- Key insight: Discover how subsidy expiration shifts employees into lower-premium, higher-deductible ACA plans.
- Expert quote: Brett Meager warns employees overvalue monthly premium over total out-of-pocket costs.
- Forward look: Expect uptake of decision-support tools and segmented education ahead of open enrollment.
Source: Bullets generated by AI with editorial review
Following the expiration of enhanced Affordable Care Act subsidies that made its plan premiums more affordable, many employee participants switched to its lower-premium, higher-deductible bronze option — and
When ACA subsidies ended at the beginning of this year, Americans who kept their plan from 2025 were expected to see an average 114% increase, or more than $1,000, in their annual premiums, according to KFF analysis of U.S. healthcare data.
Rather than
"People choose not to go to the doctor because they have to pay for the gas that will get them to work, and the income from that job isn't enough for them to afford health insurance. These are not choices anyone should have to make," said policy advocate and assistant research scientist Francesca Weaks in an article published by the University of Maryland School for Public Health.
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Lower-tier plans aren't the only answer
Going with a lower-tier ACA plan isn't necessarily the best solution for employees, and benefit leaders and advisers can provide education that equips them to make more informed decisions during this year's open enrollment, said Brett Meager, COO of insurance services platform Heathos.
"What we're missing is the confusion the employee feels in that moment," she said. "We've got to stop leading with the monthly premium as being the affordability problem, because individuals are receiving that insurance brochure and going, 'I'm $50 out of pocket for this plan. I'm $100 out of pocket for that plan,' and this is a problem for any sort of coverage plan. They're going, 'I would rather afford the $50 a month,' but what they're not factoring in is the fine print. If you're not paying it in premium, are you paying it in different percentages or your out-of-pocket max?"
Benefit leaders should be thinking about how they can leverage a decision-support tool that helps employees through this modeling, said Meager. For instance, employees need to understand silver plans' income-based cost-sharing reduction options, which can drastically cut down their premiums. KFF shows that the current average benchmark silver plan deductible of $5,304 gets reduced to $80 for people with incomes below 150% of the federal poverty line, $790 for those between 150% and 200%, and $3,727 for those between 200% and 250%.
"Many of the platforms that work with companies and individuals have this modeling," she explained. "Another great benefit they can take advantage of is to leverage the industry reps they work with — either through their broker or their network — who can come in and do sessions with employees either virtually or in person."
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'No excuse' to not know
Rather than attempt to educate employees all at once, benefit leaders should plan on segmenting communication on a scenario or personal basis, and the time to start is now, said Meager.
"There's a psychology to this that says if I pay a lot of money up front, I'm not going to get the value out of it. I'm healthy enough, my kids are too, why would I pay a high price tag?' So just telling employees, 'Think about the total spend,' doesn't make it real for them," she said. "The more we can give examples that really resonate with an employee base, the better, and if there's a way to do it live, to make it hyper-personalized to them, that's the best way."
To plan out a good communication calendar, Meager recommends planning backward from the start of open enrollment and being very prescriptive with advisers and brokers. Meager recommended following education sessions with surveys or other methods to gain employee feedback, which will help benefit leaders know whether their approach is successful and where improvements need to be made.
"Set your rates, set your plans, all of those things that may be appropriate. Give yourself some buffer time, because those rates and that information are super critical to being able to educate your employees," she said. "Set a very clear requirement no later than about 90 days before your open enrollment with that broker partner and say, "We want to do a full-court press this year, we want to make sure we're having multiple sessions for our associates, and we want a guide left behind that will help them."
Meager noted that sessions, whether video or live, should be recorded for associates who aren't present. "You want to make sure there is no excuse left for that employee to not know this information, and have multiple channels that leave behind material that walks through some of the scenarios. A simple PowerPoint slide that says, 'Here's this person's scenario, sound like you?' can be the very best way to get people to go, 'Wait a minute. I'm somewhere between this and that. How do I make this real for my family?'"
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When employers make it a point to help employees choose the best health plan for their needs, it benefits them, as well, said Meager.
"For the consumer, if you sacrifice your health because you feel like you can't afford the care you need, it will hurt you in the long run," she said. "It also speaks to the HR professional, because the reality is, if these people are feeling stressed or undereducated on this front, they're not going to show up as their best selves at work. There's a real reason for everyone in this equation to care."
