Obamacare Sign-ups Are Steady, But Warning Signs Emerge

Officials with state Obamacare exchanges have been concerned that enrollments will fall off a cliff with the Dec. 31 expiration of enhanced subsidies that make insurance more affordable.

Not yet.

So far, overall sign-ups have increased in some places, but health officials say those initial figures don’t necessarily mean consumers are happy.

Some are choosing plans with lower premiums and higher out-of-pocket costs or terminating coverage altogether at a faster rate than in prior years, according to several state-run Obamacare exchanges. New enrollments are slightly down. Meanwhile, calls to help centers are skyrocketing in some states.

“[We are] seeing extremely high levels of volume of calls coming from people who are … frustrated and overwhelmed at the premium increases,” said Audrey Gasteier, executive director of Massachusetts Health Connector, the state-run Obamacare insurance exchange. “People are struggling to figure out if they can make the math work.”

Lawmakers failed to reach an agreement on extending the subsidies — which Democrats increased during the pandemic — before leaving Washington for the holidays last week. Subsidy levels will drop in January to the original Obamacare levels Congress set in 2010, which means an average 26 percent premium increase and much higher premiums for some.

How consumers respond to higher premiums could play a part in the current stalemate over whether lawmakers try again to extend the enhanced subsidies when Congress reconvenes Jan. 5.

Before representatives and senators left town, there were small signs of movement in the House as four Republicans joined all Democrats to force a vote on a three-year extension.

In the Senate, bipartisan talks started in earnest, but thorny issues such as abortion remain a hurdle.

Democrats hope voter anger over high premiums will force Republicans to come to the table early next year.

“Let’s see what happens now when folks are home and people are looking at … premium hikes that mean it’s hard to pay bills, rent and groceries,” said Sen. Ron Wyden (D-Ore.) last week.

Republicans could take steady enrollment in Obamacare’s exchanges as a signal that the enhanced subsidies will not affect sign-ups and give them political cover for opposing an extension.

GOP lawmakers, most of whom oppose extending the subsidies, have charged for months that they were only meant to be Covid-era relief and have helped fuel an explosion of fraud on the exchanges. They also attribute the premium rise to the underlying structure of Obamacare, arguing it has stifled competition for consumers and allowed insurers to charge more.

Uncertain picture

It’s still unclear whether the relative stability on the exchanges will continue.

State officials say it could take a while to fully determine the impact on enrollment of the enhanced subsidy loss if Congress does not extend them in January.

Obamacare open enrollment started for most states on Nov. 1 and runs into next month. The deadline to get coverage starting on Jan. 1 through HealthCare.gov was Dec. 15. Some state exchanges accept enrollments for January coverage through the end of this month.

But some people on the exchanges who renew automatically might not find out their premiums spiked until January, when the first payments are due.

“If people terminate for nonpayment, [it] will take some time for the picture to come into focus,” said Danielle Holahan, executive director of the NY State of Health exchange, in an interview.

Exchange enrollments

Federal data released on Dec. 5 shows sign-ups across all 50 states increased compared with the same period in 2024.

The Centers for Medicare and Medicaid Services reported 5.7 million people enrolled in 2026 coverage, a 7.5 percent increase over this point last year, when 5.3 million people had selected a plan.

The data included sign-ups from 20 states and the District of Columbia, which run their own exchanges, and the federally run HealthCare.gov used by residents across 30 states.

The increases occurred in the state-run exchanges.

CMS Administrator Mehmet Oz posted on the social media platform X on Tuesday that more than 15.6 million people enrolled in a plan on HealthCare.gov, down from 16 million last year — a 2.5 percent decline.

In the post, Oz attributed the drop to CMS efforts to combat fraudulent and improper enrollments. The agency released a rule earlier this year that includes more eligibility checks for Affordable Care Act customers, but a federal judge paused parts of it amid an ongoing legal battle.

The agency, which oversees HealthCare.gov, pointed to Oz’s tweet and several published data in response to a request for comment on the latest enrollment figures.

State exchange officials and some insurance plans say the increases in overall enrollment figures they see don’t tell the full story.

Several state-run exchanges are experiencing a slight decline in new sign-ups and a higher rate of people with coverage dropping out, an indicator they say reflects concern about higher premiums.

California’s exchange saw a 7 percent increase in the number of people renewing their existing coverage for 2026 compared with last year. However, the state saw a 30 percent decline in new customers compared with this point last year, according to a press release.

Of the 5.7 million sign-ups nationwide on all exchanges, new enrollees declined 3.89 percent from 987,869 last year.

Increasing dropoffs

More people also appear to be dropping out.

In Massachusetts, the number of enrollees already on the exchange who terminated their 2026 coverage doubled compared with this time last year. However, new sign-ups are about the same as last year. Overall, total signups in the state have risen 16 percent from 2024, according to CMS’s enrollment snapshot released on Dec. 5.

Maryland’s total enrollment is up 6 percent compared with 2024, but the state has had a 79 percent spike in terminations.

In Washington state, terminations increased by 29 percent, while total enrollment rose 18 percent as of Dec. 5, compared with 2024, the exchange said in a statement. New sign-ups declined by 20 percent.

The terminations could be for a number of reasons, such as people getting coverage through an employer or moving on to Medicaid.

However, the terminations are likely “a leading indicator in terms of how people are reacting to premium spikes,” said

While overall premiums are up 26 percent, Obamacare customers currently receiving a subsidy are expected to see their premiums shoot up by 114 percent, according to an analysis from the health policy research organization KFF.

This increase is because enrollees who are currently subsidized will have to devote more of their annual income to health costs.

For example,an individual who makes $28,000 currently pays no more than $325 a year for an average plan, which is about 1 percent of their income. With the tax credits expiring, the amount increases to $1,562. The base tax credits created under Obamacare will remain in place.

Cutting costs

Another concern is that while people are still choosing plans, they are going for cheaper options.

Obamacare offers four metal tiers — bronze, silver, gold and platinum — of plans alongside a catastrophic option. All plans must offer the same benefits, but they differ significantly in costs.

For instance, bronze plans have lower premiums but higher out-of-pocket costs, such as higher deductibles than gold plans.

“Most members are staying with their same plan for 2026, but those who change generally move to a lower cost carrier or metallic tier,” Washington’s exchange said in a statement.

In Maryland, one-third of individuals who changed their plan tier were 50- to 64-year-olds, a population that typically earns more money and some will likely no longer receive any subsidies once the enhanced credits expire.

“These are typically higher earners and self-employed,” said Michele Eberle, executive director of the state’s exchange called Maryland Health Benefit Exchange.

The loss of the enhanced subsidies means that people earning more than four times the poverty level receive no subsidy help. Maryland has funded its own assistance program to make up half of the loss of the enhanced subsidies — but not for higher earners.

In Rhode Island, 40 percent of new customers have so far picked a bronze plan, a major jump compared with 17 percent at the same time in 2024, Lindsay Lang, executive director of the exchange HealthSource RI, said in an interview.

A few jurisdictions have open-enrollment deadlines after Jan. 15 for insurance that begins in February. They could extend them further if Congress makes a deal on the enhanced subsidies.

But states and plans have told consumers not to wait for Congress to choose an option, but consumers might still be holding out before picking a plan.

“We do have a lot of people who are just playing possum right now and not doing anything,” said Heather Stone, president of Florida-based Stone Health Insurance, in a call with reporters earlier this month.