Initial data from the 2025 Affordable Care Act (ACA) open enrollment period shows an uptick in sign-ups compared to last year, even as enhanced premium subsidies face expiration at the end of 2025. For organizations working to expand access to care, these trends illustrate both opportunity and risk for coverage affordability in the year ahead.
Early Enrollment Growth Despite Cost Uncertainty
According to federal data from the Centers for Medicare and Medicaid Services, nearly 5.8 million Americans had already selected ACA plans by day 29 of open enrollment, about 400,000 more than the same point in 2024. This early activity suggests that many people are acting sooner rather than later even amid uncertainty about future costs.
Why Premiums Are Rising, And What’s at Stake
The primary driver behind rising premium concerns is the potential expiration of the enhanced premium tax credits, first expanded during the COVID-19 pandemic. These subsidies significantly lowered monthly costs for millions of Americans and were the single biggest factor behind the dramatic growth in ACA marketplace enrollment over the past several years. Without congressional action to extend these subsidies, premiums are expected to rise in 2026, putting coverage out of reach for many households.
Political gridlock is compounding the issue, as lawmakers remain divided between extending the subsidies and pursuing alternatives such as one-time HSA contributions, and neither approach currently has enough support to pass. This uncertainty makes it harder for insurers to price 2026 plans, increasing the likelihood of higher premiums and fewer plan options.
Why this Matters to American Exchange’s Clients
For covered entities focused on expanding access to care, the shifting ACA landscape underscores a major operational challenge: insurance coverage is only useful if patients can afford it. Rising premiums, paired with unclear federal policy threaten to widen coverage gaps precisely where our clients are working hardest to close them.
This is where strategy surrounding financial assistance and enrollment support become critical:
- Premium Assistance Programs (PIAPs) can help eligible patients enroll in marketplace plans even as subsidies change.
- Data-driven outreach and enrollment support ensures that uninsured and underinsured patients understand their options before, and if, subsidies expire.
- Programs like American Exchange’s PIAP enable organizations to support coverage for their patients without sacrificing mission-critical programs
Looking Ahead
The early surge in ACA sign-ups shows that Americans value affordable coverage and are responding to rising cost signals. At American Exchange, we specialize in helping organizations design and implement Premium Insurance Assistance Programs, as well as broader enrollment strategies that can mitigate coverage gaps and optimize access, no matter the future policy environment. If your team is evaluating how to support patients through these changes, we’re here to help.
Set up a consultation with our team, here.
Sources:
“Affordable Care Act enrollment is slightly ahead of last year so far, despite expiring subsidies” Link
“ACA Sign-Ups Outpacing Last Year’s Numbers, Despite Subsidy Uncertainty”, Link
“Senate heads toward dueling partisan votes on health care, with each likely to fail”, Link
