2026 Open Enrollment Period Guide: Dates, Deadlines & Changes
The U.S. healthcare market is roiling as the Affordable Care Act’s open enrollment period, with its painful price points, is being examined by consumers. Insurers aren’t flinching, claiming that the cost of quality health care keeps going up, and that even higher prices may be on the insurance prescription list.
The 2026 healthcare pricing lists are coming out, with costs expected to rise by an estimated 18%, according to the Peterson/KFF Health System Tracker. That’s the highest cost level since 2018, the Tracker reported.
Affordable Care Act prices are set to soar next year, with an expected 18 percent cost rise, according to the most recent Peterson/KFF HealthSystem Tracker. The Tracker, which covers 312 U.S. insurers from all 50 states, represents the most significant cost level since 2018.
“The healthcare price surge is being driven by multiple factors, including medical cost inflation, higher drug costs, and an increase in hospital and doctor visits among enrollees,” said Whitney Stidom, vice president of consumer enablement at Salt Lake. City-based eHealth. “With federal subsidies expected to be reduced for many Americans who get insurance through an Affordable Care Act plan, it’s key to begin preparing now and seek expert guidance to review the various plan options when the open enrollment period begins this fall.”
With soaring prices casting a shadow over the U.S. healthcare market as Open Enrollment rolls out on November 1, what are the other significant issues facing American consumers and the healthcare insurance market?
What To Expect On the ACA Open Enrollment Date
U.S. government rules on income level limits largely remain in effect for 2026, with Americans earning up to 400% of the federal poverty level (approximately $62,000 per year for an individual or $128,000 for a family of four in 2025) still qualifying for subsidy assistance. “Subsidies work on a sliding scale, so those at the top of the income spectrum receive less help while those at the lower end may effectively pay no monthly premium at all,” Stidum said.
Enrollment-wise, ACA plan enrollees should keep their eyes open for letters or emails from their health insurance companies this fall.
“These letters should advise them of any upcoming rate increases or changes to benefits,” Stidum noted. “If their 2025 health plan will no longer be affordable, or if their coverage needs have changed, people should make the most of the open enrollment period. In most states, enrollment runs from Nov. 1 to Dec. 15, with coverage under new plans beginning Jan. 1, 2026.”
During open enrollment, ACA plan enrollees should review their coverage options and apply for subsidy assistance through a licensed private online marketplace or a government-run health insurance exchange.
“People should look at the monthly premiums, the prescription drug coverage, and the out-of-pocket costs they may face when they receive medical care,” Stidum added. “All of those issues are important to consider when trying to choose the optimal plan.”
Federal Tax Credits Expiring
Insurance professionals are bracing themselves for the anticipated expiration of enhanced health insurance premium tax credits throughout the ACA exchanges.
ACA healthcare tax credits are set to expire at the end of calendar year 2025, taking the expanded structure of the premium tax credit with them. The tax credit expansion was initially authorized by the American Rescue Plan Act of 2021 and extended under the 2022 Inflation Reduction Act through the end of this year. The policy shift is expected to hit middle-class ACA consumers hardest, as millions of Americans won’t only lose their tax credits but also face higher premiums.
“The ACA is only affordable if you qualify for subsidies and stay within the system’s rigid parameters,” said Tarek El Ali, founder at Smart Insurance Agents in Chicago, Il. “But one single income fluctuation, one provider network change, or one prescription switch can financially destroy people.”
El Ali said he’s seeing more clients choosing catastrophic plans or going uninsured because the “affordable” plans aren’t actually usable. “For 2026, I predict the subsidy cliff will hit harder as pandemic-era improved subsidies fully phase out,” he noted. “Families earning just over 400% of the federal poverty level will face brutal premium increases. The marketplace works for the poorest and richest, but the middle class is getting squeezed out completely.”
According to the Congressional Budget Office, allowing the ACA tax credits to expire would boost the U.S. uninsured by 4.2 million people over the next 10 years, putting even more pressure on the ACA model.
