louise Norris, a health policy analyst at healthinsurance.org.

Thanksgiving may be a good time for shoppers to sit down, think about their budget and discuss options with family, Cox said. Not only does this give many people time off to consider options, but it also gives Congress a few extra weeks to make potential changes.

Norris said there are three possible options for how Congress could operate.

They couldn’t do anythingIn this case, the premiums listed online now will be the final price.

It can be stretched Given the current improvements in subsidies, “in which case almost everyone will see much lower premiums for 2026,” she said.

Or they can come to a compromiseExtending subsidies, but with modifications.

“Since we don’t know what this adjustment is, it’s really hard to say how much it will impact people’s premiums, but it will be lower for at least some people than they’re seeing now,” she said.

Read more: Health care subsidies are at the heart of the lockdown fight. Here who loses if it expires

Norris said people should go to the marketplaces in their state and find out the details of the plans — because those plans are locked — but keep in mind that premiums may continue to decline.

If Congress extends premium subsidies and you’ve already set up a plan, don’t worry. Plans can be changed during the entire open enrollment period.

Regardless of whether you choose a plan now or bide your time, both Cox and Norris recommend paying attention to any potential changes.

“My other advice is to follow this closely. Make sure you stay up to date on the news about whether or not the tax breaks will be extended,” Cox said.

2. Get help from professionals

Although you may have until mid-December to finalize a plan, consumers should consider meeting with an agent, broker or navigator sooner rather than later, Cox advised.

“These people are going to be very busy this year,” she said. “You can imagine there are close to 20 million people coming to them with questions, probably.”

Read more: Most Americans are concerned about rising health care costs, an AP-NORC poll shows

Brokers and navigators are likely to be overwhelmed in the coming weeks, so if you think you might need help understanding your options or deciding on a plan, book an appointment now, she said.

“A lot of them have been doing this for years and years. They’re trusted people. You can look at their reviews, talk to friends, and maybe they’ll have a recommendation,” Cox suggested.

Additionally, this year, the Trump administration dramatically reduced funding for navigators, nonprofits that help people understand plans at no cost, among other services. In February, CMS said it would cut funding from about $100 million to just $10 million.

Navigators are great at helping people understand their options, but only state-licensed brokers can advise clients and make recommendations, Norris said. Although brokers are paid on commission, the rates are fairly similar across insurance companies, so clients shouldn’t worry too much about bias if they’re steered toward a particular plan.

Asking for help is “a really good idea, especially if you have concerns about wanting to include certain doctors in your network, or needing to cover certain medications,” Norris said.

“If it’s hard for you to look at all the options, a broker or navigator can be really helpful.”

3. Consider your health and finances when shopping for a plan

Many people who buy marketplace coverage have low incomes and qualify for cost-sharing assistance, meaning they get much lower deductibles, Cox said. This assistance is only available on silver plans, and while those premiums may increase, she said silver plans may still often be the better option, because deductibles will still be relatively low.

For people who are “really healthy,” who don’t take medications and want coverage as an option “just in case,” a no-premium bronze plan may make sense, Cox said. But she warned that these will have very high discounts.

“If what they really care about is not making a monthly payment, that’s an option for them,” she said.

One benefit of the bronze plan is that they will all have health savings account options next year, Norris said. If Congress allows the “subsidy cliff” to return before 2021 and your income is just above the threshold that makes you eligible for premium tax credits, consider putting some money into a HSA to lower your expected income for the year.

He watches: Why are millions of Americans facing soaring health care costs?

“Let’s say, for example, you’re anticipating an income of $63,000 as a single person, and then you go into the market and see that you don’t qualify for a subsidy at all. If you choose a bronze plan and you only contribute $1,000 to an HSA next year, suddenly your income drops to $62,000, and you qualify for a really big subsidy,” Norris said.

4. No matter what insurance you have, budget more for health care next year

Norris and Cox said that even if Congress extends some or all of the enhanced tax breaks, Americans should generally plan to budget more for their health care expenses, regardless of whether their insurance is provided by the marketplace or employers.

This is because the federal government changed the methodology for the maximum amounts set by insurance companies. This change raised the cap on per capita health care expenses from $9,200 for 2025 to $10,600 for next year.

That doesn’t mean all plans will have high out-of-pocket maximums, Norris said. But that makes it important to compare, especially if these costs may exceed your budget.

“Whether you’re staying on your same plan and paying more for it, or you’re moving to a plan with a lower premium but a higher deductible, you’re likely going to have higher health care costs next year one way or another,” Cox said.