Missed the 2026 ACA Deadline? Here's How You Can Still Find Health Coverage. | The Waiting Room

Plans for saving Obamacare subsidies look to be dead in the Republican Senate.

Charles Gaba is a health care analyst who tracks policy and politics at ACASignups.net. Subscribe to his Substack!

Greetings, Lincoln Square readers!

When we left off, the 2026 ACA Open Enrollment Period was winding down, although a handful of states still had a day or two for people to enroll in coverage. Meanwhile, Senate Republicans’ “final offer” to extend the enhanced tax credits — which expired back in December — amounted to a sick joke.

In fact, I’m afraid it now looks like the Senate negotiations over a “compromise” subsidy extension bill are toast.

I also took a more detailed look at the semi-final Open Enrollment data, and warned that the actual number of people enrolled in ACA coverage will almost certainly be far lower than the preliminary data suggested … and that millions of those who have managed to enroll this year could only do so by seriously downgrading their coverage to a worse plan with dramatically higher deductibles & out of pocket costs.

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So You Missed the Open Enrollment Deadline. Now What?

For most Americans, if you missed the deadline to enroll in ACA exchange healthcare coverage, your options are pretty limited at this point ... but there are some exceptions, so let’s take a look.

NATIVE AMERICANS / ALASKA NATIVES:

Members of federally-recognized Native American tribes or Alaska Natives can enroll in ACA coverage year-round.

MEDICAID & CHIP COVERAGE:

If you’re eligible for Medicaid or the Children’s Health Insurance Program (CHIP), you can enroll year-round.

SPECIAL ENROLLMENT PERIODS:

You may be eligible for a 60-day Special Enrollment Period if you have a qualifying life event like losing your existing coverage, getting married/divorced, giving birth/adopting, turning 26, getting out of prison, etc.

STATE-SPECIFIC PROGRAMS:

There are also several state-specific programs which also allow eligible enrollees to do so outside of the official Open Enrollment Period, including …

• CONNECTICUT has a Special Enrollment Period happening right now for residents earning 100 - 200% of the Federal Poverty Level (FPL) or 400 - 500% FPL only. They haven’t announced a specific cut-off date so far. The state also has their Covered Connecticut program, which offers no-cost health insurance, dental insurance and non-emergency medical transportation to all residents between the ages of 19-64 who earn up to 175% FPL. They can enroll year round without a qualifying life event.

• MASSACHUSETTS has their ConnectorCare program with $0 or low monthly premiums, low out-of-pocket costs, and no deductibles for residents who earn between 100 to 400% FPL. You can enroll year-round if it’s the first time you’re applying (or if you’ve applied before but were previously found ineligible).

• ILLINOIS has announced a Special Enrollment Period specifically for those enrolled in ACA coverage last year who were automatically re-enrolled into a plan this year. This runs through the end of March.

BASIC HEALTH PLANS:

The District of Columbia, Minnesota, New York and Oregon all have special Basic Health Plan programs available to residents who earn between 138 to 200% of the Federal Poverty Level, and which eligible residents can enroll in YEAR ROUND:

• THE DISTRICT OF COLUMBIA’s Healthy DC Basic Health Plan is quality health coverage for DC residents who have moderate incomes. There are no monthly premiums and no out-of-pocket costs for covered care. All plans cover doctor visits, urgent care visits, hospital stays, prescription drugs, mental health care, and more.

• MINNESOTA’s MinnesotaCare Basic Health Plan is a health care program for Minnesotans with low incomes. Enrollees get health care services through a health plan or on a fee-for-service basis. You can choose your health plan from those available in the county where you live.

• NEW YORK’s Essential Plan Basic Health Plan includes comprehensive benefits with $0 monthly premiums and very low-cost sharing. It has no deductible, covers comprehensive benefits, including dental and vision, inpatient and outpatient hospital care, prescription drugs and more, and covers free preventive care like routine exams and screenings.

• OREGON’s Bridge Program Basic Health Plan is for adults with income just above the traditional OHP Plus limit. Adults with annual income between 133 and 200 percent of the federal poverty level (FPL) will have access to quality health insurance through OHP Bridge. It covers medical, dental and behavioral health care. Members will have access to additional benefits, like transportation to medical appointments and health-related services.

What else is going on?

Well, with 2026 OEP officially over, several of the states operating their own ACA exchanges have already published preliminary findings. For instance …

NEW JERSEY: 81% fewer enrollees are paying under $10 per month, while 82% more are paying $100 per month or higher.

PENNSYLVANIA: ~18% of 2025 enrollees have already been forced to drop coverage due to the GOP’s failure to extend the enhanced tax credits.

CALIFORNIA: Enrollment is down 2.6% year over year; average premiums are up 35% even WITH the state backfilling 100% of lost tax credits for 15% of all enrollees

MINNESOTA: Enrollment is down 8.1% year over year; 50% higher cancellation rate and “buying down” to a worse plan has more than doubled.

MARYLAND: Enrollment is up 3.4% year over year, thanks to ~60% of lost tax credits being backfilled.

MAINE: Enrollment is down 9.5% year over year, and Bronze plan enrollment increased by 13 percentage points.

WASHINGTON: Enrollment is down over 6% already and is expected to drop off significantly more … but Premium Alignment has been massively successful in getting enrollees to upgrade to better plans.

While all of these reports are piecemeal and incomplete, they do start to lay out a picture of what the official enrollment reports will look like when released later this year (April/May for final OEP data; July for Q1 2025 effectuated data; and not until 2027 for full-year data):

• Choose Your Own Adventure: How much will effectuated enrollment drop this year?

With 2026 OEP Plan Selections wrapping up slightly over 23.0 million people, this is what actual effectuated enrollment will look like over the course of the year assuming the pattern matches one of several pre-enhanced tax credit years.

Personally, I suspect that 2016 is the one which will be closest … except without that initial enrollment surge during the first quarter, which would mean an average monthly effectuated enrollment tally even lower than the 2016 trend line would indicate:

Meanwhile, here’s what the 2025-26 Metal Level enrollment shift looks like across five of the states above (I don’t have that data yet for two of the others, and Washington is a special case due to their newly-implementing Premium Alignment):

In fact, both of my fears have already been backed up by the official quarterly investor earnings calls from five major health insurance carriers this week:

• Major insurers confirm everything I’ve been warning about

• See also this follow-up which explains a major error I made in the prior post

In the midst of all of this, Snake Oil Salesman Extraordinaire (and, unfortunately, CMS Administrator) Mehmet Oz went on CNN on Sunday and repeatedly either lied through his teeth or showed jaw-dropping ignorance about basic facts about the Affordable Care Act … which, as CMS Administrator, he’s supposedly in charge of.

(Oh yeah … speaking of CMS, they also published the latest Medicaid & Children’s Health Insurance Program (CHIP) enrollment reports. The first one breaks out total Medicaid/CHIP enrollment as of October 2025, while the second one looks at enrollment in Medicaid via ACA expansion specifically as of June 2025.

Oddly (and thankfully), for all of the very real examples over the past year of the Trump Administration “memory holing” vast amounts of data from the CDC, the FDA, the NIH and other critical federal public health websites, so far they seem to be keeping the data for enrollment in programs like Medicare, Medicaid/CHIP and the ACA pretty accurate and up to date, so far.

And with that, I’ll see you again in two weeks!