ACA Open Enrollment 2026: Sticker Shock, Shrinking Subsidies, and Why Private PPOs Are Back on the Table

If you logged into your Marketplace account this year and nearly fell out of your chair when you saw your new 2026 premium, you are not alone.

For 2026 coverage, ACA Open Enrollment runs from November 1, 2025 through January 15, 2026 in most states that use HealthCare.gov. Enroll by December 15, 2025 for coverage that starts January 1. If you enroll between December 16 and January 15, your coverage will start February 1.

But this open enrollment feels very different. Premiums are jumping, and the extra federal help many people have enjoyed the last few years is set to shrink or disappear. That is creating three big pain points:

• Sticker shock when people see their 2026 rates

• Confusion and fear about losing subsidies

• Worry about going without coverage next year

  
  

Let’s break down what is happening, how subsidies really work, and where private PPO plans may actually look more attractive now, while still being honest about who may need to stay on ACA no matter what.

What Is Different About 2026 ACA Open Enrollment?

In short, prices are up, and enhanced subsidies are at risk.

• Insurers on the ACA Marketplaces are raising premiums significantly for 2026. In many HealthCare.gov states, benchmark silver plans are seeing very noticeable increases.

• At the same time, the enhanced premium tax credits that were put in place during COVID (through the American Rescue Plan and then extended by the Inflation Reduction Act) are scheduled to expire after 2025 unless Congress acts.

  
  

If these boosted subsidies end, what people pay out of pocket for ACA coverage in 2026 could jump sharply.

That is exactly why so many families are feeling blindsided when they look at their 2026 options.

Pain Point 1: “Why Did My Premium Just Explode?”

If your income is too high to qualify for much, or any, subsidy, you are seeing the full force of these rate hikes.

For unsubsidized households, that can mean:

• Monthly premiums are jumping by hundreds of dollars

• A family silver plan that used to be barely manageable is now eating up a huge chunk of take-home pay

• Tough choices between staying insured, raising deductibles, or dropping to a bare bones bronze plan

  
  

The reality is that the ACA Marketplace was designed with subsidies baked in. When premiums go up, and subsidies get less generous, unsubsidized and lightly subsidized families take the hardest hit.

Pain Point 2: “What Happens If My Subsidy Gets Reduced?”

First, a quick refresher on how ACA subsidies work:

• They are premium tax credits, based on your household income compared to the Federal Poverty Level (FPL) and the price of a benchmark silver plan in your area.

• The law tries to cap your premium at a certain percentage of your income. If the benchmark plan costs more than that cap, you receive a tax credit to close the gap.

• The “enhanced” subsidies we have had since 2021 lowered those caps and let more middle-income households qualify, including many who used to be over the 400 percent FPL cliff.

  
  

If those enhanced subsidies expire at the end of 2025, then in 2026:

• Many people will see their tax credits drop, even if their income stays the same

• Some families will lose eligibility for any premium tax credit at all

• People who have been paying very little, or even zero dollars, for silver plans could suddenly face much higher annual premium costs

  
  

That is where a lot of the fear is coming from: “Will I be able to afford any plan next year?”

If You Do Not Qualify for Subsidies, You Might Be Overpaying on ACA

If your income is too high for a credit or you are blocked because of access to “affordable” employer coverage, the Marketplace is basically charging you full retail.

Combine full price ACA premiums with significant rate increases, and it is no surprise that many:

• Self-employed individuals

• Small business owners

• Higher-income W-2 families

  
  

are starting to feel like they are overpaying for ACA coverage compared to what they actually use.

This is exactly the group where private PPO plans have become more competitive again.

