- Healthcare experts expect monthly premiums for health insurance plans purchased through the Affordable Care Act to increase significantly in 2026.
- Out-of-pocket costs for medical expenses are also expected to rise.
- In addition, they say fewer people may be eligible to purchase insurance through the federal government program.
The 11-week enrollment period for Affordable Care Act (ACA) health insurance plans runs from November 1 through January 15, 2026.
Experts say people using this federal program to purchase insurance should examine their options carefully.
They say that’s because consumers can expect to pay higher premiums and out-of-pocket costs under their 2026 plans.
They also expect fewer people to be eligible for Affordable Care Act (ACA) coverage and predict less help will be available for people who need assistance signing up.
In addition, experts say short-term health insurance plans may not be a good option for those looking for alternatives to ACA plans.
They blame the increased costs and other difficulties on higher healthcare costs, tariffs, and the federal government shutdown.
Here is a look at some of the key changes to expect when the ACA enrollment period.
More than 90% of Obamacare enrollees receive subsidies to help them pay their monthly insurance premiums.
Those subsidies are at the heart of the budget disagreement between Republican and Democratic leaders that led to the federal government shutdown that began on October 1.
The subsidies are scheduled to expire at the end of 2025. Democrats want to lock in an extension of those subsidies as part of the government funding legislation. Republicans don’t want that provision in the bill.
The Kaiser Family Foundation (KFF) estimates that without the subsidies, ACA monthly insurance premiums for an individual would rise anywhere from $378 to $1,836 per year, depending on household income.
Without subsidies, the premiums for a family of four are predicted to rise from $840 to $3,201.
Georgetown University’s Center on Health Insurance Reforms has published some specific predictions.
- A family of four living in New Hampshire that earns $50,000 per year living will see their premiums jump from $9 to $186 per month.
- Two retirees in their early 60s living in Wisconsin on an income of $85,000 per year will see their premiums jump from $602 to $2,144 per month.
- A 28-year-old living in Oregon earning $25,000 per year will see their premiums jump from $8 to $97 per month.
The Kaiser Family Foundation (KFF) also predicts that companies that sell insurance through the ACA framework will raise monthly premiums in general by a median of 18% due to increasing healthcare costs.
Whitney Stidom, vice president of consumer enablement at eHealth, points out that the amount ACA enrollees pay for premiums out of their own pocket is predicted to rise by an average of 75% next year.
“If Congress doesn’t act soon, the enhanced subsidies (or extra financial help) many low-income and middle-income people received since 2021 will end, causing out-of-pocket premiums to spike for individuals and families,” she told Healthline.
Kanwar Kelley, MD, a specialist in otolaryngology, head and neck surgery, obesity medicine, and lifestyle medicine, and the co-founder and chief executive officer of Side Health in Orinda, CA, said these higher premiums will have a significant impact.
“These subsidies have been crucial in keeping plans affordable for middle-income and low-income families. Without them, the program would price out the population it was designed to help,” Kelley told Healthline.
It’s been reported that an individual’s annual out-of-pocket costs under ACA plans will increase from $9,200 in 2025 to $10,600 in 2026.
The out-of-pocket costs under family ACA plans is scheduled to rise from $18,400 in 2025 to $21,200 in 2026.
Stidom said these higher costs make it even more important for people to shop carefully when signing up for ACA plans.
She cited an eHealth report indicating that people can save an average of $2,000 per year by comparison shopping with a licensed insurance agency.
Experts predict that fewer people will be part of the Obamacare system in 2026.
For starters, experts say the uncertainty of the subsidies and the ACA marketplace in general might discourage some consumers from enrolling in Obamacare programs.
The Trump administration also slashed funding by 90% for navigators who helped guide consumers through the ACA marketplace in 28 states. That could also reduce the number of people who sign up.
In addition, new rules enacted by the Centers for Medicare & Medicaid Services (CMS) in June 2025 repealed the monthly special enrollment period for individuals with projected household incomes at or below 150% of the federal poverty level.
The rules also installed income verification processes for people receiving insurance premium subsidies.
