As open enrollment for health insurance through the Affordable Care Act marketplace approaches on November 1, millions of Americans are poised to face significant increases in their premiums. This uncertainty is primarily due to the absence of a Congressional agreement to end the current government shutdown and extend crucial tax credits that have made insurance more affordable for many.
In Pennsylvania, nearly 500,000 individuals are enrolled in the state’s marketplace known as Pennie, while more than 510,000 residents are covered through New Jersey’s state marketplace. Delaware has also reported a record high in enrollment, surpassing 50,000 this year, as officials emphasize the importance of these marketplaces for residents’ health coverage.
The stakes are high for those enrolled; over 90% of marketplace participants depend on tax credits to help pay monthly premiums. For example, Jason Piperberg, a freelance illustrator from South Philadelphia, exemplifies the situation many face. Recovering from treatment for papillary thyroid cancer, he relies on these credits to manage his health-related expenses. Piperberg currently pays about $115 monthly for his silver-tier plan and fears that even a doubling of his premiums could lead to insurmountable debt.
According to Matt McGough, an analyst with the health policy organization KFF, without the tax credits, average premiums could surge by over 114%, translating to an additional $1,000 per year for enrollees. For individuals with unstable incomes, substantial premium increases can pose significant financial burdens.
In light of these challenges, McGough advises enrollees to consider downgrading to lower-tier plans to decrease costs—such as switching from a gold to a silver plan or a silver to a bronze plan. However, he notes that lower premiums often come with higher deductibles, adding another layer of complexity to decision-making. He also emphasizes the importance of ensuring that healthcare providers remain in-network and that necessary medications are still covered when making any changes.
There is a growing concern that some may ultimately opt to forgo their coverage entirely. This trend could lead to increasing numbers of uninsured individuals seeking care at hospitals and clinics, which, in turn, would result in higher costs for everyone in the healthcare system due to uncompensated care.
Piperberg reflects on the implications for his health if he cannot maintain his coverage: “It’s one thing if I didn’t have this history of cancer. But I have ultrasounds coming up soon, I have blood work that I get regularly just to make sure that I’m on the right track, and so to think about not being able to do that is really scary.”
Support is available for those navigating the enrollment process, with resources like Healthcare.gov, Pennie, and Get Covered NJ offering free local assistance. Trained navigators can provide unbiased help in exploring coverage options, while brokers or agents, generally compensated through commissions, can also offer guidance.
The open enrollment period for those using the government marketplace will run from November 1 to January 15, 2026. To have coverage begin on January 1, the deadline for enrolling or changing plans is December 15, highlighting the urgency for individuals to act amidst the uncertainty surrounding premium costs and tax credits.
