If you missed our 2025 Individual Health Insurance Open Enrollment webinar a video replay is available below.
2026 ACA Open Enrollment Guide
There are unprecedented changes coming in 2026. We’re here to help you understand them, and to help you determine what your options are.
2026 Situation Overview
While not an exhaustive list, these are the major changes being implemented for 2026 plans.
Monthly premiums increasing for everyone.
The average rate increase across all insurance carriers and plans is expected to be between 18%-24%, with some states as high as 36%.
Enhanced subsidies expiring.
Unless extended by Congress, the expanded premium tax credits (ePTCs) will expire on December 31, 2025. As a result, those who received ePTCs in 2025 will see a significantly greater increase in outlay monthly premiums, with the average being more than 75%.
Highest allowable out-of-pocket limit increasing.
For a single individual, the new limit will be $10,600. For families, the new limit will be $21,200.
Auto-renewal fee for unconfirmed eligibility.
Enrollees on subsidized $0 premium plans who are auto renewed must reconfirm eligibility, otherwise a $5 monthly charge may apply.
Bronze-to-Silver auto-renewal banned.
Enrollees with Bronze plans who are eligible for cost-sharing reductions will not automatically be moved to Silver if the same plan is available.
Stricter income and eligibility auditing.
Providers must verify income and (Special Enrollment Period) eligibility more rigorously.
DACA exclusions.
Individuals with Deferred Action for Childhood Arrivals are no longer eligible for ACA coverage.
Future Open Enrollment Period shortened.
For 2027 plans, open enrollment will run from November 1, 2026 to December 15, 2026 (45 days).
Important Dates
Open Enrollment Period (OEP) for states that use the federal ACA marketplace:
- November 1, 2025: ACA Annual Open Enrollment begins; 2026 plans and pricing will be made available.
- December 15, 2025: Last day to enroll for coverage that starts January 1, 2026. If you have an existing ACA plan and you have not made changes for 2026, you will be automatically renewed.
- January 15, 2026: ACA Annual Open Enrollment ends. This is the last day to enroll for coverage that starts February 1, 2026.
OEP for states that use their own ACA marketplace:
- CO, CT, KY, MD, ME, MN, NM, NV, PA, VT, WA: 11/1/25 – 1/15/26
- CA, DC, NJ, NY, RI: 11/1/25 – 1/31/26
- GA: 11/1/25 – 1/1/26
- ID: 10/15/25 – 12/15/25
- MA: 11/1/25 – 1/23/26
- VA: 11/1/25 – 1/30/26
Sample Monthly Premium Scenarios
The sample scenarios below were developed using the KFF 2026 Enhanced Premium Tax Credits (ePTC) calculator, with national averages applied. Eligibility and amount of 2026 subsidies will vary by age, state, household income (HHI), and number of enrollees — as well as the resulting monthly premiums. To get an estimate of your monthly premiums, schedule an appointment with a benefits counselor today.
Married couple (both age 53) and three teenage children, HHI of $200,000/year.
Monthly Premium for Silver Plan:
$1,417/mo. (8.5% of HHI) if ePTCs are extended.
$2,550/mo. (15.3% of HHI) if ePTCs expire.
Married couple (both age 62), no children, HHI of $90,000/year.
Monthly Premium for Silver Plan:
$638/mo. (8.5% of HHI) if ePTCs are extended.
$2,232/mo. (29.76% of HHI) if ePTCs expire.
Single parent (age 35) and two children under age 10, HHI of $70,000/year.
Monthly Premium for Bronze Plan:
$15/mo. (0.26% of HHI) if ePTCs are extended.
$266/mo. (4.57% of HHI) if ePTCs expire.
Single adult (age 45), no children, HHI of $45,000/year.
Monthly Premium for Bronze Plan:
$10/mo. (0.31% of HHI) if ePTCs are extended.
$157/mo. (4.7% of HHI) if ePTCs expire.
Preparation Tips
This year, more than ever, it’s important to prepare ahead of time.
1
Gather these items.
Current Coverage Details
- Your current insurance card(s) (medical, dental, vision, etc.)
- Information on your current plan (premium, deductible, copays)
- Summary of what you like or dislike about your current plan
- List of your preferred providers (PCP, specialists, etc.)
- List of current medications
- Marketplace account credentials (in case you need to log in while on the call)
Financial and Eligibility Information
- Number of people in your tax household
- Dependent Information (DOB and SSN for each person enrolling)
- Estimated household income for the upcoming year (important for subsidy eligibility)
- If you receive any assistance (for example, through a state program), documentation of eligibility
2
Have a payment ready.
Your first month’s premium payment is due at time of enrollment.
3
Develop a plan with a licensed benefits counselor.
Our benefits counselors can help walk you through the steps, explain your options, answer your questions, and even process the enrollment for you. You can book an appointment with one now.
Calculation estimates are for illustrative purposes only. Premiums will vary based on benefits selected.
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