What’s Changing in 2026: A Consumer’s Guide to Marketplace & State-Based Health Insurance

Big changes are coming in 2026 for people who use Healthcare.gov or a state-based health insurance exchange. These updates will impact eligibility, premium assistance, and how you stay enrolled. If you rely on the Marketplace for affordable coverage, here’s what you need to know and how to prepare.

Loss of Enhanced Premium Tax Credits

The extra help many people have been receiving to lower monthly premiums, known as enhanced premium tax credits (ePTCs), is set to end after 2025. These subsidies, expanded under federal relief laws, made more people eligible and capped premium costs at 8.5% of income. Without Congressional action, premiums will rise for millions of Americans, with some seeing increases of 75% or more. The Congressional Budget Office estimates that approximately 4.2 million people could lose coverage as a result.

Stricter Enrollment & Eligibility Rules

New rules beginning in 2026 will make enrollment more difficult for many. Low-income households under 150% of the federal poverty level will no longer have access to year-round enrollment through Special Enrollment Periods (SEPs); instead, they’ll be limited to the standard open enrollment window or qualifying life events. Income verification will also tighten, applicants must now submit proof of income during enrollment or renewal and respond within 90 days, ending the previously available 60-day extension. Auto-renewal will also no longer be available for subsidized enrollees; if you don’t confirm your information, you could lose your financial assistance and be enrolled in a $5/month basic plan by default for members with $0 premium. And if your reported income doesn’t match IRS records, you’ll be required to justify your estimate or risk denial of coverage. These changes are meant to improve program integrity, but they also increase the paperwork and deadlines consumers must manage. Using an agent can be even more important in understanding and navigating the enrollment process.

Changes for DACA Recipients

As of 2026, individuals with Deferred Action for Childhood Arrivals (DACA) status will no longer be considered “lawfully present” for the purpose of enrolling in Marketplace coverage or receiving subsidies. This reverses a 2024 rule that expanded access and will impact roughly 10,000 people nationwide who currently rely on Marketplace insurance.

End of APTC Repayment Caps

Another major shift for 2026 is the removal of the cap on repaying excess Advanced Premium Tax Credits (APTC). In the past, if your income ended up higher than expected, your repayment was limited based on your income level. That protection is going away. Starting in 2026, if you miscalculate and receive more tax credits than you’re entitled to, you’ll have to repay the full amount, no matter your income level. This makes accurate income estimates and midyear updates even more critical.

Revised Open Enrollment Period

The open enrollment window for 2026 will run from November 1, 2025 through January 15, 2026, giving consumers around 10 weeks to select or renew their plans. However, starting in 2027, that window will likely shrink. Federally-facilitated Marketplaces are expected to reduce open enrollment to just six weeks (November 1 to December 15), while most state-based exchanges may adopt slightly longer timelines.

Expanded Access to Health Savings Accounts (HSAs)

There is good news for some consumers, beginning in 2026, many more Marketplace plans will become HSA-eligible. Specifically, bronze and catastrophic plans will now qualify as High-Deductible Health Plans (HDHPs), meaning you can open and contribute to a Health Savings Account. HSAs let you save money tax-free for qualified medical expenses, providing added flexibility and financial benefits.

Updated Cost-Sharing Limits

Out-of-pocket maximums are increasing as well. For 2026, the most you’ll have to pay for covered medical expenses in a year will rise to $10,600 for individuals and $21,200 for families. These limits are adjusted annually to reflect changes in healthcare costs and inflation, and they could impact budgeting for anyone who uses a high-deductible plan.

How These Changes Affect You

Whether you enroll through Healthcare.gov or a state-based exchange like Georgia Access, these federal rules apply across the board. Some states may offer their own subsidies or support programs, but the most significant policy shifts, such as tighter verification, reduced enrollment flexibility, and the loss of financial protections, will be nationwide. State-based exchanges may try to ease the transition with better outreach and resources, but the burden will ultimately fall on consumers to stay informed and meet new requirements.

What You Can Do to Prepare

If you use Marketplace coverage, take these steps to protect yourself. First, estimate your income carefully when applying. Without a repayment cap, underestimating can lead to a large tax bill. Be sure to update your income midyear if your financial situation changes. Second, gather and submit your verification documents on time. You’ll likely need to provide proof of income, immigration status, or other eligibility criteria more quickly than before. Third, don’t rely on automatic renewal, reach out to us to update your information and confirm your plan each year. Fourth, keep track of the enrollment window and plan to take action between November 1, 2025 and January 15, 2026. Lastly, consider opening an HSA if you select a qualifying plan. These accounts can help you manage out-of-pocket expenses while offering valuable tax savings.

