Every year, the Affordable Care Act (ACA) Marketplace opens its doors for a limited time — and that window is now here.
Open Enrollment runs November 1 through January 15, and for most people this is the only time to enroll in, change, or renew a Marketplace health plan for 2026 coverage.

But before you rush to “auto-renew,” there are some big changes and hidden details you need to be aware of this year.

1️⃣ Premiums Are Rising — and Subsidies May Shift

Many carriers have filed rate increases for 2026.
While subsidies (the Advance Premium Tax Credit, or APTC) still offset some of the cost, the enhanced subsidies that made coverage more affordable since 2021 are currently set to expire December 31, 2025 unless Congress acts.

👉 If that happens, premiums could rise sharply next year, and repayment rules for APTC will tighten.
👉 Even a small change in income could mean paying back part of your subsidy at tax time.

Tip: Review your estimated income carefully and update it if your hours, job, or household size have changed.

2️⃣ Don’t Assume Your Plan or Doctors Stay the Same

Carriers adjust networks every year. Some hospitals or specialists that were “in-network” last year may not be in-network this year.
Prescription drug lists (formularies) can also change, and copays or deductibles may reset on January 1.

Tip:

• Confirm your primary doctor and preferred hospital are still in-network.

• Re-check your prescription list before you re-enroll.

• Ask your broker to review HMO vs PPO options — not all plans work the same way.

3️⃣ Understand the True Cost, Not Just the Premium

It’s tempting to pick the lowest-priced plan, but the cheapest plan isn’t always the smartest.
High deductibles, narrow networks, and limited prescription coverage can lead to big bills later.

Tip:

• Look at the maximum out-of-pocket limit and cost-sharing levels (Silver, Gold, Bronze).

• Check if you qualify for Cost Share Reductions (CSR) — richer benefits for lower-income households.

• Ask about expanded Bronze HSA-compatible plans, which could be a strategic option for 2026.

4️⃣ Watch Out for Non-Marketplace “Look-Alike” Plans

Every year, new ads appear online promising “ACA-approved” or “$0 health plans.”
Many of these are not Marketplace plans and may not cover pre-existing conditions, prescriptions, or preventive care.

Tip: If it doesn’t come from Healthcare.gov or through a licensed agent able to offer Marketplace coverage, proceed with caution.

5️⃣ Don’t Go It Alone

Health insurance is personal, and the Marketplace rules are complex — especially this year.
Our licensed team helps you:
✅ Verify your doctors and medications
✅ Estimate your income correctly to avoid subsidy repayment
✅ Compare options across multiple carriers
✅ Handle all the paperwork — at no cost to you

Key Dates to Remember

• Nov 1 – Jan 15: Open Enrollment

• Dec 15: Last day for coverage starting Jan 1

• Jan 15: Final day to apply or change coverage for 2026

The Bottom Line

The ACA Marketplace is open, but it’s not “set it and forget it.”
Rates, subsidies, and rules are changing, and your health coverage should change with them.
A short review now can save you thousands and a lot of headaches later.

If you’re ready for personalized help, reach out to our team at Mere Benefits.
We’ll simplify the process and make sure you’re fully protected — without surprises.

📞 Call 904-654-5450
🌐 www.merebenefits.com
#simplyforyourbenefit