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
Health Insurance “Hacks”
Real, easy health insurance “hacks” that actually save time and money — use telehealth, urgent care, stay in-network, and compare Marketplace vs. Private PPO options.
Health Insurance Guides • Updated Nov 5 • Written by Robert Adams
Health Insurance “Hacks” — Real Tips That Actually Save Time & Money
Fast take:
Skip the gimmicks. Use telehealth for routine issues, choose the right site of care (Urgent Care vs ER), stay in-network to avoid surprise bills, and—if you’re generally healthy—ask about private, medically underwritten PPO options that can drop premiums. When in doubt, have us review your plan and show a side-by-side comparison.
- • Most plans include telehealth/telemedicine with low or $0 copay for common ailments.
- • Typical visit: ~15 minutes by video/phone—no waiting room.
- • Great for colds, rashes, UTI screens, refills, minor issues.
- • Non-emergencies → Primary Care or Urgent Care (faster, lower copays).
- • True emergencies → ER. Otherwise, ER = big bill + deductibles.
- • Ask your plan for preferred Urgent Care centers near you.
- • HMO/EPO: out-of-network = not covered (except emergencies).
- • PPO: out-of-network allowed, but you’ll pay more.
- • Call us—our team will verify your providers are in-network.
- • Medically underwritten PPOs can offer lower premiums for healthy applicants.
- • Often no referrals; broader access for specialists/hospitals.
- • Not for everyone—get a side-by-side with Marketplace plans.
Quick decision guide
Choose Telehealth if…
It’s routine/minor, you want fast care, and your plan shows $0–low copay visits.
Choose Urgent Care if…
It’s same-day non-emergency (stitches, x-rays, infections) and you want to avoid ER costs.
Call us if…
You’re unsure about networks, copays, deductibles, or whether a private PPO could save money.
Want us to check your “hacks” against your actual plan?
We’ll verify your doctors, map Urgent Care options, and compare Marketplace vs. Private PPO side-by-side.
Quick FAQs
Is telehealth really covered?
Most modern plans include it; many charge $0–low copays. We’ll check your specific policy.
How do I confirm a doctor is in-network?
Send us the doctor’s name and location—we’ll verify against your plan’s current network file.
Who should consider private PPO?
Applicants in good health who want broader access and potentially lower premiums. Not everyone qualifies—we’ll show a clean comparison.
Robert Adams
RKA Insurance Advisors • Private & Marketplace Health Coverage • 561-806-9913 • robert@rkainsuranceadvisors.com