Shopping for pricy ACA health plans? Some cheaper options come with trade-offs

Shots - Health News Shopping for pricy ACA health plans? Some cheaper options come with trade-offs December 21, 2025 12:48 PM ET From By Julie Appleby Pages from the U.S. Affordable Care Act health insurance website healthcare.gov are seen on a computer screen in New York, Aug. 19, 2025. (AP Photo/Patrick Sison, File) Patrick Sison/AP hide caption toggle caption Patrick Sison/AP For the millions of Americans who buy Affordable Care Act insurance, there's still time left to enroll for 2026. But premium increases and the expiration of enhanced tax subsidies have led to larger-than-expected costs. Concerned shoppers, wondering if there's anything they can do, are consulting insurance brokers or talking to representatives at ACA marketplace call centers. "We're hearing from people with complex medical conditions who don't think they can survive if they don't have access to medical care," said Audrey Morse Gasteier, executive director of the Massachusetts Health Connector, that state's insurance marketplace. And some are considering going outside the ACA to find more affordable options. But that requires caution. Congress is unlikely to extend the enhanced subsidies before the year's end. Late Wednesday, the House passed a package of measures favored by conservatives that does not address the subsidies and is largely viewed as dead on arrival in the Senate. Earlier Wednesday, however, four GOP moderates joined with Democrats to sign a discharge petition to force a vote — likely in January — on a three-year extension. The Senate and President Trump would also have to approve the measure, but if extended the subsidies could be applied retroactively . Meanwhile, the deadline for choosing a health plan is quickly approaching. The official end of open enrollment is set for Jan. 15 for coverage starting Feb. 1. In most states, it's already too late to enroll for coverage starting Jan. 1. Here are five considerations in the decision-making process: 1. Short-term plans: 'You have to be healthy' Some ACA shoppers might find themselves considering short-term insurance plans sold outside the government-run marketplaces — or steered toward the plans by insurance brokers. Be wary. Short-term plans are just that: insurance originally designed as temporary coverage for situations like changing jobs or attending school. They can look a lot like traditional coverage, with deductibles, copayments, and participating networks of hospitals and doctors. Still, they are not ACA-compliant plans and are not available on the official ACA marketplaces. They are often less expensive than ACA plans. But they cover less. For example, unlike ACA plans, they can impose annual and lifetime caps on benefits. The vast majority do not cover maternity care. Some might not cover prescription drugs. Short-term plans require applicants to complete a medical questionnaire, and insurers can exclude coverage or cancel a policy retroactively for those with preexisting medical conditions. Also, depending on the terms of the particular plan, a person who develops a medical condition during the coverage period might not be accepted for renewal. In addition, short-term plans are not required to cover care on the ACA's...

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