For plans that start on Jan. 1, the federal health insurance marketplace open enrollment deadline is less than a week away – with a lot of uncertainty still surrounding coverage.
Advocates are encouraging everyone with an Affordable Care Act plan to select a plan before Monday's deadline.
Lynn Cowles, with the advocacy group Every Texan, volunteers as a Certified Application Counselor for an organization that helps people select health plans. She urges people to log into healthcare.gov to verify their information before Dec. 15.
"Don't let the application auto-renew," Cowles said. "Go into it and actively re-enroll. Update your income estimate. See what plans are new."
What's different about this year?
Since 2021, the federal marketplace has offered enhanced premium tax credits to make ACA coverage more affordable. But those subsidies are set to expire at the end of the year – causing a dramatic increase in premiums. On average, premiums are expected to double for ACA marketplace plans, according to an analysis by the health policy organization KFF.
Blake Hudson, with the Texas Association of Health Plans, said middle-income Texans are facing a significant loss in financial help.
"It's just a staggering number that they're looking at," he said. "We're seeing instances where their cost for health insurance is going to go up four times…for their premiums."
Cowles said it's important to ensure the marketplace has the most accurate information for someone's current situation, so they don't miss out on other existing subsidies that aren't expiring.
"It doesn't happen that often, but it does happen sometimes, where if people don't update their income estimate, if inflation makes their 2025 income estimate too low to qualify for subsidies in 2026, and if they don't cancel auto draft or something, then the marketplace will not attach any premium subsidies to their 2026 health insurance plan," Cowles said. "They'll get a full month's premium deducted from their account if they set up auto draft."
Cowles said that can be "catastrophic" for some Texans and could affect their ability to afford other basic necessities like rent or groceries.
There were also some changes to Texas' marketplace options: Cowles said Aetna exited the Texas market completely.
"Anybody who's on Aetna, they're going to get mapped into a local plan that the marketplace thinks is similar to Aetna," she said. "But people really want to check on their doctor availability…. As much as people can, be proactive, go into the application, don't let auto enrollment happen."
Resources for enrollees
Cowles said enrollees should remember there is another month of open enrollment for plans that start on Feb. 1, but she still encourages people to look at their plans by Dec. 15.
For people who need help enrolling or changing their plans, there are what are known as "assister organizations" that help people navigate coverage options.
People can find those organizations by zip code through the "find local help" page on healthcare.gov.
Insurance navigators have been helping people understand their options and make sense of the changes for the entire open enrollment period. Cowles said they're trained to help people make the decision that makes the most sense for them – even if that means they can no longer afford insurance.
"As navigators it's our job to make sure that they know where their federally qualified health centers are," Cowles said. "That they know to make sure that if they go to the emergency room to ask for charity care about information about the charity care program that that hospital runs, if they do offer one – and most do in Texas."
Could there be a last-minute deal to extend the credits?
There's a lot of uncertainty about whether federal lawmakers could reach a deal before next week's deadline, but advocates said people should pay attention to any changes that might happen.
"Some of the proposals that are coming out of Congress right now…I don't know if they're meant to be actual solutions," Cowles said. "Some of them are pretty ludicrous and none of them are effective right now at stabilizing [the] health insurance market or at stabilizing people's access to health care."
If the tax credits were to be extended, advocates say they hope that would come with an opportunity for people to change their plans. Hudson said health plans would likely need time to give people options with those changes taken into account.
"If those were to be extended at the last minute, then there's going to need to be some provision for allowing people to go back in and shop and seeing what the new prices are," Hudson said.
However, Cowles said that's not federally required.
"People would just have to see what the new policy looks like and actively update their applications, most likely, in order to take advantage of the new subsidies," Cowles said. "We assume some people would get the memo and they would do it. Others wouldn't."
Cowles said that could have a negative effect on insurance rates and people's trust in the ACA marketplace.
"But that's also why we hoped that we wouldn't be in this boat right now," Cowles said.
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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