What to know as the annual sign-up window for health insurance approaches

Higher prices, less help and a government shutdown are looming over the health insurance markets as buyers look for coverage this week.

The annual enrollment window opens Saturday in nearly all states for millions of people to choose an individual plan, and there’s a heavy dose of politics at stake this year.

The federal government shut down earlier this month democrat In Congress Seeks negotiations to extend enhanced tax credits that have helped people buy coverage over the past few years. republican They say they won’t negotiate until Democrats vote to reopen the government.

Insurance customers are caught in the middle, many of whom will face the biggest premium increases seen in years and may be forced to consider switching plans.

“It sounds overwhelming, but it’s really important to shop around and consider your choices,” said Sarah Collins, insurance expert at the Commonwealth Fund.

Here’s how buyers might respond:

first deadline is 6 weeks

Buyers in most states will have until January 15 to find a plan for 2026, but they will have until December 15 to make their choice if they want coverage by New Year’s Day.

This is the main opportunity each year for people with individual coverage to find a plan for the next year. More than 24 million people enroll in individual plans for 2025, according to KFF, which studies health care issues.

People can purchase a new plan with the help of income-based tax credits through established insurance marketplaces in each state. Former President Joe Biden’s administration extended the help with enhanced tax credits during the COVID-19 pandemic. They are set to expire this year unless Congress acts on an extension.

Buyers can also find options outside these markets – sometimes at lower prices – but they will not get the tax credit assistance.

You may see an increase in prices

KFF said premiums, or the cost of coverage, will increase by about 20% on average next year. But the expiring tax credit could more than double coverage costs for some people.

Insurance Has become more expensive because the cost of care is rising, which is a big concern for Americans. Insurers also set prices assuming that the extra tax credit will expire — and healthy people who paid much less for coverage in 2025 probably won’t return because of it.

Karan Rustagi, a health actuary at Wakely Consulting Group who works with insurers, said the goal of the higher prices is to compensate for that lost revenue.

Even if Congress reinstates the enhanced tax credits before the enrollment window ends, the high prices won’t change. Rustagi said it could take several weeks for insurers to finalize rates with regulators and then update their systems and customer handbooks.

it may be difficult to find help

The Centers for Medicare and Medicaid Services in February cut by 90% funding for a federal program that provides navigators that help people find coverage.

That would reduce free assistance in more than two dozen states that rely on the federal government to run their health insurance markets. KFF Vice President Kay Pestana said this kind of help is especially important for first-time buyers who need to estimate their income to receive tax credit help.

This task can be especially challenging for seasonal workers or others whose income fluctuates.

“That one-on-one help is going to be really important,” Pestana said. “It’s not comfortable.”

If navigators are not available, health insurance brokers or agents can help. They receive a commission paid by insurers, which is often a fixed fee.

what can you do

Buyers can get information about their options by checking the market in their state. You can find it by going to healthcare.gov.

Collins said people should start there, not at Google. Search engine results may connect you to someone selling more limited, short-term insurance.

Fill out the application for tax credit assistance first, said Joshua Brooker, an independent insurance agent based in Lancaster, Pennsylvania.

This will let you know if any help is now available to you. That assistance will be automatically updated if the enhanced tax credit is renewed.

“It’s not a waste of time to make the first application,” he said.

Then choose a plan. Look beyond premiums. Consider what deductible you may have to pay, which doctors or hospitals are in the insurer’s network and how any prescriptions will be covered.

Don’t wait to see if the additional tax credit dispute is resolved. This may not happen during your enrollment window. If this happens, you may want to reconsider your choice.

“You have a mulligan,” Brooker said.

Agents say many people procrastinate purchasing insurance. As the sign-up deadline approaches, it may be difficult to find help.

“I have people every year either wait until the last day to enroll or they miss the deadline altogether,” said Shayla Teague, an insurance agent based in Anchorage, Alaska. “Make sure you have something in place, ready to go.”

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