Open enrollment for millions of Americans starts this week. This is the time when most people can choose or change their health insurance coverage for 2026.
This year, open enrollment season is mired with uncertainties tied to the government shutdown and ongoing debate among politicians over the Affordable Care Act (ACA). However, even those who don’t receive insurance through the ACA will likely see an increase in monthly insurance costs.
Here, Straight Arrow News has created a guide to address some of the most pressing open enrollment and health insurance questions.
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When is open enrollment?
For most Americans, open enrollment begins on Nov. 1. The open enrollment deadline for federal ACA marketplaces is Dec. 15 for plans starting Jan. 1. There is a second deadline — Jan. 15 — for plans starting Feb. 1.
A handful of states run their own Affordable Care Act marketplaces, and open enrollment deadlines vary slightly by state. In Idaho, open enrollment runs from Oct. 15 to Dec. 15. Other states have longer open enrollment periods, but most still begin Nov. 1.
For those who receive health insurance coverage through an employer or a spouse’s employer, the open enrollment deadline may vary. Each employer sets its own open enrollment period, so check with the company’s human resources staff for key dates.
Why are health insurance premiums going up?
Health insurance premiums have been on an upward trend over recent years. For the past three years, prices have outpaced inflation, climbing more steeply than earlier in the decade. Unfortunately, all signs point to another rise in health insurance premiums.
There are several driving forces behind this. One is simply higher spending on health care. Conditions such as cancer are becoming more common among younger people. More people are taking GLP-1s, the popular but expensive weight loss drugs. Hospital prices are increasing. Health care providers are demanding higher pay. Consequently, Americans who receive insurance through their employer are likely to see premiums rise by about 6% or 7%, according to an analysis by global consulting firm Mercer.
The government shutdown is also driving up insurance costs. Politicians are deadlocked over several health issues, including tax credits granted to the nearly 24 million Americans who purchase insurance under the Affordable Care Act.
In 2010, when the act was passed, it implemented federal subsidies meant to lower the price of health insurance. Initially, these subsidies came in the form of tax credits and cost-sharing reductions, available exclusively to low-income Americans.
In 2021, Congress passed the American Rescue Plan Act to cushion the economic fallout of the COVID-19 pandemic. This act eliminated health insurance premiums for the lowest-income households and expanded the original subsidies to all Americans regardless of income. The Inflation Reduction Act of 2022 further extended these provisions through 2025.
Democrats and some Republicans are pushing to retain these subsidies, but many Republicans are resisting. Vice President JD Vance has said these credits fuel fraud.
If the subsidies are nixed, Americans who purchase insurance through Affordable Care Act marketplaces may see their premiums double. The average premium payments for Americans who received insurance through Affordable Care Act marketplaces were $888 in 2025 and may rise to $1,904 in 2026.
Should Americans wait to purchase coverage until Congress makes a decision?
Cheryl Fish-Parcham, director of private coverage at Families USA, a consumer health care advocacy organization, said Americans should not wait to purchase coverage until Congress reaches a verdict. Americans should start the process as soon as open enrollment begins. If Congress later extends the subsidies, thus lowering monthly premiums, consumers have until Dec. 15 to change plans for coverage beginning Jan. 1, 2026.
“If Congress extends the enhanced tax credits, at that point, people should check to see if they can buy a more generous plan through the marketplace with their increased assistance,” Fish-Parcham told SAN. “Under current rules, after Jan. 15, enrollment is over in the federal marketplace and in many states, so people should be aware of deadlines and ensure they enroll in coverage,”
Given the uncertainty swirling in Washington, some consumer groups are asking for the open enrollment period to be extended. But it is unclear if such an extension will be granted.
Does health insurance cover in vitro fertilization?
The White House recently announced that the Trump administration had reached agreements with three pharmaceutical companies to lower the costs of common in vitro fertilization (IVF) medications. But does health insurance cover any part of IVF?
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The Department of Health and Human Services in 2021 found that more than 86,000 infants, 2.3% of all babies born that year, were conceived using assisted reproductive technology (ART).
Unfortunately, the answer is more complicated than a simple yes or no. Coverage varies by state, as well as the size of an employer offering coverage. Even if insurance covers IVF, there may be caveats.
For instance, in Arkansas, patients must have experienced at least two years of unexplained fertility or be diagnosed with a specific condition to be eligible for insurance to cover IVF costs. Health maintenance organization (HMO) plans, one of the five common types of insurance plans, are exempt from covering IVF.
