Health care advocates tried Monday to impart last-minute advice to those trying to find coverage as the 2026 open enrollment period for Affordable Care Act marketplace coverage comes to an end amid spiking premium rates due to a stalemate in Congress.
“We urge people to know your options, to shop and compare, and to find the most affordable plan you can. We recommend that you don’t auto-renew, but really look at the new plans and premiums, because the best choice last year is not necessarily the best deal this year,” Anthony Wright, executive director of Families USA, said Monday during an event hosted by the group Florida Voices for Health.
Dec. 15 is the deadline for enrollment for Jan. 1 health insurance coverage. People can continue to enroll in the marketplace through Jan. 15 but those health insurance policies wouldn’t take effect until Feb. 1.
“And so we really do recommend that you sign up, shop, and compare, and that you continue to fight like hell for the tax credits that keep consumers covered and coverage affordable,” Wright added.
READ MORE: Health insurance under Affordable Care Act to skyrocket after Senate fails to extend tax credits
Health insurance agent Heather Stone, who has helped 3,000 people in the Tampa and southwest Florida area buy policies through the ACA exchange, is worried about people who haven’t re-enrolled or chosen a new health plan.
“We do have a lot of people who are just kind of playing possum right now and not doing anything. This is where this concerns me,” she said. At a minimum, people who don’t want to continue their health insurance policies need to tell their insurers of their plans and to cancel auto payments.
“Or we’re going to be getting overdraft charges, right before Christmas. So, we have some concerns about the people who’ve just decided to do nothing,” Stone added.
Congress passed the enhanced premium tax credits in 2021 to further lower out-of-pocket costs for “silver” level ACA plans. The plans are named after four metals: bronze, silver, gold, and platinum. The bronze plan offers the lowest premiums and highest out-of-pocket costs. Platinum has the highest premiums with the lowest costs.
The tax credits were part of the reason behind the federal government shutdown. They expire at the end of the year.
So far, House and Senate Republican leadership hasn’t gotten on board with any extension of those subsidies, arguing they have led to a sharp rise in the cost of health insurance. GOP lawmakers have instead pursued their own legislation but, without at least some backing from Democrats, no bill will make it through the Senate’s 60-vote procedural hurdle.
Senate Republicans tried to advance a bill earlier this week from Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo but fell short of the votes needed. Democrats were unsuccessful trying to move their bill to extend the ACA marketplace tax credits for three years.
The House Republican bill, sponsored by Iowa Republican Mariannette Miller-Meeks, is unlikely to break the logjam in Congress, potentially leaving the issue as one the parties can debate leading up to next year’s midterm elections.
The elimination of the enhanced premium tax credits is hitting Florida, which leads the nation in the number of people who enroll in the federal health insurance exchange.
Costs of health insurance across the state have increased dramatically and the number of people who have enrolled in the federal exchange since open enrollment started has decreased.
The Centers for Medicare and Medicaid Services says that, as of Dec. 5, 1,686,194 Florida residents were enrolled in the exchange, which leads the nation.
For some residents in Miami, the costs of an insurance policy for a 45-year old earning $32,000 annually would have been $691 with the enhanced premium tax credit. Without the credit, the cost is $2,159.
Some of the other striking cost jumps: A family of four earning $130,000 annually would pay $11,050 annually with the enhanced premium tax credits but $26,166 annually without the credits. And a 60-year-old couple earning $85,000 annually would pay $7,225 with the enhanced premium tax credits but $34,760 without.
“Working in those last few years before retirement, if they can afford to retire on time, they will end up paying … $27,000 more in premiums,” Florida Healthy Voices Executive Director Scott Darius and host of the Monday event said.
And the spikes in insurance aren’t limited to those living in large urban areas.
Using the same examples but for people living in the North Florida area represented by Republican Kat Cammack, Darius said the 45-year-old earning $32,000 a year would have to pay $1,468 more for their insurance without the enhanced subsidies, or a 212% increase in cost.
A family of four would pay $17,351 more without the enhanced credits, a 157% increase in costs, and the pair of 60-year-olds would pay $30,504 more annually, a 422% increase.
“These are very real numbers impacting people and Floridians especially, as they grapple with their priorities for next year and their budgets for next year,” Darius said. “It’s leading people to forego coverage altogether, to settle for lower-tiered plans, or to make huge sacrifices in other parts of their life so they can keep the coverage that they have.”
Small business owner Carlos Otero, 60, has relied on the Affordable Care Act for years. He said the funding cuts and restructuring of USAID, the U.S. government agency, wreaked havoc on his small business, which he said used to work a lot with Latin American countries.
“This health crisis has been terrible for everyone in my family,” said Otero, a Latin American market research consultant who lives in Miami who moved to the area during the COVID pandemic to help care for his mother.
“This year, it came with a surprise of 900% incremental spike in my premiums and my monthly premiums, which is … already crazy from all the problems that you already have, or we already have, doing to my business,” he said. “So, obviously, having affordable care is not just an option, it’s very important.”
Otero said the spike in premiums forced him to find a different plan.
“But it will come with a cost. I will need to make choices,” he said, adding that he’s already a “senior.”
“A young senior, but I’m a senior. And I’m going to be needing more and more preventive care that I think I’m going to probably postpone if my co-payments and everything are not as they used to be,” he said. “I mean, we need the Congress to act now, not later, and extend those credits.”
Otero called it a “no-brainer.”
Lynnette Bidwell, 58, who spent 42 years working in retail management, agreed.
“I showed up every day, supporting my team, helping my customers, and doing everything I could to build a stable life. For all those years, I had health insurance through my employers. I never expected my health to decline to the point where I could no longer afford to work full-time, but that is where I found myself. I now receive Social Security Disability insurance.”
After losing her employer-sponsored coverage, Bidwell, who is divorced, enrolled in the Affordable Care Act marketplace, or exchange. With the help of an ACA “navigator,” she found coverage, a Florida Blue HMO plan that gave her continued access to the physicians she saw on her employer-sponsored plan.
“Everything changed when I went back this fall to renew for 2026. My navigator and I expected a routine renewal. Instead, we both gasped. My Florida Blue HMO silver plan, the same plan with the same benefits, went up 589%. On a limited income, that dump is just impossible.”
She said she’s been forced to switch plans, which means losing the primary care provider she’s had for more than 10 years.
“Losing him is devastating. Starting over with someone new is overwhelming. It’s just not a doctor’s appointment. It’s losing someone who understands me deeply, and knows when something is wrong by just looking at me. The emotional impact is real,” she said.
“I know I’m not alone. Many people in Florida and across the country are being priced out of their plans.”
Stone says she has “several” married clients between the ages of 59 and 64 who are considering leaving the country or going to get services abroad. Other clients are looking for health insurance plans that can be medically underwritten, such as short-term health insurance.
“And most of these people are working. They’ve done everything right. They have worked, they’re small business owners. They own restaurants, or they’ve worked for a small business that has 10 or less employees, and they have to go to the marketplace for coverage.”
Jennifer Shutt contributed to this story.
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