{"id":1282,"date":"2025-11-04T09:00:00","date_gmt":"2025-11-04T10:00:00","guid":{"rendered":"http:\/\/www.dangeladvertising.com\/?p=1282"},"modified":"2025-11-07T15:00:13","modified_gmt":"2025-11-07T15:00:13","slug":"congressional-stalemate-creates-chaos-for-obamacare-shoppers","status":"publish","type":"post","link":"http:\/\/www.dangeladvertising.com\/index.php\/2025\/11\/04\/congressional-stalemate-creates-chaos-for-obamacare-shoppers\/","title":{"rendered":"Congressional Stalemate Creates Chaos for Obamacare Shoppers"},"content":{"rendered":"

This year\u2019s Obamacare open enrollment period, which started Nov. 1 in most states, is full of uncertainty and confusion for the more than 24 million people<\/a> who buy health insurance through the federal and state Affordable Care Act marketplaces.<\/p>\n

Even with sign-up season underway, the fate of the enhanced premium tax credits that make coverage more affordable for 92% of enrollees<\/a> remains up in the air, with the prospect of significantly higher premiums looming.<\/p>\n

But there are steps marketplace shoppers can take to ensure they make the right choices for the upcoming plan year.<\/p>\n

1. Understand How We Got Here<\/strong><\/p>\n

In 2021, as part of a covid-era relief package, the ACA premium tax credits were enhanced to lower costs for previously eligible people and expand eligibility to people with incomes over 400% of the federal poverty level (which amounts to about $63,000<\/a> for one person in 2025). But those enhancements, which were extended in 2022, will expire<\/a> at the end of 2025 unless Congress acts.<\/p>\n

The debate over whether to extend them again has been at the center of a political battle of wills between Republicans and Democrats in Congress, a fight at the heart of the now month-old government shutdown.<\/p>\n

The financial implications for many marketplace enrollees are huge. Average out-of-pocket premium payments for subsidized enrollees are projected to more than double if the enhanced tax credits expire, according to KFF, a health information nonprofit that includes KFF Health News.<\/p>\n

\u201cThe longer this goes on, the more damage is done,\u201d said Cynthia Cox<\/a>, a vice president and the director of the Program on the ACA at KFF. \u201cIf someone logs on Nov. 1 and sees their premium doubling, they might just walk away.\u201d<\/p>\n

That would be a mistake, marketplace experts agree. What is clear, though, is that buyers need to beware and be informed.<\/p>\n

2. Follow the News<\/strong><\/p>\n

It can be frustrating to track day-to-day Capitol Hill machinations. But that may be your best source for up-to-date information. Congress could make a deal to extend the enhanced subsidies anytime during the next few days, weeks, or months \u2014 or not. Either way, it could affect your enrollment decision. So, pay attention.<\/p>\n

Don\u2019t count on the marketplace or your insurer to notify you about what you should expect to pay. \u201cMany state marketplaces have hit delay\u201d on sending consumers notices of net premiums, which take premium tax credits into account, said Sabrina Corlette<\/a>, a co-director of Georgetown University\u2019s Center on Health Insurance Reforms.<\/p>\n

The federal government doesn\u2019t send enrollees notices about plan premiums for the coming year for the 28 federally facilitated<\/a> marketplaces. For 2026, it has said that health plans can also opt not<\/a> to.<\/p>\n

3. Update Your Account Information<\/strong><\/p>\n

Log in to your marketplace account and update your income, household size, and any other details that have changed.<\/p>\n

This year, it\u2019s particularly important to provide an accurate estimate of your anticipated income for 2026.<\/p>\n

A provision in HR 1, sometimes called the One Big Beautiful Bill Act<\/a>, eliminated the caps<\/a> on what many people were required to repay 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.<\/p>\n

In the past few years, it\u2019s been possible to put your ACA insurance \u201con autopilot,\u201d with automatic reenrollment<\/a> in your current or a similar plan. Given the uncertainty around premiums, this is not a good year to do that, enrollment specialists say.<\/p>\n

