Lester Johnson (left), a restaurant owner in Richmond, Virginia, stands next to a sign reading “Affordable Care Act premiums will rise more than 75%” during a press conference urging Republicans to pass Affordable Care Act tax relief on Capitol Hill on September 16, 2025 in Washington, DC. (Photo by Andrew Harnik/Getty Images)
West Virginia residents insured through the federal government’s health insurance marketplace can expect some shock when purchasing 2026 plans, but experts say it’s essential they monitor what’s happening in Washington.
Open enrollment for 2026 began November 1st and continues through January 15th.
West Virginia has the highest rates in the country for insurance plans healthcare.gov. Highmark Blue Cross, Blue Shield and Caresource, the only two West Virginia companies offering plans there, were approved Tariff increases in 2026 — 13.9% for Highmark and 7.6% for Caresource.
The federal government has been closed for a month as Congress remains undecided on whether to extend expanded premium tax credits that have made Affordable Care Act plans more affordable. You could still extend the credits. Otherwise they expire at the end of the year.
Families of all sizes and incomes in West Virginia will see up to a 10-fold boost in their monthly premiums for the same plan next year an analysis of 2026 plans by the West Virginia Center on Budget and Policy. Without the extended premium credits Household premiums in the state will boost by 133%, according to the Center on Budget and Policy.
“West Virginia will be one of the hardest-hit states if Congress does not extend expanded premium tax credits that help make health insurance affordable for approximately 60,000 West Virginians who do not receive health insurance through their job or through Medicare or Medicaid,” said Kelly Allen, director of the Center on Budget and Policy. “We have, in my opinion, some of the highest commercial healthcare costs in the country, which is why we are disproportionately affected.”
For example, a 60-year-old couple with no children earning $85,000 per year in Raleigh County would see their monthly premium boost from $601 per month in 2025 to $4,646 per month in 2026 without extending the tax credits.
For a 30-year-old single woman in Raleigh County making $35,000 a year, her monthly premiums would rise from $95 a month this year to $218 a month next year.
Customers may want to wait and see
Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform, said people who buy health insurance on the market should pay attention to what happens with Congress.
“It’s hard to ask people to do that because watching what Congress is doing is like watching two toddlers fight on the playground,” Corlette said. “But this year it’s really important because if Congress does extend it, it’s going to have a significant impact on your finances [the enhanced premium tax credits].”
Allen said people should contact their representatives about the importance of extending the expanded premium tax credits.
Corlette pointed out that even if Congress extended the subsidies, they likely wouldn’t go into effect immediately, she said. This year, it might be worth waiting a little later in the open enrollment period before choosing insurance.
“[Don’t wait] too late,” she said. “You have until Dec. 15 to sign up for Jan. 1 coverage.” So don’t wait too long, but it probably doesn’t make sense to buy anything [on] November 1st of this year.”
Louise Norris, health policy analyst at healthinsurance.orgsaid people might want to sign up healthcare.govupdate your information and familiarize yourself with the available tariffs and their services.
“This is a really good first step because the actual plans themselves are not yet in limbo,” Norris said. “All of this is set in terms of what the policies cover, what the deductibles are, the out-of-pocket costs, maximums, the provider networks, what medications are covered. Those types of details won’t change.”
But there’s no wrong way to sign up, she said. If people choose a plan now and Congress later decides to approve the increased premium tax credits, people can go back and choose a different plan, she said.
“No matter what you do, it’s important to keep an eye on developments,” Norris said. “So don’t look at this now and decide you can’t afford it and then forget about it. Definitely stay informed. Because the numbers are pretty alarming.”
This year there is less support with registration
This year, the Trump administration cut a federal program This helps people who sign up for marketplace plans by 90%, from $100 million to $10 million.
“The bottom line is that it will be much more difficult for people to find someone to help them through the process, which can be complicated and confusing for many families,” Corlette said. “If you’re applying for tax credits in this case, the application can be a little confusing.”
In West Virginia, First Choice Services received $125,000 this year to run the state’s Affordable Care Act Navigator program, compared to $1.25 million last year, Corlette said.
Jeremy Smith, program director for First Choice Services, said the agency closed four of its five offices across the state and laid off most of its staff because of the budget cut. They plan to do most of their work on the phone rather than in person, he said.
“We won’t be able to travel and meet people or walk around and do the enrollment events and community like we used to,” he said.
First Choice Services also operates the state’s suicide lifeline, substance abuse treatment hotline and problem gambler hotline, so the agency is well-positioned to facilitate people over the phone, he said.
Last year, First Choice had 12 full-time employees in the Navigator program. This year, federal funding will support one and a half full-time employees, Smith said. Along with some funding from state foundations, First Choice Services has five or six people helping with enrollment, Smith said.
“We’re still trying to do everything we can to help as many people as we can,” Smith said. He added that the agency has partnerships with federally qualified health centers across the state that can facilitate people sign up if navigators are not available.
Smith added that First Choice has also made more resources available on its website due to staff cuts this year. wvnavigator.com to facilitate people register.
“So [if] “If anyone would like more information about how to enroll in a marketplace plan, they can visit our website and follow the instructions and hopefully enroll themselves,” he said. “And then when they need us, we’ll still be there.”
No insurance coverage for immigrant families
Also fresh this year, lawfully present immigrant families who are ineligible for Medicaid because they have been in the United States for less than five years and earn less than the federal poverty level will no longer be eligible for tax subsidies under a marketplace plan. This will make insurance unaffordable for many of them.
About 10,000 Deferred Action for Childhood Arrivals recipients were also excluded from health insurance starting in August after the Trump administration reversed a Biden-era policy and stripped them of health insurance eligibility.
Higher tax penalties possible
This year, marketplace customers will face higher penalties if their actual income is found to be higher than what they estimated when they applied for health insurance. To determine how much financial assistance in the form of tax credits clients are eligible for, they must estimate what their income will be next year.
This year, there will be no cap on the amount that low-income people will have to pay back to the Internal Revenue Service if they make more money than planned.
For many people who don’t receive a steady salary from a huge employer, estimating what they will make next year can be challenging, Corlette said.
“One of the key changes Congress made this year was essentially to say: If you misjudge what your income is going to be and end up getting more premium tax credits than we think you’re entitled to, the IRS can basically come back and claw back the money,” she said.
Customers would pay back the IRS on their 2027 tax return.
People who discover next year that their income forecast is off should contact the marketplace and update that information so the marketplace can adjust the subsidy in real time, Norris said.
“That way, you don’t have to worry about paying back a large amount of money when you file your taxes,” Norris said.
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