Shopping for ACA coverage? What Georgians should look for as health care premiums face uncertainty

Caption

Georgia Access is the state’s health insurance marketplace, where Georgians can compare plans and during open enrollment.

Credit: Georgia Access

As Georgians shop for health insurance on the Affordable Care Act marketplace during open enrollment, uncertainty in Congress could affect health insurance costs next year.

More than 1 million Georgians rely on ACA health plans, and premiums could increase in 2026 if enhanced federal subsidies expire.

Jacqueline Nikpour, an assistant professor at Emory University’s Nell Hodgson Woodruff School of Nursing, says consumers should compare ACA premiums, deductibles, and provider networks carefully when choosing coverage. She spoke with GPB Morning Edition host Pamela Kirkland.

Transcript:

Pamela Kirkland: This is Morning Edition; I'm Pamela Kirkland. If you're shopping for health insurance on the Affordable Care Act marketplace, there's still a lot of uncertainty about what coverage could cost next year. The Senate voted yesterday on a Democratic and Republican plan to address rising health care costs, and both failed. For now, those expanded subsidies are still set to expire at the end of 2025, which could mean higher premiums for millions of Americans, including many Georgians. So, what should consumers keep in mind as they choose a plan during open enrollment? Jacqueline Nikpour is an assistant professor at Emory University's Nell Hodgson Woodruff School of Nursing. She's here to explain what people can do right now. Thanks so much for joining me. 

Jacqueline Nikpour: Of course. 

Pamela Kirkland: A lot of people are shopping for coverage right now during open enrollment. Can you lay out what's happening with these ACA subsidies and why people are hearing that cost might change next year? 

Jacqueline Nikpour: For a little bit of context, most people who get health coverage through the Affordable Care Act, the ACA marketplace, they do get some sort of tax credit to help lower their monthly premiums. These are called subsidies, tax credits. People kind of use those terms interchangeably. But in 2021 with the American Rescue Plan Act, and then again in 2022 with the Inflation Reduction Act, the federal government actually increased the amount of tax credits to help further lower costs and support people to get health coverage during the COVID-19 pandemic. And these additional increases are what's known as the enhanced premium tax credits, or enhanced subsidies. And that's what is scheduled to end on Dec. 31 of this year. That was what, when they put those enhanced tax credits in those pieces of legislation, they slated it to have an end date of Dec. 31, 2025. So for people who get their health insurance through the ACA marketplace, the amount of tax credit subsidies that they receive towards their premium may go down, which means that those consumers would be responsible for paying a higher share of their monthly premium. 

Pamela Kirkland: Georgia relies more heavily on the ACA marketplace than many other states. So for people here at home who are shopping for coverage, what should they understand about how these potential subsidy changes could affect Georgians specifically? 

Jacqueline Nikpour: Sure. So there's about a million and a half Georgians who were enrolled in Georgia Access in 2025 — and that's Georgia's statewide marketplace for ACA plans. And it's estimated that the vast majority, over 90% of those individuals, received at least some financial assistance through the enhanced premium tax credits. Now, because these decisions are still kind of underway at the federal level, the actual changes in costs aren't yet totally clear. But if consumers are curious, you can actually go to healthcare.gov and check out what is called their free ACA subsidy calculator. So you can enter in your annual income, your ZIP code, your number of household enrollees, and it'll actually give you estimates of your 2026 costs, both with and without those enhanced premium tax credits. 

Pamela Kirkland: Who in Georgia is most likely to feel these impacts? 

Jacqueline Nikpour: Sure. And again, the vast majority of Georgians who are insured by an ACA plan do receive some sort of financial assistance through those enhanced premium tax credits. And so it is a very broad issue. But if costs do go up, it's likely that those individuals who are going to be the hardest hit are those who are living in more rural areas in Georgia. A lot of rural counties in Georgia, and in those areas, you have fewer plan options, meaning there's less competition to kind of keep prices down. And between that and the fact that many rural families have lower incomes than in more metropolitan areas, there's a much greater reliance on those tax credits. So really, rural families, rural individuals are kind of the people that are potentially most at risk if these enhanced premium subsidies do expire. Another thing to kind of consider is that Georgia is a state that chose not to expand Medicaid. So when the ACA was originally passed, states had the option to expand Medicaid to cover more individuals, mainly low-income, childless adults between the ages of 19 and 64. Georgia opted to not expand Medicaid eligibility to this group and instead put in place the Georgia Pathways Program, which covers adults up to 100% of the federal poverty level who perform certain qualifying activities each month. So adults who don't qualify for traditional Medicaid and, let's say you make too much money for the Pathways program, let's say you make above 100% of the federal poverty level, that's where the ACA marketplace may become an option for you. But these individuals are still relatively low income. And Georgia does have, again, a high number of those folks who are living in rural areas who make below the average income in a year. And again, that's where those tax credits can be really beneficial to making health coverage affordable. 

Pamela Kirkland: When people are looking at the exchange, what are the most important things they should compare? 

Jacqueline Nikpour: So I would say that the best course of action for consumers who are concerned about the cost of their ACA plans is to really be proactive and shop carefully and compare plans during the open enrollment period. You know, like as you said, we are currently in open enrollment, which started on Nov. 1. And for coverage to begin on Jan. 1, that open enrollment goes until Dec. 15. And for coverage to begin on Feb. 1, that open enrollment goes until Jan. 15. So you do still have some time if you are concerned. And with that, don't necessarily assume that the plan that you have been on for this last year — the last several years — is going to continue to be your best option just because that's what you've been doing. Right? Look at different plans, compare different monthly premiums, deductible levels, and think about what you expect your own health care needs to be when you're doing so. Think about the providers that you anticipate needing to see, the prescription drugs you'll potentially need to take, and see what plans are going to give you the best coverage for those specific needs that you anticipate at the lowest cost.

Pamela Kirkland:  And with all this uncertainty at the federal level, what's your best advice for consumers so they don't get caught off guard in 2026? 

Jacqueline Nikpour: So again, proactive planning is going to really be your best option. Right now, nothing is finalized as of yet. There continue to be efforts at the federal level to kind of work on those extensions for those enhanced premium tax credits. So staying informed and really being careful about reviewing your choices is going to be your best course of action this year — and, really, every year. And in addition to those subsidy calculators, another resource that consumers can look at are the ACA open enrollment navigators that are available to you free of charge. You can reach out and they will actually help guide you through the process, walk you through what different plans might mean for you and your health care needs, and help work with you to make the choice that's going to be best for you and your family. So staying informed, staying proactive, and using the resources available to you. 

Pamela Kirkland: Jacqueline Nikpour is an assistant professor at Emory University's Nell Hodgson Woodruff School of Nursing. Thank you so much for joining me on Morning Edition. 

Jacqueline Nikpour: Thanks so much for having me. 

Pamela Kirkland: This is GPB.