Looking Ahead

The 2026 health insurance landscape will bring significant changes. With the possible end of enhanced subsidies, tougher enrollment rules, and greater financial risks for reporting errors, consumers must stay engaged to maintain affordable coverage. While state exchanges may provide support, the main rules apply nationwide, and the stakes are higher than ever. Staying organized, watching deadlines, and updating your information will be key to protecting your health coverage in the years ahead. Please reach out to our office via phone at 706-257-5073 or email at info@michellecrawfordbenefits.com so we can assist you in navigating your coverage with ease!

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Spring Into Health: Why March Is the Perfect Time to Understand Your Coverage

March 6, 2026

Spring Into Health: Why March Is the Perfect Time to Understand Your Coverage March represents a shift. The days are getting longer, routines begin to change, and many people start thinking about spring goals such as more movement, better habits, and taking care of things they may have put off during the winter months. It’s also one of the best times of year to check in on your health and make sure your insurance coverage is still working for you. Many people associate insurance decisions with specific enrollment seasons, but staying covered and staying healthy is a year-round responsibility. A spring review can help prevent surprises, close coverage gaps, and give you confidence moving forward into the rest of the year. Why Spring Is a Natural Time for a Health Reset Winter often brings busy schedules, holidays, and illnesses that push preventive care to the bottom of the to-do list. By the time March arrives, many people are overdue for routine appointments or unsure how their current coverage works. Spring offers a chance to reset. Scheduling checkups, reviewing prescriptions, and understanding your benefits now can help you stay proactive rather than reactive. Preventive care is designed to catch issues early, when treatment is often simpler, less expensive, and more effective. Understanding Preventive Care and Your Benefits One of the most commonly overlooked aspects of health insurance is preventive care. Many plans cover services like annual physicals, routine screenings, and wellness visits at little or no cost when you use in-network providers. These services are meant to help you stay healthy, not just treat illness after it appears. Knowing what your plan includes allows you to take advantage of these benefits confidently. If you’re unsure what’s covered or when you’re eligible for certain services, a quick review can provide clarity and help you plan ahead. Life Changes Can Impact Coverage Spring often brings life changes; new jobs, growing families, income changes, or shifts in routines. Even small changes can impact whether your current coverage is still the best fit. A job change might affect provider networks or prescription coverage. A growing family can change coverage needs entirely. Reviewing your plan during times of transition helps ensure your coverage continues to support your health and financial goals. Why Reviewing Coverage Now Matters Waiting until something goes wrong to understand your insurance can lead to unnecessary stress and unexpected costs. Reviewing your coverage now allows you to ask questions, confirm details, and make informed decisions before you need care. Some key things to check include: • Are your doctors still in-network? • Are your prescriptions covered at the most affordable level? • Do you understand your deductible, copays, and out-of-pocket costs? • Does your plan still align with your current health needs? These questions are easier to address when you’re not facing an urgent situation. Mental and Emotional Health Matters Too Health isn’t just physical. Seasonal changes can affect mood, energy levels, and mental well-being. Many health plans include mental health benefits that are underutilized simply because people aren’t aware they’re available. March is a good time to evaluate whether your coverage includes access to counseling, therapy, or virtual visits that support emotional well-being. Taking care of mental health is just as important as scheduling physical checkups, and both contribute to overall wellness. Planning Ahead for the Rest of the Year A spring coverage review isn’t about making changes for the sake of change. It’s about understanding where you stand and planning ahead. When you know how your coverage works, you’re better prepared for travel, unexpected illness, or future milestones. This proactive approach helps reduce uncertainty and allows you to focus on enjoying the season instead of worrying about what might happen. Small Steps Make a Big Difference You don’t have to do everything at once. Scheduling one appointment, reviewing one benefit, or asking one question is a meaningful step toward better health management. Over time, these small actions build confidence, reduce stress, and support long-term well-being. March is a reminder that progress doesn’t have to be dramatic to be effective. A little attention now can prevent bigger problems later. Moving Into Spring with Confidence As the seasons change, taking time to check in on your health and your coverage is one of the most practical ways to care for yourself and your family. Understanding your insurance, using preventive benefits, and planning ahead helps you move into spring feeling prepared and supported. If you have questions about your health coverage, preventive care benefits, or whether your current plan still fits your needs, we are here to help. Give our office a call if you have any questions about your benefits. Staying informed is one of the most powerful tools you have when it comes to protecting your health this spring and beyond.

