What to know as ACA open enrollment gets underway

WASHINGTON – People preparing to enroll in Affordable Care Act coverage should expect several changes for the coming year, including higher premiums and fewer plan choices.

The marketplace sign-up period, also called Obamacare, is open in most states and continues through mid-January.

Among the biggest shifts are the loss of some financial aid, rising rates, possible delays when working with brokers, tighter rules for immigrants and stricter checks during enrollment.

Subsidies such as premium tax credits and cost-sharing reductions are now limited for many people who once qualified.

Health policy experts say the result will likely be less coverage and higher costs. Based on analysis of new CMS data by the nonprofit KFF, the average price of health insurance sold through the marketplaces is expected to increase by 13%.

Premium increases driven by several factors

Cynthia Cox, vice president and director of KFF’s ACA program, said the rise is being pushed mainly by higher medical costs and hospital consolidation, along with possible effects from the No Surprises Act, which bans surprise billing, and the growing use of GLP-1 drugs.

The people likely to feel the biggest impact are those who do not receive subsidies.

“They may or may not be able to afford to continue to keep their coverage into next year,” Cox said, adding that “a lot of them have already moved into bronze plans, which are the cheapest plans.”

A CMS fact sheet on open enrollment distributed recently said Americans using HealthCare.gov will still have access to low-cost plans.

ACA premiums have risen sharply for many people during Trump’s second term after Republicans opposed extending pandemic-era subsidies that had helped lower costs for most enrollees during Joe Biden’s administration.

That has led to 1.2 million fewer people signing up for exchange coverage.

Nearly 20 million people remain enrolled in ACA plans

As of February, about 19.2 million people in the United States were actively enrolled in ACA marketplace health plans, according to the Department of Health and Human Services website. Enrollment increased during the COVID-19 pandemic, when enhanced subsidies were made available through the American Rescue Plan Act and the Inflation Reduction Act, both signed into law by Biden.

New rules taking effect in 2027 will also restrict tax credits for some lawfully present immigrants, a change that could leave about 1 million more people uninsured over time.

At the same time, the Trump administration has been removing ACA enrollees from the program as part of its broader effort against what it calls waste, fraud and abuse.

In September, Vice President JD Vance and other Republican officials said they planned to remove 760,000 ACA enrollees from public exchanges, alleging that the people were fraudulently enrolled or did not exist.

Vance said the identification of those cases and the cancellation of subsidy payments for hundreds of thousands of people, part of a governmentwide anti-fraud push, would save $2.2 billion.

Cox said it is still unclear how many more people will leave ACA coverage in 2027. But with higher premiums, changes to immigration eligibility and anti-fraud efforts, “I think there’s going to be fewer people enrolled in this market, but it’s going to be harder to understand why.”