Everyone who wants ACA marketplace coverage next year should get a new eligibility determination and actively choose a plan (or opt out of automatic re-enrollment) by December 15 to avoid being enrolled in a plan they can’t afford or don’t want.

And we won’t see the full picture of who can afford their coverage until next year, when data show the proportion of people who have paid their January premium. It will also be important to monitor how many continue to pay premiums and keep their coverage throughout the year.

For other ppl with ongoing health care needs, buying down isn’t an option. These individuals will make sacrifices like cutting back on groceries, gas, and other essentials, to be able to afford their current plan’s higher premiums.

Convos w/enrollment assisters suggest many people can’t afford the same plan they had last year, so they may switch to a less generous plan w/lower premiums but a higher deductible and higher copays/coinsurance. This exposes them to more financial risk if they need care during the year.

This snapshot doesn’t tell the whole story of the impact of Congress and President Trump not acting (so far) to extend the enhancements. Time periods differ and the harm to people will take longer to show up.

Proposals to push ppl into plans w/high deductibles and out of pocket costs would simply increase the risk that they forgo needed care or face medical debt.

Three quarters of ACA enrollees have income at/below 250% FPL (~$38k for an individual), leaving little room to pay expensive medical bills out of pocket, let alone stash savings away in an HSA. www.cbpp.org/media/market...

The silver plan also comes with a much lower deductible ($700) and out of pocket cap ($3,300), providing additional protections for people who end up needing more care.

A silver plan with cost-sharing reductions is more affordable for someone at 200% FPL. In New Orleans, they could get a plan with predictable, pre-deductible copays of $10-$40 for different kinds of office visits, urgent care, and generic medications.

This bronze plan comes with a $6.5k deductible. After that, ppl still have to pay 40% of the cost of all their health care other than preventive up to the $10.6k cap. These costs would put health care out of reach—especially for ppl w/low incomes, who get reduced cost sharing with a silver plan.

Details are scarce. But we know a bronze ACA plan + a few thousand dollars in an HSA would not even cover the deductible for most bronze plans, let alone begin to make the cost of getting health care affordable. Take this 2026 plan available through HealthCare.gov to people in New Orleans.

Marketplace enrollees have a lot on their minds this year, with premiums set to increase more than $1,000/year for the average person receiving PTCs, if PTC enhancements expire. Here are some other tips for navigating ACA marketplace enrollment in 2026:

People can enroll/change plans any time before the end of open enrollment in their state. To ensure they’re getting all the financial help they qualify for, people should check back in with their marketplace in Jan in case Congress has extended the PTC enhancements. www.cbpp.org/media/market...

If you are automatically reenrolled and don’t want that plan, you can cancel that enrollment any time through Dec 31 and avoid having to pay Jan premiums. (Some people will still be protected from owing these if they simply don’t pay their Jan premium, but not everyone!)