What’s New for ACA Plans in 2026
New rules could make it harder to qualify for financial help—known as premium tax credits—that reduce your monthly premium when enrolling in an ACA (Affordable Care Act) health plan.
Stricter Eligibility Rules
Only U.S. citizens and certain lawful immigrants can now get these subsidies. New immigrants who aren’t yet eligible for Medicaid may no longer qualify for discounted coverage through the ACA marketplace.
Proof of Eligibility Is Now Required
You’ll need to verify your eligibility before enrolling in a plan. Also, most people won’t be automatically re-enrolled anymore — you’ll likely have to actively renew your coverage each year.
Limits on Special Enrollment Periods
Some people used to get subsidies during special enrollment windows — like after moving or losing coverage — even when they weren’t supposed to. That’s no longer allowed in many cases.
Watch Your Income Estimate
In the past, if you underestimated your income and got too much in subsidies, there was a limit to how much you had to pay back. That cap has been removed — now, if you get more help than you should have, you’ll have to repay all of the extra.
Stricter Rules for Immigrant Eligibility
To get coverage through Medicaid or the ACA marketplace, you now need to be a U.S. citizen or a lawfully present immigrant with verified immigration status. If your status can’t be confirmed, you may lose access to these benefits.
The Centers for Medicare & Medicaid Services (CMS) is also tightening rules around emergency Medicaid, which is sometimes used by undocumented immigrants. Federal funding will no longer be available in many of these cases.
What are ACA/Obamacare Plans?
The Affordable Care Act (ACA), known as Obamacare, was signed into law in 2010 to reform health insurance. It established Health Insurance Marketplaces, making coverage easier to obtain and offering financial assistance for those who qualify.
ACA Health Plans are designed to increase accessibility and affordability for millions of Americans, including those self-employed or between jobs.
Key Features of ACA Plans:
- Marketplace: Enroll via HealthCare.gov or state-based Marketplaces to compare options.
- Pre-Existing Conditions: Coverage cannot be denied based on pre-existing conditions.
- Subsidies: Eligible individuals can receive tax credits to lower monthly premiums.
Eligibility: Available to U.S. citizens and legal immigrants through the Marketplace, with subsidies based on income.
- ACA coverage is available to U.S. citizens and legal immigrants. Plans are available to those without insurance from a job, Medicare, Medicaid, CHIP, or other qualifying sources.
- Are you turning 26?
- As you age off your parents’ plan, consider buying an individual plan on the ACA Marketplace. If you’re self-employed, unemployed, or lack job-based coverage, you can explore various options through your state or the federal Marketplace at Healthcare.gov. When applying, you’ll find details on your eligibility for premium or cost-sharing subsidies and potential immediate Medicaid coverage.
Plan Costs: Vary by metal tier, location, age, and insurer:
| Plan Category: | Plan pays: | You pay: | Deductible is generally: |
| Bronze | 60% | 40% | High |
| Silver | 70% | 30% | Moderate |
| Silver with Cost Sharing Reductions (which equal extra savings if you are eligible) | 73-96% | 6-27%(Depends how much savings you are eligible for) | Low |
| Gold | 80% | 20% | Low |
| Platinum | 90% | 10% | Low |
Source: Healthcare.gov
How Can I Save on My Monthly Premiums?
Some individuals qualify for plans for Subsidies, also known as Premium Tax Credits, or Advance Premium Tax Credits, which lower your monthly costs. With the Trump Administration’s recent expiration of the Inflation Reduction Act, it is projected in 2026, individuals with household incomes between 100% and 400% of the Federal Poverty Level (FPL) will generally qualify for ACA subsidies in the form of Premium Tax Credits.
Check your eligibility using our ACA Subsidy Calculator, regardless of your income, to see your subsidy rate or consider switching plans.
| Income Range (% of FPL) | Eligibility | Subsidy Type | Notes |
| Less than 100% (most states) | Not eligible for ACA subsidies | — | Typically eligible for Medicaid instead |
| 100% – 138% (non-expansion only) | Eligible for ACA subsidies | Premium Tax Credits | Applies only in states that did not expand Medicaid |
| 138% – 400% | Eligible for ACA subsidies | Premium Tax Credits | Applies in most states; those under 138% generally fall under Medicaid |
What are the Coverage Benefits?
