2026 health insurance sticker shock hits home

CELINA - Area insurance agents are urging their clients to stay patient as they help them navigate the rough terrain that is the 2026 open enrollment period for the ACA Health Insurance Marketplace.

Unlike previous years, this year's enrollment period is marred by the looming expiration of COVID-era tax credits that help tens of millions of Americans afford their health care premiums - set for Jan. 1, 2026.

"The biggest change in 2026 is the reverting back to prior-to-COVID or prior-to-2021 rules, and the biggest change would be (for) anybody over 400% of the poverty line," said Josh Carrasquillo, who owns and operates CareSurance in Coldwater with his wife Renee.

More than 24 million people have ACA health insurance, a group that includes farmers, retirees, small business owners and other self-employed people who don't have other health insurance options through their work.

ACA health insurance, commonly referred to as Obamacare because it was enacted during President Barack Obama's administration in 2010, is a comprehensive health care reform law.

Traditionally, the law provides consumers with subsidies, or premium tax credits, that lower costs for households with incomes between 100% and 400% of the federal poverty level.

Those subsidies were enhanced in 2021 under the American Rescue Plan Act as a form of pandemic relief, then later extended through the end of 2025 by the Inflation Reduction Act.

The enhanced tax credits increased the amount of financial assistance already eligible ACA Marketplace enrollees received as well as made middle-income enrollees with income above 400% of federal poverty guidelines - or $62,600 per year for a single person and $84,600 a year for a couple - newly eligible for premium tax credits.

If the tax credits expire as they are set to, annual out-of-pocket premiums are estimated to increase by 114% - an average of $1,016 - next year, according to an analysis from the health care research nonprofit KFF. While some premium tax credits will remain, the level of support will decrease for most enrollees. Anyone earning more than 400% of the poverty level will no longer be eligible for the remaining tax credits, as they had been since COVID.

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

However, Kendra Seitz, an account executive at Leugers Insurance Agency, which maintains offices in Maria Stein, St. Marys and Celina, stressed that there is no need to panic, as the tax credit expiration will not affect everyone in the same way.

"If we have six appointments in one day and they're all individual health reviews, no (two people have) the same scenario. As an overall, I can say, yep (the subsidies are changing). Will everyone's premiums go up so much? No," she said. "Are there scenarios where, yes, those individuals were getting the effects of the expansion and are no longer seeing that because their income's now over that 400%? Absolutely. But what we're doing is literally going through every client and just looking at, for this scenario, what can we do for them? Are there other options out there for them? And really just navigating each person's scenario specific to them."

While not everyone is seeing huge hikes, anybody over the age of 60 is getting hit hard, Josh Carrasquillo said.

He explained that, as a worst-case example, a 62-year-old couple making $85,000 annually would at worst pay around $2,100 a month for the cheapest plan, which comes with an out-of-pocket max of $10,000.

"When they have no help, they're going to pay over $2,100 for the cheapest plan and that's not even going to be a good plan," he explained. "If you look at this couple (that makes $84,000 annually and still qualifies for subsidies) - literally it's just $1,000 difference in income projection for the year. They would pay $400 for the lowest or cheapest plan you could get. But that's an astronomical difference (in costs), and you can see why some people are up in arms about it."

In addition to the loss of enhanced subsidies, all ACA enrollees will have to deal with spiking health insurance premiums.

The amount health insurers charge for coverage on the ACA Marketplaces is rising 26%, on average, in 2026, per KFF. In states that run their own marketplaces, the average benchmark second-lowest cost premium, on which the tax credit calculation is based, is rising 17% next year. In states that use HealthCare.gov, like Ohio, these premiums are rising an average of 30%.

With those higher costs, some people will drop out of health insurance altogether, Josh said, which can cause issues for everyone.

"The more people who don't stay on (the Marketplace) that are healthy, messes up the whole pool," he added. "If you go from a scenario where it's balanced, you have healthy and unhealthy people (using the Marketplace), it all offsets itself. The minute you lose a lot of the healthy people, then you can see the cost rise for the unhealthy."

Right now, Renee Carrasquillo said, their office is seeing a lot of "thinkers," that are deciding if health coverage is even worth it or not.

Some of their clients have resorted to other ways in which they can possibly lower their monthly costs, Josh said.

Some have looked toward doing healthshare programs, which are member-based, cost-sharing programs and not traditional health insurance. While at times more affordable, they are not governed by the Ohio Department of Insurance and often have limitations on pre-existing conditions.

Others are looking to short-term insurance plans, which provide temporary coverage.

"Short-term plans, they won't cover pre-existing conditions. They have three pages of limitations. They do not follow ACA guidelines. They don't follow ACA preventatives," Josh said. "So, (if they are interested), we send the brochure to clients and say, 'Make sure you read the fine print.' And if they want the healthshare, I say 'Read the fine print.'"

Though Republicans, who lead both the House and the Senate, refused to engage on extending the COVID-era tax credits as part of a deal to end the government shutdown, it's not too late for Congress to take that step if they come around to it. They can even reinstate the subsidies after they expire.

Such a move would likely enjoy widespread favor with Americans, according to a recent poll. About three-quarters of U.S. adults - including about half of Republicans - still support extending the expiring tax credits, according to a new KFF poll conducted Oct. 27 through Nov. 2.

If lawmakers do save the subsidies, federal and state marketplaces will have to adjust the plans they've made available for consumers. Insurers and outside experts say that can be done, but may take weeks and will become more difficult as time goes on.

Even if the subsidies are extended, it may already be too late for some prospective enrollees who have already had more than a week to see next year's higher prices and make other plans.

Though he's hoping for an 11th hour solution to the expiring subsidies, Josh acknowledged it is unlikely to do any good.

"My take on it is that everybody's so far apart in what (they think) should happen. I wish something would happen. Something needs to happen, but I don't know that something will. I won't hold my breath for it. Open enrollment's already started, so it's too late. Everything's baked in for 2026. If they change something, it means they could extend how long you can sign up for (ACA plans), which isn't good for the overall system. … I'd say the biggest thing is, be patient with the agent you work with, give them time. They'll get (you) through it."

-The Associated Press contributed to this report.