4 tips for navigating higher ACA health care premiums

If you’re shopping for health insurance right now, you may have come down with a case of sticker shock.

Open enrollment for Affordable Care Act health care marketplaces began Nov. 1, and some insurance premiums have skyrocketed due to congressionally approved enhanced premium tax credits expiring.

Without those credits, some Americans may find their premium prices have doubled, and may feel uncertain about how to proceed.

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

Those premium subsidies greatly helped bring down the cost of health insurance for those who qualified. Since the creation of the ACA in 2010, people with incomes at 400% of the poverty level or lower have gotten subsidized help to pay for marketplace health coverage in the form of premium tax credits. But in response to the COVID pandemic, the federal government allowed people above that income limit to receive subsidies on a sliding scale — and increased the amount it would 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 of premium tax credits to lower their monthly health insurance bills. That jumped to 92% last year.

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

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

Congressional Democrats have demanded an extension of the expanded subsidies, refusing to pass a government budget without them. Republicans say they want to pass a budget and then negotiate over the subsidies. That impasse has led to the ongoing government shutdown, now the longest in history.

Experts say consumers shouldn’t panic, since Congress still may take action. Here are three steps marketplace shoppers should take when looking for health care on the exchange.

1. Don’t rush to pick a plan right now

Familiarize yourself with all of your options, give yourself time, and remain flexible and vigilant.

Marketplaces opened on Nov. 1 and remain open in all states until at least Dec. 15 for health coverage beginning in the new year. Some states have extended enrollment periods, but thinking about early to mid-December as your deadline is a good idea for most people, said Louise Norris, health policy analyst at healthinsurance.org.

Thanksgiving might be a good time for shoppers to sit down, consider their budget and discuss options with family, Cox said. Not only do many people have time off then to look at options, but that also gives Congress a few more weeks to make potential changes.

There are three possible options for how Congress might proceed, Norris said.

They could do nothing, in which case the premiums listed online right now will be the final price.

They could extend the current subsidy enhancements, “in which case almost everyone would see significantly lower premiums for 2026,” she said.

Or they could find a compromise, extending the subsidies but with modifications.

“Since we don’t know what that modification might be, it’s really hard to say how exactly it would affect people’s premiums, but they would be lower for at least some people than what they’re seeing right now,” she said.

READ MORE: Health care subsidies are at the heart of the shutdown fight. Here’s who loses if they expire

Norris said people should go to their state’s marketplace and familiarize themselves with the details of the plans – because those are locked in – but keep in mind that premiums may still drop.

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

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

“My other tip would be to follow this very closely. Make sure you’re staying on top of the news about whether the tax credits are being extended or not,” Cox said.

2. Get help from professionals

Though 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 folks are going to be very busy this year. You can imagine there are 20-something million people who are going to be coming to them with questions, potentially,” she said.

READ MORE: Most Americans are concerned about rising health care costs, AP-NORC poll finds

Brokers and navigators will likely be swamped in the coming weeks, she said, so if you think you may need help understanding your options or selecting a plan, book an appointment now.

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

Additionally, this year, the Trump administration substantially reduced funding to navigators, which are nonprofit organizations that help people understand plans at no cost, among other services. In February, CMS said it would reduce funding from almost $100 million to just $10 million.

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

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

“If it feels overwhelming to look through all the options, a broker or a navigator can really be helpful.”

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

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

For people who “are really perfectly healthy,” who don’t take medications and who want coverage as a “just in case” option, a zero-premium bronze plan might be reasonable, Cox said. But she warned those will have very high deductibles.

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

One benefit to a bronze plan, Norris said, is that they’ll all have health savings account options next year. If Congress allows the pre-2021 “subsidy cliff” to return and your income is right above the threshold that would make you eligible for premium tax credits, consider putting some money in an HSA to lower your projected income for the year.

WATCH: Why millions of Americans are facing a spike in health care costs

“Say, for example, you’re projecting an income of $63,000 as a single person and you go on the marketplace and you see that you don’t qualify for a subsidy at all. If you pick a bronze plan and contribute just $1,000 to that HSA next year, all of a sudden your income drops to $62,000, and you qualify for what could be a really significant subsidy,” Norris said.

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

Even if Congress does extend some or all of the enhanced premium tax credits, Americans should generally plan to budget more for their health care expenses, regardless of whether their insurance is provided by the marketplace or employers, Norris and Cox both said.

That’s because the federal government changed the methodology for out-of-pocket maximums set by insurance companies. That change raised the ceiling for an individual’s health care expenses from $9,200 for 2025 to $10,600 for next year.

That doesn’t mean that all plans will have high out-of-pocket maxes, Norris said. But it does make it important to comparison shop, especially if those costs could be budget-breaking.

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