The Affordable Care Act (ACA) mandates that most health insurance plans cover 10 “essential health benefits,” including hospital services, prescription drugs, and maternity care. Before the ACA’s 2014 implementation, individual marketplace plans often excluded critical services like maternity and mental health care, leading to unexpected costs for consumers. The ACA also ensures coverage for individuals with preexisting conditions.
10 Essential Health Benefits (subject to applicable deductibles, coinsurance and copays)
| Benefit | Description |
| Ambulatory patient services | This is the outpatient care, from doctor’s visits to same-day surgery, that you receive without being admitted to a hospital. |
| Emergency services | Insurance companies cannot charge you more for going to an out-of-network hospital’s emergency room in the case of a true emergency, such as a suspected heart attack or stroke,6 nor can they require prior approval for emergency room visits. |
| Hospitalization | This benefit includes surgery or other overnight, in-patient stays at a hospital. |
| Pregnancy, maternity, and newborn care | Insurance must cover medical services for you and your child, both before and after birth, as well as the cost of the delivery itself. Insurers must also cover birth control and breastfeeding services. |
| Mental health and substance use disorder services | Behavioral health treatment, such as counseling or psychotherapy, is a part of this benefit. |
| Prescription drugs | While insurers don’t cover all drugs, they must offer a formulary (approved list of medications) for which they’ll pay a portion of the costs. You can find a list of the medicines that your insurer covers by visiting its website. |
| Rehabilitative and habilitative services and devices | This benefit includes devices or services aimed at helping people with chronic conditions, disabilities, or injuries regain or improve skills. |
| Laboratory services | Coverage includes tests that doctors might run to aid in diagnosis. |
| Preventive and wellness services and chronic disease management | Preventive and wellness care covers routine doctor’s visits, such as annual exams and vaccinations. If you get preventive health services, such as a pap test, from an in-network provider, their services are free. However, not every service that you receive at a checkup is covered, so check your benefits before you go. |
| Pediatric services | In addition to the above preventive and wellness benefits, children’s benefits must include vision and dental care. |
Source: Healthcare.gov
When are the Open Enrollment Dates?
- November 1 – January 15 (in most states)
- Enroll by December 15 for coverage starting January 1.
- Enroll by January 15 for coverage starting February 1.
However, there are exceptions: Idaho’s deadline is December 16, while Massachusetts and Virginia extended it to January 23 and January 22, respectively.
California, New Jersey, New York, Rhode Island, and the District of Columbia have the latest deadline of January 31.
Beginning in 2027, everyone, no matter what state, will have the same enrollment deadline: December 31.
Can I Apply For a Plan Outside Open Enrollment?
If you experience a Qualifying Life Event (QLE), you can enroll in a health insurance plan outside the open enrollment period. QLEs grant a 60-day Special Enrollment Period (SEP) for selecting new coverage or changing existing plans.
QLEs may include:
- Loss of health coverage
○ Losing existing health coverage, including job-based, individual, and student plans
○ Losing eligibility for Medicare, Medicaid, or CHIP
○ Turning 26 and losing coverage through a parent’s plan
- Changes in household
○ Getting married or divorced
○ Having a baby or adopting a child
○ Death in the family
- Changes in residence
○ Moving to a different ZIP code or county
○ A student moving to or from the place they attend school
○ A seasonal worker moving to or from the place they both live and work
○ Moving to or from a shelter or other transitional housing
- Other qualifying events
○ Changes in your income that affect the coverage you qualify for
○ Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder
○ Becoming a U.S. citizen
○ Leaving incarceration (jail or prison)
○ AmeriCorps members starting or ending their service
Your SEP begins the day of the event, and coverage typically starts the first day of the following month. If you don’t enroll within 60 days, you’ll have to wait for the next Open Enrollment Period, but you may be eligible for temporary coverage in the meantime. Remember, using a SEP incurs no penalties, and insurers must accept your application just like during the Open Enrollment Period.
