2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now
Major 2026 Open Enrollment updates: Premiums up, out-of-pocket limits higher, and subsidy extensions uncertain. Compare Marketplace vs Private PPOs before it’s too late.
Enrollment Help • Nov 5 • Written by Robert Adams
2026 Open Enrollment Changes: What’s New, What’s Driving Cost, and What to Do Now
Fast take:
The 2026 open enrollment is bringing significant shifts — premium hikes, higher out-of-pocket caps, and subsidy uncertainty all combine to change the game from previous years. If you’re qualifying for coverage for 2026, it’s time to compare [Marketplace](chatgpt://generic-entity?number=0) vs. private medically-underwritten PPOs vs. COBRA exit strategies and pick your right window **before the clock runs out**.
- • Premium filings show increases for 2026 in many states.
- • Max out-of-pocket limits are rising — you may pay more if you use care.
- • Subsidy changes are unconfirmed — if enhanced credits fade, your “net” cost could jump.
- • Not tied to federal subsidy legislation — pricing is independent.
- • Often broader PPO networks and fewer referral restrictions.
- • Eligibility required, but it’s a powerful option when Marketplace costs spike.
What’s new for 2026 open enrollment
The landscape has shifted in part due to macro-factors and in part due to policy. Here’s what’s driving the changes:
- Carrier cost-trend is higher → claims, drugs, and specialty care all escalate and carriers file accordingly.
- Higher out-of-pocket maximums → The yearly cap is creeping up again, meaning more financial risk for members.
- Subsidy uncertainty → If enhanced credits aren’t extended or phase down, even a stable income could leave you paying more.
- COBRA exposure remains extreme → If you’re losing employer coverage, staying on COBRA might cost more than shopping alternatives now.
What this means for you and your family
For example: a 45-year-old couple with two children saw a typical Bronze Marketplace renewal jump from $1,250 / mo in 2025 to around $1,650 / mo in 2026. The max out-of-pocket climbed from $8,700 to $10,000. That means:
- • You’ll pay a higher premium just to stay in the same segment.
- • If you or a family member use care early in the year, you’ll hit higher OOP sooner.
- • If subsidies are reduced, your net cost could rise again — even if your plan looked okay today.
That’s why we tell households: don’t renew blind. Compare Marketplace vs Private PPO vs COBRA alternative to see your real cost before you lock in.
What to do next: Your 3-step checklist
1) Submit your details
ZIP, ages, income estimate — so we can test all paths for you.
2) Verify your doctors & prescriptions
Network changes in 2026 are real. Let us check before you pick a plan.
3) Compare your three paths
Marketplace vs Private PPO vs COBRA exit — pick the one that fits your risk-level and timing.
Let’s lock the right 2026 plan for your ZIP.
We’ll run Marketplace vs Private PPO vs COBRA escape for your exact family, verify your doctors, and tell you which enrollment window you’re actually in.
Quick FAQs
Will I automatically see higher 2026-costs if I stayed in the same plan?
Often yes — even if your benefits didn’t change. Because premiums and OOP maximums are rising across the board.
What if enhanced subsidies get extended again?
Great if they are — but don’t bet on it. We prepare your plan assuming worst-case and then re-run if credits improve.
Can I switch mid-year if I pick wrong?
Maybe — but limited. That’s why we use a licensed advisor to match your timing, plan, and risk exposure before you enroll.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com
Time is Running Out: The Open Enrollment Deadline for Health Insurance Quotes is December 15th!
Open Enrollment 2026: Enroll by Dec 15 for Jan 1 or by Jan 15 for Feb 1. We’ll compare Marketplace vs Private PPO and verify your doctors first.
Open Enrollment • 2026 Deadlines • Written by Robert Adams
Open Enrollment 2026: Last Day for Jan 1 Coverage Is Dec 15 — Don’t Miss It
The 2026 window runs Nov 1 → Jan 15. Enroll by Dec 15 for a Jan 1 start, or by Jan 15 for a Feb 1 start. Prices are up in many ZIPs, so compare Marketplace vs. Private PPO (if eligible) before you lock in the wrong plan.
Key 2026 dates
- Nov 1: Open Enrollment starts.
