Millions of people who get their health insurance through the Affordable Care Act marketplace are bracing for sticker shock as open enrollment begins Nov. 1.

Without a deal in Congress to end the government shutdown and extend critical tax credits that helped many people afford their coverage, premiums are expected to skyrocket.

In Pennsylvania, nearly 500,000 people are enrolled in the state's Affordable Care Act insurance marketplace, Pennie. More than 510,000 people are enrolled in plans obtained through New Jersey's state marketplace, while enrollment in Delaware hit an all-time high this year at just over 50,000, according to officials.

More than 90% of marketplace enrollees nationwide rely on tax credits to afford their monthly premiums, like Jason Piperberg, a freelance illustrator living in South Philadelphia.

The 36-year-old is still recovering from treatment for papillary thyroid cancer.

"I don't get regular paychecks every month," he said. "Having the extended tax credits allowed me to not be in immense debt."

Piperberg said he pays around $115 a month now for his silver-tier plan and couldn't afford to have his premiums double or more without the tax credits.

Matt McGough, an analyst with the nonprofit, nonpartisan health policy organization KFF, said without the credits, average premiums are expected to soar by more than 114%.

"That can mean over $1,000 more that they're paying per year," he said. "For people who have, you know, very volatile incomes year-to-year, that can be really substantial." 

McGough said there are a few good options, but enrollees can consider dropping down to lower-tier plans to bring down costs — like moving from a gold to silver plan, or silver to bronze.

But be warned, plans with lower monthly premiums often have higher deductibles, he said.

With any change to your coverage, be sure to check whether your providers are still in-network and your medications are still covered, he said. 

McGough fears many people may opt to simply drop their coverage altogether, which could come at a cost to everyone.

"That means that there's going to be more uninsured people that show up at the hospital and clinics and potentially are receiving uncompensated care, which increases premiums across the health care system," McGough said. "Those costs don't disappear."

For Piperberg, dropping his coverage might be the only option he can afford, even though he can't really afford to go without.

"It's one thing if I didn't have this history of cancer," he said. "But I have ultrasounds coming up soon, I have blood work that I get regularly just to make sure that I'm on the right track, and so to think about not being able to do that is really scary." 

You can get free local help with the enrollment process through Healthcare.gov, Pennie and Get Covered NJ. Trained navigators can provide unbiased assistance to help you search coverage options. Brokers or agents can also help, but they are generally paid a commission by health insurance providers.

The open enrollment period for those who get their health insurance through the government marketplace runs from Nov. 1 to Jan. 15, 2026. For coverage to start Jan 1, the deadline to enroll in or change plans is Dec. 15.

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