This year, open enrollment for the Marketplace (ACA) has been used to push misinformation and “fake news” from politicians on both sides of the aisle for political gain, leaving the waters muddier than ever and causing mass confusion on an already complex topic. Let’s set the politics aside, explain what is actually occurring, and review some tips for the consumer.
Myth 1: Renewal notices guarantee you keep your same plan and doctors.
Let’s start here to help keep the timeline straight. Every year in October, carriers send out renewal notices, and this is where the confusion usually starts. A renewal notice and premium adjustment should be for the plan you selected the year before, right? Unfortunately, the plan you selected last year is likely not going to be available. Consequently, carriers send a letter with a rate for a “similar plan,” and the rates are typically much higher.
Carriers do not send a list of all the plans they offer—just the “closest option.” All available options are listed on Healthcare.gov (or state exchanges). Since many Marketplace clients have preexisting conditions, they often don’t want to change doctors. Many will renew at a much higher rate out of fear of losing their provider. However, “renewing” your policy does not guarantee your doctor will accept that plan in the new year.
When the Affordable Care Act (ACA) was created, one goal was for everyone to be able to “keep their doctor,” but that never fully materialized. Every year, doctors change contracts and the carriers they accept; some even change which tiers (Bronze, Silver, or Gold) they take. These changes occur more frequently in the Marketplace than anywhere else in the health insurance industry. This is why we never auto-renew Marketplace policies; there is too much volatility to confidently know that our clients are truly protected. Always contact your doctor directly to confirm which Marketplace plans they will accept in the coming year.
Myth 2: All subsidies (tax credits) were taken away completely or cut in half.
Subsidies are based on the National Poverty Level (NPL) and always have been. To receive a subsidy to help pay premiums, your household income must be above 100% but no more than 400% of the NPL. If you are below 100%, you may qualify for Medicaid. If you are over 400%, there is no assistance, and you pay full price for the plan. These are often referred to as the “Obama credits,” and this has not changed for 2026. For a single-person household, the cutoff is approximately $62,600 in annual income for 2026.
What did expire were the expanded tax credits that began during the COVID-19 pandemic in 2020. These were referred to as the “Biden credits,” which allowed those earning over 400% of the NPL to receive assistance. As an agent, I saw people making $200k+ still receiving assistance depending on their county. These credits were designed with an expiration date of 12/31/25.
Myth 3: Marketplace rates are still going to go up in 2026.
As currently designed, this is not going to happen. The only way rates would change mid-year is if Congress reaches an agreement to reinstate or extend the expanded credits. There is plenty of debate on that front still to come. However, this would only affect those over 400% of the NPL. If you have already selected a plan for a 1/1 start date or are in the process of selecting one for 2/1, you are set. Almost every call we receive from Marketplace clients asks when the rates are going up—turn off the news; they aren’t!
Tips for the Consumer
The Deadline: The deadline for Marketplace plans with a 2/1/26 start date is 1/15/26. If you do not select a plan by then, you will not be able to get Marketplace coverage in 2026 without a Special Enrollment Period (SEP).
Qualifying Events: SEPs are triggered by “life events” such as getting married, getting divorced, or the birth of a child.
Documentation: From the start of the pandemic until recently, the Marketplace was not strictly enforcing documentation rules for SEPs. This led to significant abuse and fraud. Moving forward, you will need to provide documentation for any special enrollment—we have seen no exceptions.
Alternatives to the Marketplace
Many consumers in the individual market (those without employer-sponsored plans) who are over the 400% NPL are opting for private insurance policies instead of the Marketplace.
Pros: These typically have lower rates, larger networks, and are still managed by major carriers. They have no enrollment deadlines and are available year-round.
Cons: There are no tax credits or financial assistance. Most require medical underwriting, so not everyone will qualify. Additionally, because of how the ACA is written, most private plans do not cover all “Minimum Essential Coverage” at 100%.
At the end of the day, no health plan is perfect and no policy covers everything. It is vital to work with a licensed agent and be open about your situation—including your health, medications, and specific preferences. As I tell my clients: “This is your policy, not mine; let’s customize it for you.”
Article Contributed by Derek Tice with Tice Health and Life Insurance
Click Here to Connect with Derek Tice and his team at https://ticehealthandlife.com/
