Dec. 15 last day for ACA health coverage starting Jan. 1

With more than 1 in 6 Ohioans who receive health insurance through the Affordable Care Act (ACA) expected to no longer purchase coverage, Ohio’s uninsured rate may rise by 29% in 2026, according to Health Policy Institute of Ohio (HPIO). Meanwhile, those who are renewing their coverage have been making those decisions without certainty about the extent to which their costs will go up.

Monday is the last day to enroll in an ACA plan for coverage to start Jan. 1, 2026. Open enrollment extends a month beyond that, but coverage selected between Dec. 16 and Jan. 15 will start on Feb. 1.

Heidi Rupp, senior account executive at UIS Insurance & Investments in Findlay, said the rise in Affordable Care Act premiums comes amid other changes affecting almost every type of health insurance. For example, multiple Medicare Advantage plans announced they would be exiting the Hancock County market at the end of the year, leaving many local seniors insured by those plans having to find new insurance. People insured through employers, also, will see their 2026 premiums rise steeply. And many plans have a more limited network than they once did.

Among ACA plans, premiums will rise by 26% nationwide, HPIO reports. In states that run their own marketplace, premiums are expected to increase by 17%, while states that use the federal healthcare.gov marketplace, such as Ohio, are expected to see an average increase of 30%.

“This is the largest rate change insurers have requested since 2018,” HPIO reports, adding that insurers cited among their reasons: rising hospital costs, increasing use of expensive pharmaceuticals and biologics, such as Ozempic; economic forces such as potential tariffs on medical supplies, inflation and labor shortages; and the expectation that some people, especially those who are younger and healthier, might drop coverage due to the expiration of enhanced premium tax credits.

Enrollees who make less than 400% of the federal poverty level qualify for permanent subsidies in the program that help them offset premium costs. In 2021, Democrats in Congress added additional subsidies, known as enhanced premium tax credits, that apply to enrollees regardless of their income. Those COVID-era subsidies are set to expire Jan. 1.

What the change means

The Associated Press reported this week that their expiration would mean the average subsidized enrollee will see their annual premium payments go up by 114%, from an average of $888 in 2025 to $1,904 in 2026, according to the healthcare research nonprofit Kaiser Family Foundation (KFF).

On Thursday, the Senate rejected legislation to extend these Affordable Care Act tax credits.

Rupp, meanwhile, has been helping Hancock County residents enroll in plans while it remained uncertain whether the credits would be extended. It was hard to predict what to expect – they knew they would be paying more, but not how much more.

Some of Rupp’s clients have opted to cancel their insurance, saying they cannot afford the premiums, but more have worked with her to renew their policies.

“The sentiment is, ‘You never know what’s going to happen,’” she said.

And ACA plans cover pre-existing conditions, she noted. Anyone with a chronic illness, or even anticipating significant healthcare expenses in the shorter term, likely already has doctor’s appointments lined up into 2026. If you know you will be needing your health insurance, you don’t want to drop it right now, Rupp said.

But the costs she is discussing with clients include just the insurance premiums. There will be healthcare costs beyond that. Rupp said that this year, more clients have been exploring different options than before, such as maybe considering a plan that has lower premiums but requires them to pay more out of pocket. Depending on their specific situation, some may opt to spend less initially, knowing that puts them at more financial risk should the unexpected happen.

A November HPIO policy explainer states that nearly 600,000 Ohioans got health insurance through the marketplace in 2025, and enhanced premium tax credits over the past four years have made coverage affordable for more Ohioans. With those tax credits expiring and large increases in the cost of premiums, more than 100,000 Ohioans are expected to no longer purchase insurance coverage in 2026, HPIO reported.

HPIO reports that Ohio may see an additional 140,000 people who are uninsured, increasing the state’s uninsured rate by 29%.

Cynthia Cox, a vice president and director of the ACA program at KFF, told the AP that especially hard-hit groups will include a small number of higher earners who will have to pay a lot more without the extra subsidies and a large number of lower earners who will have to pay a small amount more, said.

Rupp has some clients paying the full cost of their health insurance premiums. This varies depending on age, gender and income, but can be around $1,000 per month per person for higher incomes.

The Ohio Department of Insurance lists five ACA plans available in Hancock County for 2026: Buckeye Community Health Plan; CareSource Ohio, Inc; Community Insurance Company; Medical Health Insuring Corporation of Ohio; and Molina Healthcare of Ohio.

Rupp encouraged people, when selecting a plan, to pay attention to what healthcare providers are in network. Because a particular practice accepted a particular insurance this year doesn’t mean they necessarily will next year, she noted.

Individuals can explore plans and sign up at healthcare.gov.