Healthcare Marketplace Changes: What You Need to Know for 2026 📈

If you have a hard time remembering to pay monthly premiums, I encourage you to set reminders. If the plan terminates due to non-payment, and there is no qualifying life event that allows for re-enrollment, you will have to wait until open enrollment, November 1 - December 15, (correction) and the plan will become effective January 1, 2026.

The year-round Special Enrollment Period (SEP) for individuals earning below 150% of the Federal Poverty Level will be eliminated starting in August 2025, impacting the year-round enrollment allowance for some low-income households.

Losing/lost coverage?

You are now required to provide proof of Loss of Coverage. The lag time between the Marketplace and Insurance companies to update this information may cause you to be without coverage for a period of time. If this happens to you, work with your agent to resolve with the Marketplace, especially if you take life-threatening prescriptions. One of my client’s and I were able to work with the Marketplace and got this resolved in 1 day (the average success rate is 15-30 days AFTER the call is made).

Be sure to READ ALL correspondence from the Marketplace.

If you do not understand a notice…

DO NOT IGNORE - Work with your agent to get a clear understanding of the program’s expectations.

Lastly. Now more than ever, it is proving to be beneficial to have a good agent on your team for your health insurance needs. I entreat you to find someone who is trustworthy to partner with so you will not have to potentially face these uncertainties alone.

More to come… Stay encouraged.

With recent legislation, if you know someone that has lost/is losing Medicaid, please consider having them call me.

I more than likely will be able to help them secure health insurance at an affordable rate. If they work and file taxes, I’m 99.999% sure I’ll be able to assist.

Thank you!