Health Insurance Markets Face Uncertainty
Higher prices, less help, and a government shutdown all hang over health insurance markets as shoppers start looking for coverage this week. The annual enrollment window for millions of people to pick an individual plan opens Saturday in nearly all states, and a heavy dose of politics weighs on this year’s search.
The federal government shut down earlier this month as Democrats in Congress demanded negotiations to extend enhanced tax credits that have helped people buy coverage the past few years. Republicans say they won’t negotiate until Democrats vote to reopen the government. Stuck in the middle are insurance customers, many of whom will be facing the biggest premium hikes they’ve seen in years and may be forced to consider changing plans.
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“It seems overwhelming, but it really is important to shop and consider your choices,” said Sara Collins, an insurance expert with the Commonwealth Fund. Here’s how shoppers can respond:
Understanding the Enrollment Window
Shoppers will have until Jan. 15 in most states to find a plan for 2026, but have to make their choice by Dec. 15 if they want coverage starting New Year’s Day. This is the main chance people with individual coverage have every year to find a plan for the next year. More than 24 million people enrolled in individual plans for 2025, according to KFF, which studies health care issues.
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People can buy a new plan with help from income-based tax credits through insurance marketplaces set up in every state. Former President Joe Biden’s administration beefed up that help with enhanced tax credits during the COVID-19 pandemic. Those are set to expire this year unless Congress works out an extension. Shoppers also can find options outside these marketplaces — sometimes for a lower price — but they won’t get tax credit help.
Price Hikes and Their Impact
KFF has said that premiums, or the cost of coverage, will jump around 20% next year on average. But the expiring tax credits could cause coverage costs to more than double for some. Insurance has become more expensive because care costs are rising, a big worry for Americans. Insurers also set prices assuming the extra tax credits would expire — and that healthy people who paid little for coverage in 2025 might not return because of that.
The higher prices aim to make up for that lost revenue, said Karan Rustagi, a Wakely Consulting Group health actuary who works with insurers.
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The higher prices may not change even if Congress restores the enhanced tax credits before the enrollment window ends. It can take insurers weeks to complete rates with regulators and then update their systems and customer handbooks, Rustagi noted.
Finding Help in a Changing Landscape
The Centers for Medicare and Medicaid Services in February cut funding by 90% for a federal program that provides navigators who help people find coverage. That will lead to less free help in more than two dozen states that rely on the federal government to run their health insurance marketplaces. Kaye Pestaina, a vice president with KFF, said help like this is especially important for first-time shoppers who need to predict their income to get tax credit help.
That task can be especially challenging for seasonal workers or others who see their income fluctuate. “That one-on-one assistance is going to be really important,” Pestaina said. “It’s not intuitive.” If navigators are not available, health insurance brokers or agents can help. They receive commissions paid by insurers, often a flat fee.
Taking Action
Shoppers can get a sense for their options by checking their state marketplace. You can find that by visiting healthcare.gov. Collins said people should start there, not Google. Search engine results could connect you with someone selling more limited, short-term insurance.
Fill out the application for tax credit help first, said Joshua Brooker, a Lancaster, Pa.-based independent insurance agent. That will tell you whether any help is available to you now. That assistance will automatically be updated if the enhanced tax credits are renewed. “Doing that first application is not lost time,” he said.
Then pick a plan. Look beyond the premium. Consider any deductibles you may have to pay, what doctors or hospitals are in the insurer’s network, and how any prescriptions would be covered. Don’t wait to see whether the extra tax credit debate is resolved. That may not happen during your enrollment window. If it does, you can revisit your choice. “You do have a mulligan,” Brooker said.
Agents say many people procrastinate on insurance shopping. That can make it tougher to find help as sign-up deadlines approach. “I have people every year either wait until the very last day to enroll or they miss the deadline entirely,” said Shayla Teague, an insurance agent based in Anchorage, Alaska. “Make sure you have something in place, ready to go.”
Conclusion
The health insurance market is facing significant challenges, from price hikes to reduced assistance for shoppers. However, by understanding the enrollment window, the potential for price increases, and where to find help, individuals can navigate these challenges and find the coverage that best suits their needs. It’s crucial for shoppers to be proactive, considering their options carefully and seeking help when needed, to ensure they have the health insurance coverage they require.
Frequently Asked Questions (FAQs)
Q: What is the enrollment window for health insurance in 2026?
A: The enrollment window for 2026 opens on Saturday in nearly all states and will last until Jan. 15 in most states. However, for coverage to start on New Year’s Day, the choice must be made by Dec. 15.
Q: Why are health insurance prices increasing?
A: Health insurance prices are increasing due to rising care costs and the potential expiration of enhanced tax credits. Insurers have set prices assuming these credits will expire and healthy individuals might not return due to higher costs.
Q: Where can I find help with choosing a health insurance plan?
A: Help can be
