For the millions of Americans relying on Affordable Care Act (ACA) insurance, the window for enrollment for the 2026 coverage year is still open. However, recent premium increases and the expiration of enhanced tax subsidies have resulted in unexpectedly high costs. Many concerned shoppers are reaching out to insurance brokers or calling ACA marketplace representatives to explore their options. "We're hearing from individuals with complex medical conditions who feel they cannot survive without access to medical care," stated Audrey Morse Gasteier, executive director of the Massachusetts Health Connector.
Some consumers are even contemplating alternatives outside the ACA framework to find more affordable options, but this path requires careful consideration. Currently, Congress shows little inclination to extend the enhanced subsidies before the year concludes. Recently, the House passed a conservative-backed package that does not address these subsidies, which is largely expected to stall in the Senate. However, a coalition of four GOP moderates and Democrats has initiated a discharge petition to force a vote on a three-year extension, likely scheduled for January. If approved, these subsidies could potentially be applied retroactively.
As the deadline for selecting a health plan looms, consumers must act quickly. The official end of open enrollment is January 15, 2026, with coverage commencing on February 1. For most states, the opportunity to enroll for coverage starting January 1 has already passed. Here are five critical considerations to keep in mind during the decision-making process:
Some ACA shoppers may be tempted to explore short-term insurance plans sold outside government-run marketplaces, often recommended by insurance brokers. However, it’s vital to proceed with caution. Designed as temporary coverage for transitional situations like job changes or school attendance, short-term plans can appear similar to traditional insurance, featuring deductibles and participating networks. Nevertheless, they are not ACA-compliant and are not available on official ACA marketplaces.
Although short-term plans often come with lower premiums, they provide limited coverage. For instance, they may impose annual and lifetime caps on benefits, do not cover maternity care, and could exclude prescription drug coverage. Applicants typically must complete a medical questionnaire, allowing insurers to deny coverage or retroactively cancel policies for pre-existing conditions. Additionally, short-term plans are not mandated to cover essential benefits outlined by the ACA, such as preventive care and emergency services. Critics have labeled these plans as "junk insurance," while proponents argue they might be suitable for specific individuals. "If you choose to enroll in short-term coverage, make sure you understand what it lacks," advised Ronnell Nolan, president and CEO of Health Agents of America.
Another type of health coverage that consumers may encounter is known as an indemnity plan, which supplements traditional health insurance by contributing toward deductibles or copayments. Similar to short-term plans, these indemnity plans do not adhere to ACA coverage regulations and typically pay a fixed dollar amount for services, which may fall short of total costs, leaving policyholders responsible for the remaining balance.
Another option is a faith-based sharing plan, which pools contributions from members to cover medical expenses. These plans are not recognized as insurance and have faced scrutiny for their lack of guaranteed payouts for health expenses. While they generally cost less than ACA plans, they are not subject to ACA rules, making them a last resort for many consumers.
For those who wish to remain within the ACA framework, exploring Bronze or Catastrophic plans may be beneficial. These plans usually have lower premiums but come with significantly higher deductibles. According to KFF, the average deductible for bronze plans is around $7,500 nationally. Newly introduced eligibility criteria for catastrophic plans may now allow individuals over 30, who are losing subsidies due to the expiration of enhanced tax credits, to qualify for these plans. However, potential enrollees should be mindful that these plans can have deductibles that reach the ACA's annual out-of-pocket spending limit of $10,600 for individuals and $21,200 for families.
Insurance brokers like Lauren Jenkins have observed clients earning under $25,000 a year facing potential premium increases to $100 or more monthly for silver-level plans, prompting them to consider more affordable bronze options, which may entail high deductibles.
Shopping around can yield surprising results. Consumers may find lower premiums by switching to different plans, even within the same insurance provider. Coverage levels, ranging from bronze to platinum, can vary in cost, and in some areas, gold-level plans may even be less expensive than silver plans. For small business owners with only one employee, group plans might offer more favorable rates compared to individual policies, though this option is not available in every state.
Insurance experts recommend that consumers do not procrastinate in their decision-making. Taking preliminary steps, such as visiting the official federal or state marketplace website, can help individuals prepare for the 2026 plan year. Even without new congressional measures, subsidies will still be available but at reduced levels, with an income cutoff for households earning more than four times the poverty level—$62,600 for individuals and $84,600 for couples in 2026.
When searching for coverage, ensure you are on an official ACA website, like Healthcare.gov, to avoid look-alikes that do not offer compliant plans. These government websites can also direct consumers to licensed brokers and counselors who can assist with applications. Lastly, remember that consumers must pay their first month's premium for coverage to take effect.