Marketplace Premium Change Notifications: What They Mean & How to Respond

Marketplace Premium Change Notifications: What They Mean & How to Respond

Fast take: If you received a Marketplace premium change notification, your 2026 rate is likely increasing—sometimes significantly. Don't auto-renew without comparing options. We'll verify your doctors, compare ACA plans vs. private PPOs, and show total annual costs before you commit.

Got a premium increase notice?

We'll compare your current plan against new Marketplace options and private PPOs—and verify your doctors stay in-network.

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What your notification means

Premium increase

✓ Your monthly cost is going up for 2026
✓ Increase can range from 10-30%+ depending on your state
✓ Driven by medical inflation, drug costs, and policy changes

Plan changes

✓ Network may have changed—verify your doctors
✓ Deductibles and out-of-pocket maximums may be higher
✓ Prescription formulary tiers may have shifted

Why premiums are jumping for 2026

• Medical inflation: Hospital and provider costs continue rising faster than general inflation
• Specialty drugs: GLP-1 medications and other high-cost drugs are pushing claims higher
• Subsidy uncertainty: Enhanced ACA subsidies may expire, raising net costs for middle-income families
• Carrier adjustments: Insurers are repricing based on 2024-2025 utilization patterns

What to do right now

1) Don't auto-renew blindly

If you do nothing, your current plan will automatically renew at the higher 2026 rate. You have until January 15 to switch plans during Open Enrollment.

2) Verify your provider network

Marketplace plans frequently change networks. Your current doctors may no longer be in-network for 2026—check before you commit.

3) Compare total annual cost

Don't just look at premium changes. Factor in:

• New deductible amounts
• Copays and coinsurance changes
• Out-of-pocket maximum increases
• Expected usage based on your health needs

4) Check alternative options

If your Marketplace premium is jumping significantly and you don't qualify for strong subsidies, private PPO options may offer:

• Lower total annual costs for healthy applicants
• Broader nationwide PPO networks
• Fewer referral requirements and restrictions

How to decide in minutes

Stay on Marketplace if...

✓ You qualify for strong income-based subsidies
✓ Your doctors are still in-network for 2026
✓ A different Marketplace plan offers better value
✓ You're comfortable with HMO/EPO restrictions

Consider Private PPO if...

✓ Your premium jumped 20%+ and subsidies are minimal
✓ You want nationwide PPO access and flexibility
✓ You travel frequently or need specialists
✓ You prefer direct access without referrals

How RKA handles premium increase notifications

• Network verification: We confirm your doctors are in-network for 2026—before you commit
• Side-by-side comparison: Current plan vs. new Marketplace options vs. private PPOs
• Total cost projection: Annual costs including premiums, deductibles, and expected usage
• Fast enrollment: We'll switch you to the best option before the January 15 deadline

Don't pay more without comparing options

We'll verify your doctors, compare all available plans, and show clear annual costs—before January 15.

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FAQ

Can I switch plans after getting a premium increase notice?

Yes—during Open Enrollment (through January 15), you can switch to any Marketplace plan or explore private PPO options if eligible.

Will my doctors still be covered in 2026?

Not necessarily. Networks change annually. We verify your specific providers before you commit to any plan.

Are private PPOs always more expensive than Marketplace?

No. If you don't qualify for subsidies, private PPOs can offer lower total costs with broader networks—especially for healthy applicants.

For education only; eligibility and benefits vary by carrier and state. Always review official plan documents.