The Affordable Care Act marketplace opened one week ago, and millions of Americans are making crucial decisions about their health coverage for 2025. However, rising premiums, changing subsidies and increasing prescription drug costs are creating financial challenges for consumers heading into 2026.
Cynthia Cox, vice president and director of the program on the ACA at KFF, a nonprofit health policy organization, explained the factors driving these cost increases affect both ACA marketplace shoppers and those with employer-sponsored insurance.
"Whether you're getting your insurance through the Obamacare markets or through your employer health care, costs are going up a lot next year," Cox said.
She identified several common factors contributing to rising costs across all insurance markets, including the expense of GLP-1 drugs like Ozempic and Wegovy, which treat both diabetes and weight loss, along with increasing hospital and prescription drug costs.
For ACA marketplace consumers, an additional concern looms: enhanced tax credits that reduce premium costs for about 22 million people are set to expire next year.
"That means people will get less financial help at the same time that insurance premiums are rising," Cox said.
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Even if Congress extends the subsidies, the situation remains complex for consumers currently shopping on the exchanges.
For those struggling with rising costs, Cox recommended several strategies. Employees should consult their HR departments to understand all available options and benefits, including telemedicine services.
ACA marketplace shoppers should seek help from agents, brokers or navigators who can review options in detail. Cox advised scheduling appointments early, as this open enrollment season will be particularly busy.
"Consider whether you might be able to switch to a lower premium plan, even if it has a higher deductible. You might still be better off with that plan than being uninsured," Cox said.
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