How to Properly Access and Use Your Health Plan Portal

March 4, 2026

How to Properly Access and Use Your Health Plan’s Online Portal In today’s digital-first world, your health plan’s online portal is one of the most powerful tools available to help you manage your healthcare. From reviewing benefits and finding providers to tracking claims and downloading important documents, online member portals are designed to make healthcare more convenient and transparent. However, many members either don’t know how to access their portal or aren’t using it to its full potential. Learning how to properly access and navigate your health plan’s online portal can save you time, reduce frustration, and help you take control of your health. What Is a Health Plan Online Portal? A health plan online portal is a secure website or mobile app provided by your insurance carrier. It gives members 24/7 access to their plan information in one centralized location. While features vary by insurer, most portals allow you to view coverage details, manage personal information, communicate with your health plan, and access wellness tools. If you’ve ever waited on hold to ask a simple question about your benefits, the portal can often provide those answers instantly. Step 1: Gather What You Need Before You Start Before registering, have a few key items ready. You’ll typically need: • Your health insurance ID card • Your member ID number • Personal information such as your date of birth and ZIP code • An email address you can access regularly Using a personal email address rather than a shared one helps keep your information secure and ensures you receive important plan notifications. Step 2: Register for an Account Visit your insurance carrier’s official website and look for a link labeled “Member Login,” “Register,” or “Create an Account.” If your plan offers a mobile app, you can also download it from the App Store or Google Play and register there. During registration, you’ll create a username and password. Choose a strong password that includes a mix of letters, numbers, and symbols, and avoid using the same password you use for other accounts. You may also be asked to set up security questions or enable two-factor authentication for added protection. Once registered, you’ll typically receive a confirmation email to verify your account. Step 3: Log In and Explore the Dashboard After logging in, you’ll be taken to your member dashboard. This is the home screen of your portal and provides an overview of your plan. Common sections include: • Coverage and benefits • Claims and explanations of benefits (EOBs) • Digital ID cards • Provider search tools • Prescription drug information Take a few minutes to click through each section so you know where to find things when you need them. Familiarity now can save stress later. Step 4: Learn How to Use Key Features View benefits and coverage The portal breaks down what your plan covers, including copays, deductibles, and out-of-pocket maximums. This is especially helpful before scheduling appointments or procedures. Check claims and costs You can track claims as they are processed and review EOBs to understand what was billed, what your plan paid, and what you may owe. This helps you catch errors early and avoid surprises. Find in-network providers Most portals include a provider search tool that helps you find doctors, specialists, hospitals, and pharmacies that are in-network, saving you money and ensuring coverage. Access digital ID cards If you forget your physical insurance card, your digital ID card can usually be accessed or downloaded directly from the portal. Did you know that some carriers are no longer sending physical ID cards? The online portal may be the only way to access your member ID. Manage prescriptions Many portals allow you to review covered medications, find lower-cost alternatives, and connect with mail-order pharmacy services. Step 5: Use Wellness and Support Tools Beyond basic plan information, many portals include wellness resources such as: • Preventive care reminders • Health assessments • Fitness and incentive program tracking • Telehealth access • Care management or nurse support lines These tools are often underused but can add significant value to your health plan. Step 6: Keep Your Information Updated Make sure your contact information, address, and communication preferences are current. This ensures you receive important notices, plan updates, and benefit reminders without delays. Step 7: Know Where to Get Help If you have trouble registering or navigating the portal, look for a “Help,” “Support,” or “Contact Us” section. Most insurers offer step-by-step guides, FAQs, or customer service support to assist you. Our office may also be able to assist, if needed. Why Using Your Portal Matters Your health plan’s online portal puts important information at your fingertips and helps you make informed decisions about your care. By learning how to properly access and use it, you can avoid unnecessary calls, better understand your benefits, and feel more confident managing your healthcare. Taking a little time to set up and explore your portal today can lead to smoother, smarter healthcare experiences tomorrow.