Open Enrollment 2026: What You Need to Know
Premiums are rising again. 2026 Marketplace plans are pricier with higher deductibles and OOP limits. Here’s what’s driving it — and how to compare Marketplace vs Private PPO options before Open Enrollment.
Open Enrollment 2026: What You Need to Know
Important dates
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We’ll verify your doctors and meds, compare Marketplace vs. Private PPO, and show clear costs—no pressure, just answers.
What’s changing for 2026?
- Medical inflation & utilization: Hospital and provider costs continue to ripple through next year’s premiums.
- Prescription drugs: High-cost specialty meds remain a driver; formularies and tiers can shift.
- Subsidy math: Income and household size determine savings. We’ll confirm your eligibility band before you choose.
- Networks: HMO vs PPO vs EPO—pick based on the doctors/hospitals you actually use, not just the premium.
How to choose the right plan (quick framework)
- Doctors & facilities first: We confirm in-network status and referral rules.
- Rx check: We price your actual meds across plans (tier, prior auth, step therapy, mail-order).
- True annual cost: Compare premium + expected usage (copays/coinsurance + deductible + max out-of-pocket).
- Access & travel: If you need multi-state flexibility or out-of-network options, consider PPO over HMO.
Quick FAQs
When should I enroll?
Enroll early. Dec 15 starts Jan 1 coverage; Jan 15 starts Feb 1 coverage.
Can private PPOs be cheaper than Marketplace?
Yes—especially for healthy households that don’t qualify for large subsidies. We’ll model both paths.
Can you confirm my doctors and hospitals?
Absolutely. We verify providers and prescriptions before we present options.
Bottom line
Open Enrollment 2026 is your chance to realign cost, access, and coverage. We’ll do the homework—net cost, doctors, medications, and network rules—so you can enroll with confidence.
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