One potential ‘time bomb’ is the expiration of the federal tax credits that made premiums more affordable during the pandemic.
“Many families will have their monthly premiums escalate by hundreds of dollars without those increased credits,” said Robert Tsigler, an attorney at New York City-based Robert Tsigler, PLLC. “To a family that is already very budget-conscious, even an addition of $150 to $200 per month can’t be ignored.”
Tariff Pressures Continue
Even into 2026, drug and supply costs are likely to experience some upward pressure from tariffs or import stresses.
“For instance, generic drugs could see a 3‑8% boost in price changes, which could be tacked on to co‑pays or plan pricing,” said Guillermo Triana, founder and CEO at PEO-Marketplace.com in Miami, Fla.
Specialty drugs are somewhat insulated but are still subject to upward price pressure. “Vaccines are covered under ACA as an essential health benefit, so most marketplace plans will have to cover CDC‑recommended vaccines (e.g., flu, COVID, etc.),” Triana said. “If there’s a state law mandating a particular vaccine (school entry, for example), insurers generally will comply with that mandate as well. Precisely how that is covered, whether by copay or deductible, will vary from plan to plan.”
All ACA‑covered vaccines are also covered under the ACA preventive care rule. “Flu, COVID, HPV, tetanus, etc. would not cost you anything unless you go out‑of‑network or to a retail clinic where you may see an admin fee,” Triana noted. “The best way to avoid the stress is to get those shots from an in-network provider.”
On Medicare and Medicaid Cuts
In recent years, the ACA has expanded coverage through Medicaid expansion, Marketplaces, and preexisting-condition protections, and it continues to reduce the uninsured rate. Now those expansions, particularly with Medicare and Medicaid, are at risk.
“As coverage losses from Medicaid redeterminations after the pandemic protections ended, millions have been disenrolled during the unwinding,” said Lisa A. Cummings,
attorney and executive vice president at Cummings & Cummings Law in
Dallas, Tx. “For Medicare, 2026 brings higher projected Part B premiums and deductibles, even as plan payments rise, pressuring beneficiaries rather than program funding lines.”
Attending physicians view the Medicaid per capita caps as catastrophic, with annual funding cuts of 25%-to-30 % over the next decade, based on CBO estimates.
“States also propose to reduce postpartum coverage of 12 months to 60 days,” said Dr. David Ghozland, a practice owner and OB/GYN specialist in Orange, Cal. “The onset of most of the severe complications of the mother, such as bleeding, extreme depression, and infections, are revealed between the third and sixth months of delivery.”
Ghozland also views the new Medicare payment practice structure as ‘frustrating’.
“The payment made to physicians remained the same as in 2001, but my practice expenses increased by 40%, he said. “With more cuts, it will reduce the number of doctors who will accept Medicare. The older patients who require prolapse repair or to treat incontinence, for example, will not find surgeons willing to attend to them.”
Are There Higher Healthcare Costs On the Horizon?
U.S. healthcare consumers can expect insurance premiums to continue rising as subsidy buffers expire and carriers must adjust prices to account for inflation across the healthcare supply chain.
“Prices are absolutely on the rise,” said Randy Lobur, growth marketing manager at Action Benefits in Southfield, Mich. “Some of the latest figures put the average rate filing at an 18% increase, and that’s without considering Congress’s inaction on expanded premium tax credits. If those credits expire, consumers who are using those credits could be paying up to 75% more out of pocket for their premiums in 2026.”
Some ACA tiers will be price-impacted more than others, healthcare experts say.
“Middle-tier Silver plans will probably see the biggest increases since they are the ones that have to attract subsidy-qualified buyers and unsubsidized buyers,” Triana said. “My bet is that the premiums won’t stabilize until the federal and state regulators line up funding rules for those in the middle.
Until then, carriers will probably adjust their networks and/or benefit tiers to mitigate their losses. “This upcoming enrollment period will favor those who treat plan selection as a business decision versus a checkbox,” Triana added.