How to Pay for Prescription Drugs
Health plans may help cover certain prescription medications, with those on your plan’s formulary typically costing less.
Check Coverage:
- Visit your insurer’s website for a list of covered prescriptions.
- Review your Summary of Benefits and Coverage from your insurance company or Marketplace account.
- Call your insurer with your plan information, available on your insurance card or plan description.
If Your Prescription Isn’t Covered:
- Ask your insurer about a one-time refill for your medication after enrollment.
- You can initiate a drug exceptions process for non-covered prescriptions, usually requiring your doctor’s confirmation of necessity.
If Your Exception Is Approved:
- The drug will generally be treated as covered, with costs counting towards your deductible and out-of-pocket limits.
Denied Exception?
- You can appeal the decision for a review by an independent third party.
Pharmacy Options:
- Confirm whether your regular pharmacy is in-network for your new plan by contacting your insurer. Check for mail delivery options as well.
How To Enroll
Navigating the ACA Marketplace plans can feel overwhelming, especially when enrolling in a health insurance plan that suits your needs. Here are some resources to help you enroll in an ACA plan.
- Visit Healthcare.gov for resources or to find your state’s Health Insurance Marketplace; each state has specific enrollment instructions.
- For the 2026 plan year, Illinois will move from the federal marketplace (HealthCare.gov) to its own state-based exchange, Get Covered Illinois. Starting November 1, 2025, residents will enroll through this new state-run platform instead of the federal system.
- Compare insurance plans by carrier and out-of-pocket costs through Healthcare.com’s Health Insurance Marketplace. Find plans here.
- Speak with a licensed insurance agent for personalized assistance and potential time and cost savings; a team is available daily from 9 AM to 6 PM EST at 855-376-1365.
Alternative Plan Options
If you and your family do not qualify for ACA plan subsidies, non-ACA plan options such as short-term health insurance, supplemental plans, fixed benefit coverage, faith-based plans and dental and vision bundles can provide flexible, affordable coverage that fits your needs.
Short-Term Health Insurance
Short-term health plans offer fast, flexible coverage for people in transition, such as those between jobs, aging off a parent’s plan, or awaiting new benefits. Enroll online in minutes with coverage starting as soon as the next day.
Choose terms from 1 month to 364 days (state availability may vary), enjoy broad provider access, and benefit from preventive care, doctor visit copays, free telemedicine, and prescription discounts. Ideal for students, gig workers, early retirees, or anyone needing a low-cost bridge plan, these policies adapt to your lifestyle while helping you avoid lapses in protection before long-term coverage begins.
Supplemental Health Plans
Supplemental health insurance fills coverage gaps left by primary plans, helping with deductibles, copays, and living expenses during serious illness, injury, or hospital stays. Options include accident, critical illness, cancer, and hospital indemnity insurance, plus everyday care and umbrella gap coverage.
Ideal for those with high-deductible or low-cost plans, these benefits can be added during open enrollment, after qualifying events, when buying a health plan, or year-round for select policies. By covering unexpected costs and protecting your finances, supplemental plans bring peace of mind without straining your budget, especially when paired with affordable private health insurance.
Dental and Vision Insurance
Dental and vision plans promote long-term wellness by making preventive care affordable. Dental coverage often includes exams, cleanings, x-rays, fillings, and major procedures, sometimes starting next day. Vision plans help pay for eye exams, glasses, and contacts, plus offer discounts on LASIK and low-vision care.
Bundling saves money and provides preventive benefits such as early detection of systemic health issues. Both plans feature broad provider networks, no-wait options, and coverage for individuals or families. From protecting your smile to preserving your sight, these plans help manage out-of-pocket costs while keeping your oral and visual health on track.
Health Care Sharing Ministry Programs
Faith-based health care sharing programs allow members, usually Christians, to pool monthly contributions to cover each other’s eligible medical costs.