Why Private PPO Plans Look Better Than Ever (For the Right People)

Off-exchange, there are private, medically underwritten PPO options that are not part of the ACA Marketplace. They are not right for everyone, but for the right households, they often check some big boxes:

• Competitive pricing compared to full price ACA plans, especially for healthy individuals and families who do not qualify for subsidies

• National PPO networks with broad access to doctors and hospitals

• Options to customize deductibles, copays, and supplemental coverage (accident, critical illness, hospital benefits, and more) to protect against big bills

  
  

In many areas, when you compare a full price Marketplace silver plan with a private PPO for a healthy family, you will sometimes see:

• Similar or lower monthly premiums on the private PPO

• Lower or more flexible out-of-pocket exposure

• Better access to preferred doctors and hospitals

  
  

It is very important to understand what these private PPOs are and are not:

• They are usually medically underwritten, which means your health history matters

• They are not guaranteed issue like Marketplace plans

• Pre-existing conditions can impact eligibility, pricing, or waiting periods, depending on the carrier

• They may not be available in every state or for every situation

  
  

So while private PPOs look more attractive than ever for many unsubsidized, relatively healthy households, they are not a one-size-fits-all solution.

Marketplace Plans Are Still Guaranteed Issue, and That Matters

Here is the big reason ACA Marketplace coverage still plays a crucial role:

ACA Marketplace plans are guaranteed issue and cover pre existing conditions.

By law:

• You cannot be denied an ACA-compliant plan because of your health

• You cannot be charged more just because you have a pre-existing condition

• Plans must cover essential health benefits like hospital care, maternity, mental health, and prescriptions

  
  

That is why, for some people, staying on ACA may be the right call even if the premium stings, including:

• Folks with serious or multiple chronic conditions

• People undergoing or expecting major surgeries

• Those on very expensive brand-name medications

• Anyone currently in cancer treatment or advanced heart disease care

• People who have had recent major health events, such as a heart attack or stroke

  
  

If a private PPO carrier is likely to:

• Decline the application

• Heavily increase the premium because of the health history

• Exclude or delay coverage for key conditions

  
  

Then a guaranteed issue ACA plan with full essential health benefits is usually the safer long-term choice, even at a higher monthly cost.

Common Fears Right Now and How to Respond

“I am scared I will not have coverage next year.”

• Mark the key deadlines

  • December 15, 2025 is the last day to enroll for coverage starting January 1, 2026

  • January 15, 2026 is the final day of open enrollment for a February 1 start

• If you currently have a Marketplace plan, do not just let it auto renew without checking the new premium, network, and deductible

• If ACA premiums are too high, talk with a licensed advisor about both Marketplace and private PPO options before dropping coverage

  
  

“What if I pick the wrong plan and get stuck?”

• Compare plans on more than just the premium. Look at the network, deductible, max out of pocket, and your usual medications

• Use this open enrollment window to shop side by side:

  • ACA options, with or without subsidies

  • Private PPO options, if you qualify health-wise

• A good advisor can help you work through “what if” scenarios, such as pregnancy, surgery, or a hospital stay

  
  

“I am healthy now, but what if something big happens?”

This is where strategy matters:

• If you are healthy and unsubsidized, a private PPO plus smart supplemental coverage might give you strong protection at a lower price than ACA

• If you already know you have heavy medical needs, ACA’s guaranteed issue, essential health benefits, and out-of-pocket caps may still be your best safety net

  
  

What Should You Do During This Open Enrollment?

Here is a simple way to think about it:

1. Check your 2026 ACA options first. See the new premium and how much, if any, subsidy you still get.

2. If your subsidy shrank or disappeared, do not assume ACA is your only option. Get quotes for private PPO coverage if you are generally healthy. Compare apples to apples: monthly premium, max out of pocket, network, and what happens in a worst-case scenario.

3. If you have major health concerns, prioritize guaranteed issue. Marketplace plans cannot turn you down or charge more because of your conditions. You are paying for that protection, but for many people it is worth every penny.

4. Work with an independent advisor, not a random telemarketer. An independent, licensed agent can show you both ACA and private options, explain trade-offs in plain language, and help you avoid spammy lead mills and bait-and-switch tactics.

   
   

Open enrollment this year is not the year to set your plan to auto-renew and hope for the best.

Premiums are changing. Subsidies are changing. But you do have options, especially if you take the time to compare ACA and private PPO plans side by side and make a decision based on your health, income, and risk tolerance, and not just the first number you see on a website.