It’s unlikely to make budget-restricted consumers feel any better, but Lobur believes ACA coverage remains affordable, considering health insurance is what it’s intended to be: a financial product that protects enrollees from catastrophic financial losses.
“However, deductibles and out-of-pocket maximums can absolutely look daunting when you’re shopping around,” Lobur noted. “Consumers who don’t like the premiums they’re seeing might consider purchasing lower-premium plans with higher deductibles and out-of-pocket maximums.”
In most cases, those expenses “can be offset by Health Savings Account contributions, or with supplemental coverage like Critical Illness or Accident products, which can pay a lump sum when health issues arise,” Lobor added.
Tips on Maximizing Your ACA Health Experience
If you already have an ACA plan, the renewal process is still the same: sign in, confirm your information is accurate, and see if there are any changes you need to make.
“Premiums, deductibles, and plan networks do all adjust from year to year,” Triana said. “Some providers drop or switch tiers, so if you ignore it and let it auto‑enroll, you might lose a new subsidy opportunity or get stuck on a plan you no longer want.” Yet even if you do auto‑enroll, pay close attention. “It’s worth your time to at least glance at what changed in the plan,” Triana added.
Selecting a plan is primarily based on your anticipated usage rather than the cost.
“For example, if you visit two or more physicians a year, consider skipping bronze,” Triana noted. “Gold plans are pricey until you have a $2,000 deductible in March and are covered for the rest of the year.”
“It’s illogical to save $80 per month on a premium only to pay $300 more in prescriptions,” Triana said. “Concierge services are available if you are in over your head, but for most people, 30 minutes of review time is plenty.”
Looking ahead, US healthcare consumers should brace for the worst in 2026, especially if the ACA plan subsidy issue remains unaddressed.
“Premium outlook hinges on whether enhanced credits are extended,” Cummings said. “If enhanced credits lapse after 2025, average Marketplace premium payments would more than double for many.”
The best ‘next steps’? Due diligence is key for ACA users.
“Consumers should become familiar now with the enrollment period and how to find the information; pre-check networks and drugs to the extent possible, and plan for increased premiums for 2026,” Cummings advised.
The federal marketplace typically opens in the fall and runs into mid-January. Exact dates for 2026 may vary by state-based exchange, so check your state’s marketplace or HealthCare.gov for final dates. Enrolling by the early December deadline usually ensures coverage starts January 1.
Expect routine updates to premiums, plan networks, formularies, and subsidies. Some states may adjust their enrollment windows and special enrollment rules. Always review 2026 plan details—benefits, out-of-pocket costs, and in-network providers—before you renew.
You may qualify for a SEP if you experience a qualifying life event such as losing coverage, moving, getting married, having a baby, or a significant change in income. SEPs are time-limited, so file your application promptly after the event.
Yes. You can compare options and switch plans during Open Enrollment. Review total costs (premiums plus deductibles and copays), covered drugs, and provider networks before you submit your new selection.
There is no federal penalty for going without coverage, but some states and DC have their own individual mandates and penalties. Check rules for your state before opting out of coverage.
HealthCare.gov serves states that use the federal marketplace. State-based marketplaces run their own websites and may set different enrollment windows or extra plan options. Your eligibility for savings works in either system based on income and household size.
If you enroll by the early December cutoff (varies by marketplace), coverage generally begins January 1. Enrollments completed later in the window usually start February 1 or March 1, depending on your marketplace’s rules and payment timing.
Premium tax credits lower monthly premiums if your household income falls within eligible ranges. Cost-sharing reductions are available on Silver plans to reduce deductibles and copays for qualifying households. Update your 2026 income estimate to get accurate savings.
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Brian O’Connell is a nationally recognized financial journalist, best-selling author, and former Wall Street bond trader with over 20 years of experience. He is the author of The 401(k) Millionaire and CNBC’s Creating Wealth, and has contributed to The Wall Street Journal, U.S. News & World Report, Forbes, CBS News, and TheStreet.
