10 Key Things Consumers Need to Know About Health Insurance in 2026
Health insurance is changing again in 2026, and what worked last year may not work this time. Prices are shifting, some government discounts may end, and plan details are harder to predict. Deadlines remain firm, but the rules around who qualifies and how much it costs are less stable. If you buy coverage through the ACA marketplace or another individual plan, it’s important to know what’s different this year.
This guide breaks down what matters most, so you can make smarter choices before the enrollment window closes.
Coverage Must Be Purchased by December 15 for a January Start
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To begin coverage on January 1, consumers must enroll and pay by December 15. Signing up between December 16 and December 31 still allows enrollment, but coverage won’t begin until February 1. A missed deadline means waiting for a qualifying life event, such as job loss or relocation, to become eligible for coverage later.
Automatic Renewal May Not Reflect the Best Plan
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Auto-renewal is convenient but risky. Many plans change deductibles, doctor networks, or even disappear entirely. Premiums often rise. A familiar policy name doesn’t mean identical coverage. Taking time to compare updated plan details before re-upping helps avoid surprise costs or coverage gaps in the new year.
Premium Subsidies for Middle-Income Households May Expire
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Households earning between 200% and 400% of the federal poverty level received extra premium subsidies through 2025. If those subsidies aren’t extended, coverage could become significantly more expensive for millions. Lawmakers haven’t made a final call yet, so it’s a space to watch heading into open enrollment.
People Earning Above 400% of Poverty Level Are Ineligible for Aid
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Federal premium assistance is no longer available for individuals or households above 400% of the federal poverty level. Consumers just over this line may consider adjusting income where legally possible to regain eligibility. Marketplace plan costs at this income level can be high, depending on location and age.
Medicaid Eligibility Remains Unchanged for Now
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No immediate changes are taking effect for Medicaid or Medicaid expansion. Households below 138% of the poverty level remain eligible. However, redetermination rules are expected to tighten in the future, requiring biannual proof of income and qualifying activity, such as work or caregiving.
Children May Qualify Even If Parents Do Not
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Children in households with incomes up to 217% of the poverty level may be eligible for low- or no-cost insurance through separate state programs, such as MIChild. These aren’t tied to parental eligibility. Even if you’re not covered, check your child’s status—many qualify through school or state-supported outreach programs.
Veterans Should Recheck Eligibility Under Expanded Rules
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Recent expansions to VA eligibility mean some veterans who were previously denied access to VA health benefits may now qualify. Verification is required through VA channels, but the broader criteria may reduce or eliminate the need for separate private insurance if VA care is available.
Age-Based Pricing Will Affect Older Adults More
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Even though ACA plans don’t price by health status, they do adjust premiums for age. People in their late 50s and 60s are likely to see some of the steepest rates, especially if they’re above subsidy levels. Comparing plan tiers can sometimes offset that bump, depending on location and provider networks.
Gold Plans May Cost Less Than Silver for Some Enrollees
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In certain income ranges and zip codes, gold-tier plans have lower premiums than silver-tier options. It’s not a mistake. It’s just the result of how ACA pricing formulas work. Instead of defaulting to silver, it’s worth checking if a gold plan offers better value after factoring in deductibles and copays.
Unbiased Assistance Is Available Nationwide
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ACA assisters and patient financial counselors are available across the country at no cost, and their guidance doesn’t come with sales pressure since they aren’t tied to insurance companies or commissions. If you want help comparing plans, handling paperwork, or understanding benefits, healthcare.gov offers a lookup tool that connects you with trained support in your area using your zip code.