Some insurance carriers may also opt out of the ACA marketplace. Aetna has already announced it will not participate in the ACA system in 2026.
Short-term, limited-duration health plans have been sold in the past to individuals through the “non-group” (individually-purchased) private insurance market and through industry associations.
These plans, sold in 36 states, were designed for individuals who experience a temporary gap in health coverage, such as those between jobs.
They’ve been marketed as less expensive alternatives to plans sold through the ACA exchange. They generally offer coverage from 1 to 6 months.
However, an October 2025 report from the Kaiser Family Foundation (KFF) noted a number of issues with these insurance plans. They include:
- Short-term health insurance health plans don’t provide subsidies, so people who purchase them may end up with higher monthly premiums than people with subsidized ACA plans.
- Many short-term plans exclude people with medical pre-existing conditions, so applicants with cancer, obesity, or who are pregnant may be declined coverage.
- Short-term plans generally have higher deductibles, some as high as $25,000 per year.
- 40% of short-term plans don’t cover mental health or substance use disorder treatments, and more than 90% don’t cover adult immunizations or maternity care.
- Short-term health insurance plans are not required to allow consumers to automatically renew their policies. “An individual who buys a short-term policy and then becomes seriously ill will not be able to renew coverage when the policy ends,” the KFF report states.
In addition, the Trump administration has stated it won’t enforce consumer protections on short-term plans.
According to the KFF report, consumers “could end up enrolled in plans that cover less than they thought and leave them on the hook for higher out-of-pocket costs than are permitted under [ACA] plans.”
The Commonwealth Fund estimates that 5 million Americans will lose their ACA health insurance coverage in 2026 if Congress does not renew subsidies.
CBO officials also predict that eligibility changes made by the Trump administration will cause 3 million more Americans to become uninsured.
The Center on Budget and Policy Priorities notes that many people who sign up for ACA plans in the fall may not be aware of how much their monthly premiums have increased until they make their first payment in January.
That “sticker shock” will also be true for the 50% of ACA enrollees whose polices are automatically renewed each year.
In addition, the Commonwealth Club estimates that nearly 340,000 people in health-care related professions will lose their jobs next year as healthcare providers reduce their workforces in reaction to fewer people having health insurance.
The research organization also projects that the loss of individual and business income will cause state and local tax revenues to decline by $2.5 billion.
Kelley said these impacts could have ripple effects throughout the country.
“When prices for plans increase, families will have to make decisions on downgrading to cheaper plans with less coverage and higher deductibles or dropping insurance,” he explained.
“This will lead to smaller pools of insured individuals who will utilize more services, driving up costs even more. Those without coverage will delay or forego preventive care, which tends to increase healthcare costs long-term as primary prevention is lost.”
Consumers can sign up on the federal government’s healthcare.gov website. Here are some basics you should know.
If you don’t sign up during the open enrollment period, you can’t enroll or change coverage during the rest of the year unless you have a “life change” such as losing your health insurance or having a baby.
Most enrollees qualify for programs that help lower premiums, out-of-pocket costs, and deductible payments.
Most ACA plans cover 10 essential health benefits, including emergency services, hospitalization, preventive services (i.e., recommending screenings), laboratory services, and prescription drugs.
Monthly premiums are paid directly to your insurance company. Failure to pay can result in the loss of coverage.
The ACA’s primary objectives were to provide an opportunity for everyone to purchase health insurance regardless of pre-existing medical conditions or other restrictions. It also helped lower monthly premiums and out-of-pocket costs.
In 2025, more than 24 million Americans had health insurance through the Affordable Care Act, the highest number of enrollees for any one year. This is more than double the number of people who signed up for coverage in 2021.
The ACA marketplace remains an important source of health insurance coverage for people who are self-employed or own small businesses, in addition to individuals and families.
Stidom said that ACA plans remain a cost-effective purchase for most households.
“It’s key to remember that ACA plans will, for most people, still be the most affordable way to obtain comprehensive health insurance coverage, which can help improve access to preventive care and provide financial protection in case of serious medical issues,” she said.
“It’s also important for people to compare plans carefully and not assume what worked this year is the right option for 2026.”
