Caroline Gomez-Tom on ACA Health Plan Price Hikes For 2026

Frederica Freyberg:
In health care news, Affordable Care Act premiums are expected to increase sharply when people enroll starting in November. Insurance companies are making their projections now for 2026 rates. In Wisconsin, nearly 850,000 people are enrolled in ACA plans. 12 insurers across the state that offer marketplace plans, project increases ranging from 6.6% to 34.5%, according to health system analysts. What’s driving this increase? We turn to Caroline Gomez-Tom, an enrollment manager with the Covering Wisconsin program, which helps people sign up for marketplace plans. And thanks very much for being here.

Caroline Gomez-Tom:
Thanks for having me, Frederica.

Frederica Freyberg:
So when you saw these projected premium hikes, what was your reaction, especially to the like 34.5% increase?

Caroline Gomez-Tom:
Yeah, it was definitely a startling hike, except we weren’t necessarily surprised knowing that there were some things that were in the mix regarding enhanced premium tax credits that were going away or potentially going away. You know, Congress could still act in, you know, these several months before the end of the year and then some other policy changes that have happened at the federal level. Plus healthcare costs rising, inflation, etc., that could be a part of this. But to see the numbers that we are expecting for this year, it, it took, it took your breath away.

Frederica Freyberg:
Yeah. So these enhanced tax credits are due to expire at the end of 2025. How did those tax credits help with out-of-pocket costs?

Caroline Gomez-Tom:
Yeah. So these extended tax credits, they have been in place now since 2020 and essentially, they expanded, really, the discounts or the amount that people qualified for to lower their cost of insurance, especially for those folks that had slightly higher incomes. So that middle income range above 400% of the federal poverty level. And what that means is that people had more options to consider when they were looking at the healthcare.gov options. Instead of just going directly to the lowest costing bronze plan with a crazy out of pocket cost for an individual, they could actually shop around realistically and look at the plan that may cost a little more per month, but because of those extended premiums, they could afford it, but had also lower out of pocket costs for them.

Frederica Freyberg:
And so did those premium tax credits encourage a lot more people to actually enroll?

Caroline Gomez-Tom:
Absolutely and we can see that even just this last year where we hit a milestone year in enrollment. In Wisconsin, we had 313,000 people sign up, which was the highest we’d seen since the marketplace opened in 2014.

Frederica Freyberg:
So according to an analysis that we read, there are other drivers other than these enhanced tax credits of rate hikes, like the cost of health care itself, which you mentioned, including specialty drugs like Ozempic. What’s it like for people with ACA plans to see such swings in costs?

Caroline Gomez-Tom:
Yeah, I think it’s tough because we’re already talking about folks who otherwise don’t have access to another form of coverage. These are folks that don’t qualify for Medicaid. They usually do not have an option for health insurance through their employer. So they’re already going to healthcare.gov because there are limited options for them. And then without this additional financial assistance to help lower the cost of insurance. And sure, there still will be some tax credits for most folks, but there still will be some that really will get priced out of the marketplace. And that I — you know, that’s, that’s very difficult for folks to go without health coverage.

Frederica Freyberg:
So if someone is enrolling or re-enrolling for next year, what is your advice?

Caroline Gomez-Tom:
Well, I would say to start early, get connected with a health insurance navigator. Covering Wisconsin still has our navigator program and we will help people sign up for coverage through healthcare.gov. They can call 211. They can also reach us directly on WisCovered.com or our website – CoveringWI.org – to sign up for an appointment. And they need to shop around. And I normally would say they should shop around, but really this year, I think it’s a need to make sure that they understand all the options that are available to them so that they can make a sound choice, because what I don’t want to see are people just foregoing even going to healthcare.gov because they’re deterred by cost. We want people to at least know what their options are so they can make a sound decision.

Frederica Freyberg:
All right. Great advice. Caroline Gomez-Tom, thanks very much.