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Many Texans will pay more for ACA health insurance. Here's what to know about open enrollment | Houston Public Media

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  Published in Media and Entertainment on Friday, October 31st 2025 at 13:36 GMT by Houston Public Media

Many Texans Will Pay More for ACA Health Insurance: What You Need to Know About Open Enrollment 2025

Every fall, millions of Americans face the yearly decision of whether to stay on their current health plan, switch to a new one, or drop out of coverage entirely. In Texas, that decision is becoming more complicated. According to recent reporting from Houston Public Media, the upcoming Open Enrollment period for the Affordable Care Act (ACA) Marketplace—scheduled from October 15 to November 18, 2025—is expected to bring higher premiums for many Texans. The news has come as the state’s marketplace adjusts to a new mix of plans, shifting subsidies, and a broader national trend toward higher insurance costs.

Why Premiums Are Rising in Texas

1. Reduced Federal Subsidies
   The American Rescue Plan Act initially lowered the threshold for premium tax credits, allowing more people to qualify for subsidies. The 2025 policy cycle now rolls back some of those benefits, meaning many people will pay a larger share of their premium out of pocket. For those with incomes between 100 % and 400 % of the federal poverty level, subsidies have been recalculated, often resulting in higher payments.

2. Higher Deductible Plans
   Insurers are increasingly offering plans with lower monthly premiums but higher deductibles and out‑of‑pocket maximums. These “high‑deductible health plans” (HDHPs) can be attractive for young, healthy individuals who want to keep costs low, but they also mean that anyone who needs regular care will face larger upfront costs.

3. Provider Network Constraints
   Several insurance carriers have tightened or reorganized their provider networks, which can limit access to doctors and hospitals for Texans. In areas with fewer participating providers, insurers can charge higher rates to compensate for a narrower network, a cost that is passed on to the consumer.

4. Texas’ Stance on Medicaid Expansion
   Unlike many neighboring states, Texas has not expanded Medicaid under the ACA. As a result, a large segment of the population that would otherwise qualify for state or federal assistance is forced to rely on the marketplace, where premiums are inherently higher. The lack of expansion also reduces the overall pool of insured individuals, driving up costs for everyone.

How to Navigate the Open Enrollment Period

Step 1 – Review Your Current Coverage
Before deciding whether to stay or switch, compare the annual cost, deductible, copayments, and coverage limits of your current plan with the new options. Don’t just focus on the premium—look at total potential costs for any medical care you anticipate.

Step 2 – Check Eligibility for Subsidies
Use the federal tool at HealthCare.gov to estimate whether you qualify for a premium tax credit. You’ll need to provide your household size, income, and the estimated cost of the lowest‑premium silver plan in your area. If you’re close to the 400 % federal poverty line, you might still qualify for a reduced credit but could face higher premiums overall.

Step 3 – Compare Plans on the Texas Marketplace
The state’s marketplace, accessible at TexasHealthInsuranceMarketplace.com, lists all available plans in your zip code. You can filter by insurer, deductible, out‑of‑pocket maximum, and even read patient reviews of hospitals and doctors. Pay particular attention to “out‑of‑network” charges, which can dramatically increase costs if you need specialists or emergency services.

Step 4 – Understand Your Plan’s Network
If you have a primary care doctor or a preferred hospital, confirm that they are in the network for any plan you’re considering. Switching to a plan that excludes your preferred providers may result in higher charges for routine care and a longer wait for referrals.

Step 5 – Seek Assistance if Needed
The Texas Department of Insurance offers a Consumer Assistance Program that can walk you through plan comparisons, help you estimate out‑of‑pocket costs, and clarify any confusing language in the plan documents. Their help center can be reached at TDI Consumer Help.

Key Dates to Remember

• Open Enrollment Begins: October 15, 2025
• Open Enrollment Ends: November 18, 2025
• Premium Changes Effective: January 1, 2026

If you miss this window, you may not be able to enroll again until the next open enrollment cycle, unless you qualify for a Special Enrollment Period (e.g., job loss, change in residence, or family event).

Practical Tips for Managing Higher Premiums

• Bundle Your Health Needs: If you have chronic conditions or expect significant medical care, consider plans with lower deductibles, even if the monthly premium is higher. Over the course of a year, lower out‑of‑pocket costs can outweigh higher premiums.

• Use Preventive Care: All ACA plans must cover preventive services—such as vaccines, screenings, and annual check‑ups—at no cost to you. Utilizing these services can catch health issues early, saving you money later.

• Keep Track of Provider Costs: If you’re using out‑of‑network services, track the costs and consider negotiating or requesting a “cobertura de costo compartido” (cost sharing reduction) for future visits.

• Plan for Emergencies: Even if you have a low‑deductible plan, emergency care can still push you toward your out‑of‑pocket maximum. Understand how your plan handles emergency services and whether you can request an “out‑of‑network” emergency exemption if you’re traveling or in a remote area.

What the Future Holds

Analysts project that ACA premiums will continue to climb in Texas through at least 2027, driven by the same factors that are influencing costs nationwide. The federal government is exploring policy tweaks—such as restoring the 2020 subsidy rules or allowing “small‑group” plans to operate in the marketplace—that could provide relief. Meanwhile, Texas lawmakers are debating whether to pursue Medicaid expansion; a decision there could have a significant impact on premium affordability.

Quick Reference Resources

Bottom Line

The next Open Enrollment period is a pivotal moment for Texans. Rising premiums mean that many will need to re‑evaluate their health plans, assess subsidy eligibility, and navigate a complex landscape of provider networks and cost structures. By starting early, comparing plans in detail, and seeking assistance when needed, you can make an informed decision that balances monthly costs with the quality of care you and your family deserve.