How to Shop for Obamacare When Subsidies Are in Limbo

Open Enrollment Begins Amid Congressional Gridlock

Starting November 1, millions of Americans who don’t receive insurance through their employer, Medicare, or Medicaid can sign up for Affordable Care Act (ACA) health coverage via HealthCare.gov or state marketplaces.
But this year’s enrollment season comes with uncertainty — Congress remains deadlocked over whether to renew expanded tax credits that have kept premiums affordable.

With the federal government shut down and partisan divisions deepening, many consumers will face steep premium hikes or reduced subsidies.

“In a word, mayhem is what’s going to happen during this open enrollment,” said insurance agent Jeff Smedsrud.

Why You Should Shop Carefully

Even if you’re already enrolled, don’t auto-renew your plan. Premiums and subsidy amounts have shifted dramatically.
Experts advise reviewing new plan options and consulting licensed brokers or marketplace navigators before deciding.

Key enrollment dates:

• Dec. 15 – last day to sign up for coverage starting Jan. 1

• Jan. 15 – final deadline for coverage beginning Feb. 1

“People should really look and see what they are facing,” said Justin Giovannelli, health researcher at Georgetown University. “There’s no reason to delay that.”

If Congress later passes a subsidy extension, you may adjust your selection during the open enrollment period.

Understanding Plan Tiers and Costs

Marketplace plans fall into four “metal” tiers:

• Bronze: lowest premiums, highest deductibles

• Silver: moderate premiums, with subsidies based on this tier

• Gold: higher premiums but lower cost-sharing

• Platinum: highest monthly cost, minimal out-of-pocket expenses

The Silver plan is crucial for those earning less than $39,126 (individual) or $80,376 (family of four). These plans qualify for premium and cost-sharing subsidies.

If your income is higher, compare all tiers — sometimes Gold plans cost less than Silver due to market pricing quirks.

Young adults under 30 who don’t qualify for subsidies may consider catastrophic plans, which have high deductibles but lower premiums and essential protections.

Update Your Income — or Risk Tax Penalties

Premium subsidies are based on projected income, so accuracy matters.
If you underestimate and earn more than expected, you’ll owe money back when filing taxes.

A recent law removed limits on repayment caps, meaning mistakes could cost thousands — especially for those near 400% of the poverty level (around $63,000 for individuals).

“People should be more diligent than ever,” said Katie Keith, adjunct law professor at Georgetown. “Update your income throughout the year if it changes.”

Avoid “Junk” Insurance Alternatives

Some short-term or faith-based health plans don’t follow ACA protections, such as covering pre-existing conditions or major procedures.
These may appear cheaper but can leave policyholders with massive medical bills.

“A lot of it can be junk coverage that doesn’t cover what you need,” warned Anthony Wright, CEO of Families U.S.A.

Always confirm that a plan is ACA-compliant before signing up.

What If Congress Restores Subsidies Later?

If lawmakers eventually extend enhanced tax credits after enrollment, adjustments may take time to reflect — meaning higher bills could persist temporarily.

Despite uncertainty, experts urge Americans to stay insured.

“Even a few days in the hospital can cost tens of thousands,” Wright said. “Insurance protects your savings — and your home.”