- Dec 15: Deadline for Jan 1 coverage.
- Jan 15: Final day to enroll for a Feb 1 start.
Am I eligible for savings?
Most households qualify for some level of credit on Marketplace plans based on income, household size, and ZIP. We’ll run the numbers and show your net premium—then compare against a private, medically underwritten PPO if you’re eligible (often lower premiums for healthy applicants).
- • Can be cheapest if you qualify for credits.
- • Many plans are HMO/EPO; referrals are common.
- • Credits reconcile at tax time.
- • County/ZiP options vary, networks differ.
- • Often no referrals; broader networks.
- • Pricing isn’t tied to ACA credits.
- • Great fit when keeping doctors/hospitals matters most.
What to do right now (5 minutes)
1) Send basics
ZIP, ages, household/income range.
2) List doctors & meds
We verify networks + prescriptions.
3) Compare 3 paths
Marketplace • Private PPO • COBRA exit if needed.
Beat the Dec 15 cutoff for Jan 1 start.
We’ll show your net premium with credits, verify your doctors, and stack it against a Private PPO if you’re eligible.
Quick FAQs
What happens if I miss Dec 15?
You can still enroll by Jan 15 for a Feb 1 start. After that, you’ll need a Qualifying Life Event—or see if a Private PPO is available.
Will my doctors be in network?
We verify your providers and prescriptions for both paths before you enroll.
Are Private PPOs cheaper?
For healthy households that qualify, they can be competitive vs. unsubsidized Marketplace plans. We’ll show both.
Robert Adams
RKA Insurance Advisors • 561-806-9913 • robert@rkainsuranceadvisors.com
Take advantage of your chance to secure health insurance quotes for the upcoming year. The Open Enrollment Deadline for 2023 is quickly approaching, and time is running out. December 15 marks the last day individuals and families can apply for or renew their existing health insurance plans to start January 1st. So don't delay - take advantage of this window of opportunity to make sure you have the coverage you need for the coming year.
How do I know if I'm eligible for a subsidy?
During the Open Enrollment period, which runs from November 1 to January 15 each year, individuals and families can shop for, compare, and purchase health insurance coverage. Small business owners and the self-employed also have the opportunity to find quality coverage during this time. December 15 is the cut-off for a plan to start January 1st.
Speaking to a licensed health coverage advisor, you can get an estimate of your costs and premiums and see how much you could save on a qualified health plan. The amount of savings you may qualify for depends on your income level, the size of your family, and the type of coverage you select. Five out of six people generally qualify for savings when purchasing a health plan. In addition, you can compare and check eligibilty for medically underwritten private plans not available on the marketplace exchange.
Don't wait to take advantage of Open Enrollment! Make sure to speak to a licensed advisor who can compare all your coverage choices. Doing so will help ensure you get the coverage you need at an affordable rate. For example, suppose you're eligible for a subsidy and don't get health insurance quotes by the Open Enrollment deadline of January 15. In that case, you may have to wait until the next Open Enrollment period to get a plan at a discounted rate. Especially if you are not eligible for medically approved coverage options, so take advantage of the chance to save on family and individual health insurance or small business and self-employed health insurance coverage. Get your health insurance quotes now and take advantage of affordable plans before it's too late.
How do I enroll in a health insurance plan?
When enrolling in a health insurance plan, it's vital to ensure you are getting the best coverage for your needs and budget. One of the best resources you can use to help you choose the right plan is a Licensed health coverage advisor. They can provide personalized advice, guidance, and information about the plans available and what will work best for your situation.
In addition, you can also utilize an online enrollment platform to get instant quotes from multiple insurers. This will help you compare rates and features between the various plans to choose the best fit your requirements. Online quote comparisons do not consider or compare medically underwritten plans. These plans must be provided by a licensed advisor. Rates can be, at times, 20-30% more affordable than marketplace plans if you do not qualify for substantial savings. Don't miss out on this important opportunity - December 15 is the Open Enrollment Deadline for coverage to begin January 2023. Act now to secure your health insurance coverage for the coming year.
Reach out to us today to ensure you have the best coverage at the most affordable rate!