By Anna Wilde Mathews
Nov. 3, 2025
For around 24 million people enrolled in Affordable Care Act plans, things are about to get crazy.
Enrollment for next year’s coverage started Saturday, and virtually everything is changing all at once. Premiums for many plans are shooting upward. The federal subsidies that most enrollees use to pay for their insurance are set to shrink, though Congress might still reverse that in coming weeks. New rules will add additional wrinkles, including the risk of higher tax bills.
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The upshot: If you have Obamacare, you really need to dig in and be careful about what you choose during the open enrollment period, which begins Saturday and lasts until Dec. 15, for coverage that starts Jan. 1.
If you don’t, you could get hit with huge bills next year. You could also be locked into health insurance you can’t afford.
“This is the most extreme pricing change we’ve seen,” said Jeff Grant, a former official with the Centers for Medicare and Medicaid Services, which oversees federal ACA implementation. “Nobody can understand what this means until they go shop.”
Here’s what ACA enrollees need to know to navigate this year’s hazards.
Getting started
You can start the shopping process on HealthCare.gov, the federal insurance marketplace that serves 30 states for 2026. If you don’t live in one of them, it will bounce you to your state’s website.
You should consider getting advice from an expert, perhaps someone recommended by a friend or relative. HealthCare.gov includes a “find local help” button that leads to advisers. Groups representing brokers and agents also offer directories.
Many Obamacare insurance premium hikes for next year are well into double-digit percentages. Most enrollees don’t pay the full premium, but declining federal subsidies will still leave them with far higher monthly bills.
The pain will be spread unevenly. Its impact will depend on factors like your income level, your age and what plans are sold in your area. Health research nonprofit KFF offers an explainer on how the subsidies work here, but the best thing to do is to get on your government marketplace for a reality check.
Some of the biggest increases, in dollar terms, will hit people who make slightly over 400% of the federal poverty level, which is about $62,600 for an individual. Many of those people qualified for a subsidy this year, but they won’t get any help at all next year because enhanced federal payments are set to lapse. You can find federal poverty level cutoffs for different family sizes here.
Bigger bills
Kevin Foster, 64, a retired business consultant in Lafayette, Calif., logged on to the state marketplace recently to check his rates for next year and couldn’t believe what he saw. Eligible for a subsidy in 2025, he and his wife are slated to lose it in 2026.
The couple’s monthly insurance bill of about $580 will shoot up to more than $3,200, or an annual cost of more than $38,000. The 2026 version of their plan comes with a family deductible of $14,400, pushing the total past $50,000.
“It was really just pure shock,” he said. “I was like, ‘Are you kidding me?’”
He’s likely to have to tap his savings until he can get Medicare, he said, but he’s also trying to find a cheaper plan, or an alternative like purchasing travel health insurance and temporarily relocating abroad.
For other enrollees, the rising costs are leading to wrenching choices.
Jordan Euckert and her husband currently pay $129 a month, after a subsidy, to cover their family of six in Bedford, Texas. Next year, the cheapest plan that includes the children’s hospital and doctors their kids need will set them back about $550 a month.
Euckert, 31, who works for a small construction firm, said the family probably can’t afford that. Now, she’s wondering if the couple should go uninsured, while keeping their children covered. Though both spouses are healthy, her husband’s job as a roofer poses a constant risk.
“It’s just like all those what ifs, like what if I got sick, what if my husband got sick—what would we do?” she said. “I don’t know.” She is hoping the couple’s agent can come up with a better solution.
ACA enrollees said they are still hopeful that Congress might restore the bigger federal subsidies that are in effect this year. Democrats and Republicans have been clashing over the issue.
“Keep an eye on things, watch the news coverage,” said Cynthia Cox, a vice president at KFF. If Congress does vote to block next year’s drop-off in the payments, you will want to take another look at your insurance choice, because different 2026 plans might suddenly be more affordable.
Limited options
For most enrollees, the main option to hold down monthly costs will be choosing skinnier ACA plans, with higher deductibles and other out-of-pocket charges.
Some enrollees are looking at other choices. Scott Leavitt, an insurance broker in Boise, Idaho, said a married pair of his clients who own their own firm are considering switching to a small-business plan, or coverage purchased for an employer, rather than an individual or family.
Some ACA enrollees can join a spouse’s employer plan, or might be forced to look for a job that comes with health benefits.
Agents say ACA enrollees should be careful about products that don’t carry the same protections as Obamacare plans. Short-term medical plans, for instance, can refuse to cover pre-existing illnesses, as well as drugs and other types of medical services. So-called healthcare-sharing ministry plans aren’t regulated as insurance, and can have similar limits and shortfalls.
Another type of product, known as fixed indemnity plans, will pay out a set amount for certain medical services, but their setup can leave patients on the hook for whatever a healthcare provider bills above that amount, potentially tens or hundreds of thousands of dollars.
“Once that $15,000 or $10,000 is done, there’s no more coverage,” said Heather Stone, a health-insurance broker based in Fort Myers, Fla. “If you need chemo, it’s not going to cover anything like that.”
Other wrinkles
While the ACA-subsidy sticker shock is hard to miss, many enrollees may not be aware of other new rules that could affect them this year. Here’s a helpful tipsheet.
For one thing, lower-income enrollees in the past could sign up for new ACA plans year-round, a loophole that has now closed. “They are not going to let you find out you have an illness in April and then come back and enroll into a major medical plan,” said Johnny Wallin, chief operating officer of Marketplace Insurance Exchange, a health-insurance brokerage.
One of the biggest changes might not surface until tax season in 2027. When enrollees sign up for their 2026 plans, they have to estimate their income for that year. If they end up making more money than they estimated, they get too much subsidy, and they have to pay back the difference when they file their taxes.
In the past, the law capped how much most enrollees would have to repay, but that limit is now gone. So the tax bill could be thousands of dollars for some people.
After Ja’Net Adams chooses an ACA plan this year, she plans to meet with her accountant to plan for the tax implications. “We’re going to have to sit down in December and say ‘What do we need to make sure happens in 2026 so that we don’t have a big tax bill because of this?’” said Adams, 44, who owns a financial consulting firm in Kernersville, N.C.
Write to Anna Wilde Mathews at Anna.Mathews@wsj.com
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