While not insurance, they can be affordable alternatives aligned with religious values. Members pay a set “share” amount, submit bills for reimbursement, and often participate in community support through prayer. Enrollment typically requires agreement with a statement of faith and a healthy lifestyle. Coverage varies and is not guaranteed, but online sign-up makes it easy to find a plan that fits your budget and beliefs. These programs work best for those comfortable with non-traditional community-based cost-sharing.
Fixed Benefit Medical Insurance
Fixed benefit medical insurance pays set cash amounts for covered services like hospital stays, surgeries, or lab work, regardless of provider or network. With no deductibles, benefits start immediately and can be paid directly to you or your provider.
This predictable coverage is ideal for those with limited savings or who want to avoid surprise medical bills. Quick payouts and freedom to choose any doctor provide flexibility and control. Whether used as a standalone option or paired with other plans, fixed benefit insurance delivers affordable, reliable protection without the complexity of traditional health plans.
Health Insurance Terms Glossary
| Term | Description |
| Agent (broker) | A licensed individual or entity helping consumers select and enroll in health insurance plans, typically paid a commission percentage by the insurers. |
| Affordable Care Act (ACA) | Landmark health reform legislation passed in 2010, aiming to increase health insurance quality and affordability, lower the uninsured rate, and reduce healthcare costs. |
| Coinsurance | The percentage of costs a patient pays for a covered health care service after the deductible has been met. |
| Copayment | A fixed amount one pays for a covered health care service, usually when receiving the service. |
| Dependent | An individual, typically a spouse or child, covered by a primary insured person’s health insurance plan. |
| Deductible | The amount one pays for covered health care services before the insurance company starts to pay. |
| Federal poverty level (FPL) | A measure of income level issued annually by the Department of Health and Human Services (HHS), used to determine eligibility for specific programs and financial benefits. |
| Health Insurance Marketplace | Federal and state organizations that collectively form an “exchange” of health insurance plans that can be federally subsidized for more affordable rates. |
| High Deductible Health Plan (HDHP) | A plan with a higher deductible than a traditional insurance plan, usually with lower monthly premiums but higher out-of-pocket costs. |
| Health Maintenance Organization (HMO) | A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. |
| In-network coinsurance | The percentage of costs one pays for covered health care services within the provider network. |
| In-network copayment | A fixed amount one pays for covered health care services from providers within the network. |
| Marketplace | An online organization operated by federal or state governments where one can shop for, compare, and buy health insurance. |
| Medicaid | A state program that receives federal dollars to provide health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. |
| Network | The facilities, providers, and suppliers your health insurer has contracted with to provide health care services. |
| Obamacare | Informal term for the Affordable Care Act (ACA), a comprehensive healthcare reform signed into law by President Obama in 2010. |
| Open Enrollment Period | The yearly period when people can enroll in a health insurance plan; outside this period, one needs a special circumstance to qualify for enrollment. In most states, this period is November 1 – January 15 annually. |
| Out-of-network coinsurance | The percentage of costs one pays for covered health care services outside the provider network. |
| Out-of-pocket maximum/limit | The most you must pay for covered services in a plan year; after this amount, your health insurance company pays 100% of covered benefits. |
| Out-of-pocket costs | Expenses for medical care that aren’t the responsibility of the insurance company, including deductibles, coinsurance, and copayments for covered services, plus all costs for non-covered services. |
| Out-of-network copayment | A fixed amount one pays for covered healthcare services from providers outside the network. |
| Pre-existing condition | A health problem, like asthma, diabetes, or cancer, that existed before the date that new health coverage starts. |
| Preferred Provider Organization (PPO) | A type of health plan that contracts with medical providers to create a network of participating providers; you pay less if using network providers. |
| Premium | The amount that must be paid for health insurance or a plan, usually paid monthly by you and/or your employer. |
| Premium tax credit | A tax credit or subsidy designed to help eligible individuals and families with low to moderate income better afford health insurance purchased through the Marketplace. |
| Qualifying Life Events (QLE) | Certain life events that allow enrollment in health insurance outside the Open Enrollment Period. |
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