Note: The U.S. government partially shut down on Wednesday, October 1, 2025. This means that nonessential services are closed, workers are furloughed, and those in essential work will not be paid during the closure. This is because the Senate did not approve the continuing resolution approved earlier by the House of Representations to keep funding the government by the deadline.
While healthcare is at the center of the current federal budget debate, some of the changes listed may be modified by negotiations on re-opening the government or by other legislation. So, the changes discussed in this article might not take effect. We will provide updates if there are changes.
Open enrollment for the Health Insurance Marketplace begins on November 1 and runs until December 15. During this time, you can enroll in or change your coverage plan. An individual who changes their plan during open enrollment will get their new coverage plan on January 1, 2026.
Pennie is Pennsylvania’s health insurance marketplace. It allows Pennsylvania residents to purchase private health and dental insurance coverage, often at reduced rates under the Affordable Care Act (ACA).
However, the passage of the Reconciliation Bill (One Big Beautiful Bill Act) on July 4, 2025, includes changes to ACA. These changes affect eligibility, enrollment, and benefits available through the Health Insurance Marketplace.
Eligibility for coverage, premium tax credits, and cost-sharing through the Health Insurance Marketplace will be limited to certain individuals by January 1, 2027. Only U.S. citizens, green card holders, Cuban and Haitian entrants, and lawful residents under the Compact of Free Association, can receive these benefits. This new provision excludes DACA recipients, asylees, and refugees.
For those who are eligible, automatic enrollment through the Health Insurance Marketplace will end at the start of 2028. Individuals will have to re-enroll every year during the open enrollment period.
Premium tax credits, which help low-income individuals pay monthly premiums, are also affected. Individuals will have to confirm their eligibility for premium tax credits by reporting their household income, family size, place of residence, citizenship status, and health coverage status. If they do not, they will not receive subsidies, and the cost of their coverage is at risk of going up. This will take effect at the start of 2028.
These eligibility verifications will be more important in the coming years. If a premium tax credit recipient is paid more than their income allows, they will have to pay back these tax credits in full. In the past, repayment was capped at a certain amount depending on income level. Reporting your income carefully can help avoid increased penalties when this provision goes into effect in 2026.
The new law also does not extend the deadline for enhanced premium tax credits. These credits help those who make more than 400% of the Federal Poverty Line pay for health insurance. They will expire at the end of the year.
Though these premium tax credits are due to expire, pending legislation could keep this provision alive longer.
