BOSTON -- Open enrollment for the state’s insurance exchange got underway Wednesday, and some people could be hit with double-digit increases as a result of President Donald Trump's decision to scrap federal health care subsidies.

Trump recently decided to eliminate monthly payments to insurers to help make coverage for lower-income people more affordable, arguing that the subsidies enacted by his predecessor, Democrat Barack Obama, were illegal.

To offset the loss, the Massachusetts Health Connector is setting higher-than-anticipated premiums for its mid-level -- or silver -- medical coverage plans.

"People have a couple options," said Jason Lefferts, spokesman for the Health Connector. "They can go up to a gold plan and pay a little more, they can go down to a bronze plan and pay less, or they can shop directly through their carrier and get the same plan at a lower cost."

Low-income people who qualify for tax credits -- which constitutes a majority of the 253,000 people insured through the exchange -- will not feel the full brunt of the increases, Lefferts said.

But about 80,000 middle-income individuals who don't qualify for the credits will see an average 26 percent increase next year, he said. Originally, the cost of those plans was expected to increase by 8 percent.

Lefferts said how much people pay depends upon the plan they choose, their income, age and other factors.

The Health Connector is encouraging those affected by the rate hikes to shop around for another plan — even if it’s off the exchange.

"Whether they stay with us or go to another carrier, we don't want people to lose coverage," Lefferts said. "We want people to have health insurance."

Suzanne Curry, a senior policy manager with the Boston-based advocacy group Health Care for All, said people need to shop around.

"We're telling people to consider their options," she said. "They need to spend more time than in previous years reviewing different health plans."

The group has been holding informational sessions around the state to help people navigate the process and has set up a hotline.

Curry said the Trump administration's decision to ax the subsidies will hurt middle-class workers, whose income has mostly been stagnant.

"We're really disheartened by this decision because its going to impact people's budgets," she said. "It's going to hit these people really hard."

Under both the Affordable Care Act and Massachusetts health care law, every adult in the state is required to get health coverage or pay a penalty.

As a result, Massachusetts has the highest insured rate in the nation, with 97.5 percent of residents covered, according to the U.S. Census, and 99 percent of all children.

The state's health exchange offers at least 52 plans by insurers including Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, Fallon Health, Neighborhood Health Plan and Tufts Health Plan.

Gov. Charlie Baker, a Republican, has written to lawmakers and testified before Congress calling on them to restore the payments.

Attorney General Maura Healey filed a legal challenge that would have required the Trump administration to continue the payments, though a judge has refused to issue an injunction blocking the move.

While the Trump administration has slashed the budget for TV commercials and other public outreach, the Baker administration plans to spend about $1.1 million on ads to encourage people to get health coverage.

The state has also hired new workers to help people sign up for coverage on the exchange, at a cost of more than $1.6 million.

"They're going to be hearing from us quite a bit," Lefferts said. "We want to be as helpful as possible."

Because Trump stopped the payments immediately, the state was on the hook for $28 million through the end of the year. The Baker administration has tapped a health care reserve fund to bridge the gap through the end of the year.

Individuals must sign up by Dec. 23 to get coverage beginning Jan. 1, 2018. They have until Jan. 23 to select a health plan to begin Feb. 1.

More information can be found on the Health Connector website: https://www.mahealthconnector.org or by calling

Health Care for All's toll-free hotline at (800) 272-4232

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at cwade@cnhi.com.