Open enrollment for 2026 Affordable Care Act health coverage ends next week, and Georgia residents are bracing for increased premiums and limited affordable coverage options compared to last year.
Advocates predict that premiums in Georgia could jump as high as 75% on average, and that Black Georgians, who face higher uninsured rates than white residents, will be disproportionately impacted by these changes.
“We do know that Black Georgians are over-represented among marketplace enrollments, and so as costs go up for those marketplace plans, Black Georgians will be hit first and hardest,” said Laura Colbert, executive director of Georgians for a Healthy Future.
These changes in coverage come as a result of Congress choosing to not extend enhanced ACA subsidies, also known as enhanced premium tax credits, at the end of 2025. For those who qualified, the tax credits helped bring down the cost of ACA premiums.
Advocates worry that the expiration could lead to more people choosing to go uninsured. Georgia is already a state with one of the highest uninsured rates in the country, according to data from the U.S. Census Bureau.
Melvin Coleman, president and CEO of the Atlanta Black Chambers, told Capital B Atlanta that many entrepreneurs and small-business owners utilize ACA health plans, as they often don’t qualify for group plans.
As a result of the enhanced ACA subsidies expiring, he said, many Black entrepreneurs in the Atlanta area are being faced with much higher costs this year for insurance.
“People are having to make very difficult decisions about their health care insurance, and the impact is they have to put off important exams and procedures. So it gets to be a question of, dare I say, life or death in some scenarios,” Coleman said.
Morale O’Cain, a salon studio owner and hairstylist for 20 years, said that her monthly ACA health plan premium rose $200 this year, and she is now faced with the possibility of going uninsured.
“I actually thought about not carrying the insurance, and truly it would depend on if I can find coverage that I can afford,” O’Cain said.
With less than a week left before the open enrollment period ends, O’Cain said it’s been stressful figuring out what to do. One major concern is being able to have access to mammograms and other procedures that help monitor for breast cancer.
“Having a mother that is a breast cancer survivor — they located cancer in her body in two different locations at two different times — it’s very important that I have certain tests to identify cancer,” O’Cain said. “I’ve had anxiety about whether I will be able to have insurance coverage.”
What are ACA subsidies?
ACA subsidies began in 2014 when the ACA marketplace plans first became available. In 2021, Congress offered a temporary enhancement to those subsidies as part of a pandemic relief package. Then in 2022, lawmakers extended the enhanced subsidies to 2025.
The enhanced premium tax credits allowed for more households, like middle-income families, to be eligible for the subsidies and also increased the value of the tax credit altogether, according to KFF.
Last month, U.S. Senate members voted down a three-year extension for the enhanced ACA subsidies. On Thursday, the U.S. House passed legislation that once again aims to extend the subsidies, but some lawmakers predict the legislation will die in the U.S. Senate.
According to Axios, there are talks in the U.S. Senate of a compromise being worked out, including a proposed bipartisan bill that would extend the subsidies for two years but with more limitations.
But as open enrollment is coming to a close on Jan. 15 in Georgia, advocates say residents are running out of time to make decisions. Even if Congress does pass an extension, they say, the benefits of enhanced ACA subsidies for 2026 may be limited.
Colbert with Georgians for a Healthy Future said that if Congress does approve an extension this January, they would most likely need to reopen the enrollment period for people to choose their plans. That, however, is not a part of the legislation that is currently being debated, she said.
On top of that, she said that many insurers have already set their premiums for this year, so if an extension for the enhanced subsidies is passed, it wouldn’t change the premium rates itself but would only give financial assistance to people to deal with the rates.
How to prepare
Despite the coverage changes, advocates are urging people to not go uninsured.
“So every year, people should always go back to the marketplace and check to make sure their plan still meets their needs and fits their budget. This year, people should be particularly diligent about that, and they should ask for help in sorting through their options,” Colbert said.
Residents looking for help in picking their 2026 health plan can reach out to a trusted local insurance agent, or contact organizations like Georgians for a Healthy Future to speak with local certified application counselors for free.
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