AUSTIN (Nexstar) — For the nearly 4 million Texans who currently use the Affordable Care Act (ACA) marketplace to get their insurance, Saturday is the time to start looking at renewals. Open enrollment starts then, and in order to have health insurance starting on Jan. 1, current enrollees must select their 2026 plan by Dec. 15. The final deadline is Jan. 15 to get insurance starting on Feb. 1.
Costs are set to rise dramatically for many in 2026 — with insurers hiking pre-subsidized premiums by an average of 35%. Despite the potential sticker shock, experts say a large portion of those currently on the program will still be able to find great deals on the Healthcare.gov marketplace.
‘If you go out there and shop, you may find good consumer value’
Experts say one of the easiest ways to save money is to take time and find the right plan at the right price, regardless of your current plan.
Texas 2036 Director of Health and Economic Mobility Policy Charles Miller, a former budget and policy adviser for Gov. Greg Abbott, said that those currently enrolled in plans “shouldn’t be scared” of reports on premium increases.
“We want to get the word out that there are low premiums. There are free plans out there. Current enrollees shouldn’t be scared about a lot of the reporting about the premium increases,” Miller said. “If you stay on your same plan, you may see premium increases. If you go out there and shop, you may find good consumer value.”
Plan availability and pricing are determined on multiple factors — namely your county, age and income.
Ahead of the open enrollment period, Miller tested various scenarios in the ACA marketplace to see what plan prices look like. For people making less than 200% of the federal poverty level (FPL) — $30,120 for an individual and $62,400 for a family of four — there was at least one free plan available in each of the four cities he looked at: Austin, Houston, Brownsville and El Paso.
76% of current ACA enrollees in Texas make less than 200% of the FPL.
Due to the complexity of finding the right healthcare option, Miller recommends consulting an insurance broker — and to try and find one you can trust.
“You don’t have to pay [brokers] out-of-pocket. They are paid on a commission basis of the plans they recommend,” Miller explained. “It is important that you find a trusted one — maybe you could get a recommendation from a co-worker or friend or somebody within your community that has gotten covered before to make sure they’re providing good advice to you.”
Who is hurt most by the expiration of the tax credits?
Enhanced ACA subsidies were first introduced in 2021 in the American Rescue Plan, increasing the amount of savings on monthly premium costs and expanding the amount of people eligible to receive the subsidy. Certain subsidies that aren’t expiring have been there since the beginning of the ACA.
“The way the subsidies were designed is that, based on your income, you would have a required individual or family contribution that was measured as a percentage of your income,” Miller said.
In the beginning, those subsidies started for those making 100% of the FPL and were capped at 400% of the FPL — $62,600 for an individual or $128,600 for a family of four in 2025. Those above the threshold were on the other side of the “subsidy cliff,” making too much money to be eligible for assistance on ACA premiums.
The 2021 enhanced subsidies removed the subsidy cliff, allowing all making over 100% of the FPL to qualify and increasing the subsidies for those who already did. The ones hit the hardest by the expiration of the enhanced subsidies would be those above the 400% of FPL threshold.
“In general, I would say if you’re eligible for a subsidy, you should not hesitate,” Consulting Actuary Greg Fann said. “But if you’re not subsidy-eligible, you probably need to look elsewhere (for your health insurance) because you’re not going to get a good value.”
Only 7% of ACA enrollees in Texas made over 400% of the FPL — as many who earn that much have alternative means of getting health insurance.
“The people (enrolled in the ACA over the subsidy cliff) are likely to either be self-employed (or) early retirees who would have that relatively high income but would not also have access to insurance by other means,” Miller said.
Prices will likely rise for many of the 93% of current Texas enrollees who make under 400% of the FPL. However, Fann and Miller say a it’s still a good deal on an essential.
“It’s still a very, very good value for people in Texas,” Fann said. “You can make the percentage argument, ‘Hey, I paid $20 last year, I’m paying $60 this year, my premium’s tripled,’ but you’re paying for a product that costs $600 to $700.”
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