Paying for health insurance is about to become more painful for millions of Americans \u2014 including hundreds of thousands of residents in Massachusetts.<\/p>\n
Costs are skyrocketing as a significant share of federal subsidies that help people pay for health care expire at the end of 2025.<\/p>\n
The change affects coverage offered through state exchanges, like the Massachusetts Health Connector, that sell subsidized coverage to individuals and families. This includes self-employed adults; low- and middle-income families who earn too much to qualify for Medicaid but still need help affording insurance; and other residents who don\u2019t get insurance from their employers.<\/p>\n
In Massachusetts, the federal government spends $1.5 billion annually to subsidize health coverage for residents. At the end of the year, $425 million of those federal subsidies will evaporate \u2014 unless Congress takes action<\/a>.<\/p>\n Meanwhile, medical care is also growing more expensive, which pushes up insurance prices.<\/p>\n This is complicating the choices for residents as they enroll in coverage for 2026. The annual period to sign up for Connector plans begins Nov. 1 and ends Dec. 23.<\/p>\n \u201c\u200aThis is definitely a challenging open enrollment period,\u201d said Audrey Morse Gasteier, executive director of the state\u2019s Health Connector. \u201cWe are encouraging people to not drop their coverage, to check out their options, to reach out to us and allow us to help you navigate your choices.\u201d<\/p>\n Here\u2019s what to know about this enrollment period.<\/p>\n Who is paying more<\/p>\n More than 337,000 residents will pay higher monthly premiums for health insurance coverage in the coming year. The first bills for these plans will come due in late December, according to Connector officials. The amount of each customer\u2019s increase will depend on several factors, including age, income and where they live.<\/p>\n Costs will more than double for many people, especially older adults in their 50s and 60s. Here are a few examples:<\/p>\n \tA 62-year-old couple living in Watertown and earning $86,000 per year will see their costs rise by $1,741 per month for the same plan they have now. They\u2019ll pay a total of $3,134 per month. \tA 57-year-old couple with a similar salary in Worcester will pay $1,687 in monthly premiums, up from $528. \tAbout 26,000 people will no longer qualify for any help, based on their incomes.<\/p>\n Separately, about 34,000 immigrants<\/a> who live in Massachusetts lawfully are also set to lose subsidized insurance, because of a change in federal law under President Trump.<\/p>\n \u201cIt will be a gut punch to working families in Massachusetts,\u201d said Alex Sheff,\u200asenior director of policy and government relations at Health Care For All, a Boston-based advocacy group.<\/p>\n The Health Connector has more information about premium costs here<\/a>.<\/p>\n Why costs are soaring<\/p>\n The federal government shutdown began<\/a> over a dispute about health insurance subsidies. These are known as enhanced premium tax credits, and they were enacted during the Biden administration to make insurance more affordable during the COVID-19 pandemic. The credits are set to expire at the end of the year.<\/p>\n Democrats want Republicans to agree to fund the subsidies in 2026. Republicans say they\u2019ll talk about subsidies only after Democrats agree to keep funding the government. The two sides have yet to announce a deal.<\/p>\n Insurance costs are already on the upswing, and not just for people who purchase plans on state exchanges. During the past five years, insurance costs for families increased 26%, according to a national survey from the research organization KFF<\/a>.<\/p>\n Lora Pellegrini, president of the Massachusetts Association of Health Plans, which represents local insurers, said medical providers and prescription drugs are becoming more expensive, pushing premiums higher.<\/p>\n \u201cThese cost pressures,\u201d she said, \u201care making care unaffordable for far too many residents.\u201d<\/p>\n Many insurers are limiting coverage of injectable weight loss drugs, known as GLP-1s, because of escalating costs. They\u2019re also cutting jobs, as they contend with financial losses.<\/p>\n Shopping for insurance<\/p>\n Individuals earning less than $62,000 a year will continue to receive discounted insurance \u2014 but their subsidies will be smaller.<\/p>\n Residents should research their options before deciding on a health plan, according to state officials and advocates. But not all plans provide the same levels of coverage. A health plan with a lower premium might cover a smaller network of medical providers and require higher out-of-pocket payments for medical treatments and drugs.<\/p>\n \u201cPeople have to make very difficult choices,\u201d Sheff said. \u201cIt’s really important for people to shop and look for the right option.\u201d<\/p>\n Health Care For All offers guidance to consumers who call their help line<\/a>, at 800-272-4232.<\/p>\n And Connector officials said their call center is ready to take questions and provide answers, in English as well as other languages. Several community organizations across the state, known as navigators<\/a>, also have staff who can help people enroll in coverage.<\/p>\n The impact of higher costs<\/p>\n Soaring premium costs means individuals and families buying insurance will have less to spend on other essentials, such as groceries, rent and utility bills.<\/p>\n Surveys have shown that people often skip or delay medical care when they\u2019re concerned about costs. Health policy experts worry this could worsen when premiums rise in 2026.<\/p>\n High prices will likely discourage some people from buying insurance at all. The Congressional Budget Office estimates 4 million people<\/a> will become uninsured after the enhanced tax credits expire at the end of 2025.<\/p>\n