If a patient meets Arkansas’ threshold for coverage, the state only requires insurance to cover a lifetime maximum of $15,000. On average, one round of IVF costs between $20,000 and $25,000. The average cost per live birth is around $60,000.
Many states have different levels of IVF coverage alongside different laws, but there are resources, such as the National Fertility Association, that help cut through the noise.
Which plans cover Wegovy, Zepbound or other GLP-1 drugs?
GLP-1 drugs such as Wegovy and Zepbound, initially developed to treat Type 2 diabetes, are becoming increasingly popular treatments for obesity. Still, few insurance companies cover the drug – especially when it is used for weight loss alone. Insurance coverage varies by state and insurer.
Medicare, for instance, does not generally cover GLP-1 medications, save for a limited number of plans. Medicaid programs in 14 states and Washington, D.C., do not cover GLP-1 treatments for obesity; another 22 states provide only partial coverage. Insurance generally covers GLP-1 drugs for the treatment of Type 2 diabetes.
This year, some of the largest health insurance companies, including Elevance, CVS and Kaiser Permanente, started covering Wegovy for some patients with heart conditions who need the drug to lower their risk of heart attack and stroke. However, many companies do not cover the drug for weight-loss treatment alone. Other companies, such as UnitedHealthcare, have shifted away from Wegovy and now cover Zepbound for adults with obesity who also have at least one additional weight-related condition, such as high blood pressure, Type 2 diabetes or sleep apnea.
Coverage may change soon: There are currently a series of lawsuits against insurance companies for refusing to cover GLP-1 drugs for certain FDA-approved conditions.
Which health insurance company denies the most claims?
Earlier this year, researchers at KFF analyzed 2023 claims data from insurance companies offering plans through the ACA. They found that the denial rate ranged from 1% to 54%, varying drastically from state to state. Overall, insurance companies denied 19% of the 392 million in-network health claims submitted nationwide in 2023.
Blue Cross Blue Shield of Alabama and UnitedHealth Group had the highest denial rates — over 30% —followed by Health Care Service Corporation and Molina Healthcare, both with denial rates over 25%. Of all the states required to submit data to the federal government, health insurance companies in Alabama denied the most claims on average, about 34%.
Are health insurance premiums and medical expenses tax-deductible?
If a person receives health insurance through an employer or a spouse’s employer, premiums are not tax-deductible. Self-employed Americans who purchase their own insurance can deduct the full cost of the monthly premium from taxable income.
Anyone can deduct medical expenses from taxable income as long as a person has paid those expenses out-of-pocket and not from a health savings account (HSA), spent at least 7.5% of adjusted gross income for that year on the expenses and itemized their tax deductions.
Can someone walk me through picking a plan?
The government offers a service that connects Americans with an agent to navigate the entire process. Families USA warns that services this year are limited due to funding cuts.
“It might take longer to get an appointment, and people should reach out immediately for assistance. It will be easier in states with state-based marketplaces,” Fish-Parcham told SAN.
She also warned that there are numerous fraudulent sites with misleading names that sell junk insurance. Consumers can verify companies through the official website maintained by the Centers for Medicare & Medicaid Services.
What happens if a person doesn’t have health insurance?
While there is no longer a federal tax penalty for not having health insurance, some states still impose fines. California, Massachusetts, New Jersey, Rhode Island and Washington, D.C., all issue penalties, most based on household income.
In California, the minimum fine is around $900 per uninsured adult and $450 per uninsured child.
In the District of Columbia, the penalty can be up to 2.5% of family income or $795 per adult and $397.50 per child, whichever is higher. There are some exceptions. If a person’s income is below the federal tax-filing threshold or if an individual receives a hardship exemption, such as during or after a natural disaster, that person may not face a penalty for not having health insurance.
With the ever-increasing cost of health insurance, many might consider foregoing insurance altogether, regardless of potential fines. If a person forgoes insurance and then requires medical care, they might incur exorbitant medical bills, leading to debt and tax penalties.
Patients will not be denied care if they walk into an emergency room needing immediate treatment. The Emergency Medical Treatment and Labor Act of 1986 mandates that anyone seeking care in an ER must be examined by a health care professional and given stabilizing care.
A patient will be responsible for the full payment of those services unless the hospital provides financial assistance or waives payment entirely. Emergency room services can be costlier for uninsured patients because they do not benefit from the lower rates that insurance companies negotiate with hospitals. Some visits can cost upwards of six times as much for uninsured people, averaging between $1,500 and $3,000.
