ACA Open Enrollment: 5 Mistakes That Cost People Thousands

Mistake 1

Assuming You Don't Qualify for Subsidies

Millions of people skip the Marketplace because they assume they earn too much. But the premium tax credit (Advanced Premium Tax Credit, or APTC) extends to individuals earning up to 400% of the federal poverty level — roughly $58,320 for a single person and $120,000 for a family of four in 2026. Recent legislation has further expanded eligibility, meaning some people at higher incomes now qualify for at least some subsidy.

Don't guess. Run the numbers at Healthcare.gov or let us do a quick estimate together. The difference between a subsidized and unsubsidized plan can be hundreds of dollars per month.

Mistake 2

Choosing a Plan Based on Monthly Premium Alone

The cheapest monthly premium is almost never the cheapest plan. A Bronze plan at $140/month looks great until you get sick and hit a $9,000 deductible. The real comparison is total annual exposure: your monthly premium multiplied by 12, plus your maximum out-of-pocket if you actually need care.

A Silver plan with cost-sharing reductions (available to lower-income enrollees) can dramatically reduce what you actually pay at the doctor. A Gold or Platinum plan with higher premiums can be the better financial deal if you have predictable medical needs. The metal tier that wins depends on your health, your income, and how you use care.

Mistake 3

Auto-Renewing Without Comparing Plans

If you did nothing last year, you were probably automatically re-enrolled in your existing plan. That's convenient — and often costly. Plans change every year. Premiums go up, provider networks shift, drug formularies are revised, and better options may emerge from carriers that weren't available to you last year.

Spending 20 minutes comparing plans during open enrollment can easily save you $500–$2,000 annually. That's time well spent. Don't let inertia make this decision for you.

Mistake 4

Not Verifying Your Doctors and Medications Are Covered

Found a plan with a great premium? Before you enroll, check the provider directory and drug formulary — the list of covered medications.

HMO and EPO plans require you to use in-network providers (with limited or no out-of-network coverage). If your doctor isn't in the network, you'll either need a new doctor or pay full out-of-network rates. For specialty medications, formulary placement affects your copay dramatically — the same drug can be a $30 copay on one plan and $300 on another.

Mistake 5

Missing the Deadline — and Not Knowing Your Special Enrollment Rights

When open enrollment closes, most people are locked out of the Marketplace until the next year. But qualifying life events open a Special Enrollment Period (SEP) that lets you enroll mid-year. These include:

• Losing job-based or other health coverage
• Getting married, divorced, or legally separated
• Having a baby, adopting a child, or placing a child for foster care
• Moving to a new coverage area
• Turning 26 and losing coverage under a parent's plan
• A household income change that affects your subsidy eligibility

You typically have 60 days from the qualifying event to enroll. Don't wait. And if you're not sure whether your situation qualifies, ask — the answer is often yes.