Association members shared information at a virtual news conference Wednesday, Nov. 12, about what Marketplace consumers can expect for next year and the importance of window shopping plans early.

Marketplace open enrollment began Nov. 1. Enrollment by Dec. 15 allows for coverage to begin Jan. 1. Enrollment by the deadline of Jan. 15 allows coverage to begin Feb. 1.

Although there’s been no debate yet, Congress still could act to extend the enhanced premium tax credit, originally established in the American Rescue Plan Act of 2021, rather than let it expire on Dec. 31. Regardless of the political situation, Wednesday’s message to consumers was to not delay in checking out the plans available.

The impact of a return to regular premium tax credits will vary for marketplace applicants based on a variety of factors, including income, age, family size, etc.

Brittany Zephier

Lindsey Karlson, director of Programs and Training with CHAD, said the expiration of the enhanced credits reverts the marketplace back to the Affordable Care Act’s operations before 2020. The ACA set affordability benchmarks based on income, she said. For example, a family or individual at 200% of the federal poverty level would pay 6.6% of income toward premium costs in 2026. At 150% of the poverty level, the percentage drops to 4.19% of income.

Karlson said another change with the expiration of the enhanced credits is that individuals earning more than 400% of the federal poverty level are no longer eligible for any premium tax credits.

Brittany Zephier, Navigator Program manager with CHAD, based in South Dakota, said most individuals who have checked out the marketplace so far have opted to enroll in coverage for next year.

“The costs have gone both up and down, depending on their income changes and plan selections,” she said.

CHAD provided an example of a 30 year old woman earning $31,200 a year with no employer-sponsored insurance coverage. Receiving the enhanced premium tax credit in 2025, she paid $52, or 2% of her income, for a marketplace plan. In 2026, with the same income but using the regular premium tax credit, her monthly premium rises to $172 a month, or 6.6% of her income.

“Some individuals may also be required to submit additional verification documents. Because of these changes, we really want to emphasize the importance of logging in early and reviewing your plan options ahead of time. By logging in early, it gives people enough time to update their household and income information, review the plans available to them, compare pricing and, ultimately, choose a plan that fits their needs and budget,” Zephier said. “Even with the changes, there is still financial help available and plans continue to cover those essential health benefits, including primary care and specialty care visits, prescriptions, mental health services, maternity care and preventative services.”

Individuals and families can renew an existing plan or enroll in a new plan, providing affordable insurance for people who don’t have employer coverage or aren’t eligible for Medicaid or Medicare, Zephier said.

Lori Kinn, director of business and patient development at Family HealthCare in Fargo, advised having a list of your medications and providers on hand in comparing plan options because ensuring a continuum of care is important.

Resource tools on the marketplace website can provide an idea of how people might be affected by expiration of the enhanced credit. Also, help in comparing plans and completing applications is available through certified application counselors or Navigators with Northland Community Health Center in Minot or Minot State University’s Center for Persons with Disabilities.