This is especially true for people who, without a deal in Congress, will no longer qualify for subsidies next year, specifically those whose incomes are over 400% of the federal poverty level.<\/p>\n

4. Shop Based on Sticker Prices<\/strong><\/p>\n

When people see their projected premiums, assuming Congress hasn\u2019t reached a deal to extend the enhanced credits, many will be shocked.<\/p>\n

Health insurance premiums on the marketplaces are expected to increase, on average, 26% next year, according to KFF<\/a>. That\u2019s the largest rate increase since 2018.<\/p>\n

Until now, people have largely been shielded from those increases by the enhanced premium tax subsidies that nearly all enrollees receive. Here\u2019s how it works: Most people with ACA marketplace plans are responsible for paying a portion of their premium based on a sliding income scale, and the government pays the rest.<\/p>\n

According to an analysis by KFF, if the enhanced credits are not renewed, a family of four with $75,000 in income, for example, will be responsible<\/a> for paying $5,865 in annual premiums for a benchmark silver plan in 2026 \u2014 more than double the $2,498 it\u2019ll pay if they are renewed.<\/p>\n

When evaluating a plan, focus on the listed price. If it\u2019s not affordable without the enhanced tax credits, it\u2019s not a good buy.<\/p>\n

\u201cPeople need to make a decision based on what is in front of them,\u201d Cox said.<\/p>\n

If you can\u2019t 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 provide comprehensive coverage, including covering preventive care at no cost, and may cover some doctor visits before the deductible.<\/p>\n

\u201cIn most cases, it makes more sense to have a bronze plan than to be uninsured,\u201d she said.<\/p>\n

The Trump administration has been promoting catastrophic plans<\/a> as a more affordable option for people who face financial hardship, including those who don\u2019t qualify for subsidies because their incomes are either less than 100% or more than 400% of the federal poverty level.<\/p>\n

Similar to bronze plans, catastrophic plans cover a set of essential health benefits, provide free preventive care, and must cover at least three doctor visits before people reach their deductible. But catastrophic plan deductibles are the highest of any type of marketplace plan: $10,600 for individuals and $21,200 for families in 2026.<\/p>\n

\u201cThey are expensive relative to what they cover,\u201d said Jennifer Sullivan<\/a>, director of health coverage access at the Center on Budget and Policy Priorities, noting premiums can cost several hundred dollars.<\/p>\n

5. Come Back, Check, and Recheck<\/strong><\/p>\n

If you\u2019re dismayed at premium prices on your first pass, \u201cdon\u2019t slam the computer shut and decide that there are no options for you,\u201d Sullivan said. \u201cCongress might still act and things might change radically.\u201d<\/p>\n

Lawmakers could restore the enhanced premium tax credits right up to the end of the year, or later.<\/p>\n

In a majority of states, including the 28 that use the federal government\u2019s centralized marketplace, open enrollment lasts until Jan. 15. There are also other key dates to remember.<\/p>\n

In most states, people must enroll<\/a> by Dec. 15 for coverage starting Jan. 1, and by Jan. 15 for coverage starting Feb. 1, though some states have later deadlines.<\/p>\n

6. Wait To Pay Your Premium<\/strong><\/p>\n

Premium payments are generally due before the plan takes effect, although marketplaces and insurers have flexibility to extend deadlines, Corlette said.<\/p>\n

They might allow people extra time to make a first payment, for example. \u201cWe\u2019ve seen that in the past. State officials and insurance companies have gotten creative to try and keep people in coverage,\u201d she said.<\/p>\n

But if there is a last-minute deal and someone has already paid their premium for January coverage and received a lower tax credit than the deal provides, they should still be able to receive the higher credit.<\/p>\n

\u201cThere are ways to make people whole,\u201d Corlette said, although how that might happen this enrollment period is unclear.<\/p>\n

KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n

USE OUR CONTENT<\/h3>\n

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