Texans may see surge in ACA costs

Millions of Texans are likely to see higher prices when they sign up for Affordable Care Act health insurance this year.

Open enrollment for the ACA marketplace begins Nov. 1, but Congress is still debating whether to maintain subsidies that have helped millions of Americans afford health insurance. The fight over those subsidies, known as enhanced premium tax credits, is at the heart of the federal government shutdown that began Oct. 1.

Nearly 4 million Texans enrolled in ACA plans this year, and many of them will see their health insurance premiums rise if Congress does not extend the subsidies. Premiums are expected to increase across the board due to higher health care costs, so many Texans could be in for sticker shock when they go to sign up for coverage, health policy experts said.

Higher premiums could be jarring for someone who has their ACA plan set to automatically re-enroll each year, said Lynn Cowles, the health and food justice director at the nonprofit Every Texan. She recommends logging onto the ACA marketplace website to actively re-enroll beginning Nov. 1.

"You should see how things look different, and make an active plan selection for 2026 if you decide you can stay covered," she said.

The process for signing up for ACA coverage is largely unchanged this year, thanks to a court order that blocked certain changes that were set to take effect.

Here's what you need to know about the process.

When is ACA marketplace open enrollment?

Open enrollment for ACA marketplace health insurance plans begins Nov. 1. There is a Dec. 15 deadline to sign up for coverage that takes effect Jan. 1, 2026.

After that deadline, Texans can still sign up for health insurance until Jan. 15, 2026, but their coverage will not kick in until Feb. 1, 2026.

Prices could spike unless Congress acts

Congress created the enhanced premium tax credits in 2021 to lower or offset health insurance premiums for ACA plans. Enrollment in the ACA marketplace has more than doubled since then, to more than 24 million enrollees this year.

The enhanced subsidies are set to expire at the end of 2025. If they do, millions of Americans could see their premiums increase by about 114% - or more than $1,000 year-over-year - in 2026, according to an analysis by the nonprofit health policy organization KFF.

Leaders from five Houston health systems sent a letter to lawmakers to urge Congress to extend the enhanced premium tax credits. The subsidies have helped to reduce health insurance premiums for about 3.4 million Texas residents, including more than 667,417 in Harris County, they said in the letter.

Democrats have pushed to extend the subsidies as part of any funding legislation that would end the ongoing government shutdown. Republicans have said the subsidies could be considered later because they do not expire until the end of the year.

But the looming expiration of the subsidies has created uncertainty for millions of Americans and health insurance companies. Community Health Choice, a nonprofit insurer that serves the Houston area, has letters that are ready to be sent to its members in the event the subsidies are extended, said Rudy Guerra, vice president of community connections and sales for the insurer.

"We don't know what action is going to be taken," he said.

Actively re-enroll to avoid sticker shock

Texans who have their ACA coverage set up to automatically re-enroll each year are at higher risk for sticker shock if the subsidies are not extended, Cowles said. In Texas, more than 1.4 million enrollees -- or 36% -- automatically re-enrolled in ACA plans last year, according to data from the Centers for Medicare and Medicaid Services.

Many of those enrollees could be paying a premium for the first time if the subsidies had covered the full cost in prior years, Cowles said.

"If they're not paying attention to the news or anything right now, they're going to auto-enroll, and chances are they're going to have a monthly premium payment to make," she said.

Experts recommend taking steps to actively re-enroll this year, such as logging in to healthcare.gov or reaching out to an advisor, to avoid unexpectedly higher costs. Enrollees have until Jan. 15 to change their plan if they determine they can't afford the higher premiums.

"I think the general message is to take action," Guerra said. "Do not wait."

Pause of special enrollment period

Individuals with incomes at or below 150% of the federal poverty level (about $48,000 for a household of four in 2025) had been able to enroll in ACA plans at any time through what's known as special enrollment periods. But the Centers for Medicare and Medicaid Services paused special enrollment periods this year "due to concerns over increased unauthorized enrollments and adverse selection risk."

Special enrollment periods can be critical for individuals with lower incomes, Guerra said.

"If you're under (150% of the federal poverty level), that's a very vulnerable population that doesn't have a lot of options as far as coverage is concerned," he said.

However, certain qualifying life events - such as losing health coverage, moving or having a baby - will still trigger a 60-day window when someone can apply for an ACA plan outside of the open enrollment period.

Some ACA changes on hold

The so-called "One Big Beautiful Bill" that Congress passed this summer includes additional changes to the ACA marketplace.

But some are not taking effect this year, and others have been delayed by a lawsuit.

The cities of Baltimore, Chicago and Columbus filed a lawsuit that challenged some key changes to the marketplace, including a $5 cost for individuals who automatically re-enroll in coverage.

A federal judge in Maryland granted a preliminary injunction in the case, putting those changes on hold.

The "One Big Beautiful Bill" shortens the ACA open enrollment period by one month beginning in 2026, meaning it will end Dec. 15 instead of Jan. 15.

The law also calls for automatic re-enrollment to end altogether beginning in 2027.

Help is available

The healthcare.gov site offers a "Find Local Help" tool that lists "navigators" who offer free assistance with the ACA marketplace. However, health policy experts have noted that assistance could be limited this year because the Trump administration announced a 90% cut to funding for the navigator program.

The tool lists thousands of assisters, agents and brokers in Houston who offer help to enrollees. Cowles recommends reaching out to an assister, because agents and brokers are paid a commission by insurance companies.

Legacy Community Help has been an assister since 2010, and lends help to thousands of Houston residents each year, said Ivonne Coraza, senior director of eligibility. Legacy offers in-person and virtual appointments for English and Spanish speakers.

Signing up for a plan takes roughly an hour. Patients are asked to provide documents such as their most recent tax return, their birth certificate, their Social Security card, a photo ID and proof of address to complete the application.

Legacy encourages all patients to sign up for coverage, and helps them sign up for a plan that covers any medications or specialists they need, Coraza said.

"We sit there and review all of the different plans that are offered, in order for us to be able to get them to the correct plan," she said.