What Are the 2026 Changes to Individual and Family Health Insurance Marketplace Plans?

As we approach 2026, significant changes are coming to individual and family health insurance marketplace plans that will directly impact your coverage options and costs. Understanding these modifications is essential for making informed decisions during the upcoming open enrollment period. At Borde & Associates, we're committed to helping you navigate these complex changes with confidence and clarity.

Open Enrollment Period for 2026 Coverage

The open enrollment period for 2026 individual and family health insurance marketplace plans runs from November 1, 2025, through January 15, 2026. This critical window gives you the opportunity to shop for new plans, compare coverage options, and make necessary adjustments to your existing coverage.

During this period, you can access plans through HealthCare.gov or your state-specific marketplace exchange. We strongly encourage you to review your current coverage and explore your options early in the enrollment period to ensure you have adequate time to make the best decision for your family's healthcare needs.

Substantial Premium Increases Across Marketplace Plans

One of the most significant changes you'll encounter in 2026 is a dramatic increase in health insurance premiums. Health insurers participating in ACA marketplaces are implementing substantial rate increases, with the median proposed premium increase reaching 18% across 312 insurers in the United States.

These premium increases vary by region and insurer, with some areas experiencing increases of 20% to 26%. However, the actual premiums you'll pay will be affected by more than just these base rate increases, as we'll explain in the following sections.

Why Premiums Are Rising

Several factors contribute to these premium increases:

• Rising healthcare costs and medical inflation
• Changes in federal regulations
• Adjustments to actuarial assumptions
• The expiration of enhanced financial assistance programs

The End of Enhanced Premium Tax Credits

The most consequential change affecting your out-of-pocket costs in 2026 is the expiration of enhanced premium tax credits. These subsidies, which have been in effect since 2021, significantly reduced the cost of marketplace coverage for millions of American families.

Congress has not extended these enhanced tax credits, meaning substantially less financial assistance will be available starting January 1, 2026. This change will result in dramatic premium increases for most marketplace enrollees, regardless of the underlying premium increases implemented by insurers.

Real-World Impact on Families

The expiration of enhanced tax credits will affect families differently based on their income, age, and location. Here are some examples of how these changes might impact real families:

Middle-Income Families:

• A family of four earning $50,000 annually in New Hampshire will see premiums increase from $9 to $186 per month: nearly a 2,000% increase
• Families earning between $50,000-$75,000 annually will experience some of the most dramatic increases

Older Adults:

• Two retirees in their early 60s earning $85,000 yearly in Wisconsin will experience premiums rising from $602 to $2,144 per month: a 250% increase
• Older adults face disproportionately higher impacts due to age-based premium pricing

Young Adults:

• A 28-year-old earning $25,000 annually in Oregon will see premiums jump from $8 to $97 per month: a 1,113% increase

Overall, the average marketplace enrollee's premium is expected to increase by 114 percent, with some analyses suggesting out-of-pocket costs could increase by more than 75% as healthier individuals may drop coverage due to affordability concerns.

Additional Regulatory Changes Affecting Costs

Beyond the tax credit expiration, new federal regulations will add an additional 4.5% increase to premiums for most marketplace consumers in 2026. These regulations change how the government calculates premium contribution rate increases, further compounding the cost burden on families.

The same regulatory changes will also affect out-of-pocket maximums, which could increase by 15.2% compared to 2025 levels for consumers in both employer-sponsored and marketplace plans.

Financial Assistance That Remains Available

While enhanced tax credits are expiring, some financial assistance will continue to be available in 2026. Understanding what help remains can be crucial for your family's healthcare planning:

Basic Premium Tax Credits

Standard premium tax credits will still be available based on income eligibility. However, these provide significantly less assistance than the enhanced credits that are expiring.

Cost-Sharing Reductions

Cost-sharing reductions that lower your deductibles, copayments, and coinsurance will remain available for eligible individuals and families with incomes up to 250% of the federal poverty level.

Public Program Eligibility

The marketplace will continue to check your eligibility for public programs like Medicaid and the Children's Health Insurance Program (CHIP), which may provide more affordable coverage options for qualifying families.

Important Note: Fewer people are expected to qualify for assistance in 2026, and the amount of help available will be considerably smaller than in recent years.

Consumer Notifications and What to Expect

If you're currently enrolled in a marketplace plan, you should receive notifications about 2026 premium changes by the end of October. However, the process varies:

• State-based marketplaces typically send automatic notices to current enrollees
• HealthCare.gov (the federal marketplace) does not automatically send consumer notices about premium increases

If you haven't received a notice, you may not learn about increases until you log into your marketplace account or receive bills from your health plan in January. We recommend proactively checking your account during the open enrollment period.

How to Prepare for These Changes

Given the significant changes coming in 2026, here's what you can do to prepare:

Review Your Current Coverage

• Assess your current plan's benefits and costs
• Determine if your current plan still meets your family's needs
• Consider whether you can afford potential premium increases

Explore Your Options Early

• Log into your marketplace account as soon as open enrollment begins
• Compare available plans in your area
• Calculate the total cost of coverage, including premiums, deductibles, and out-of-pocket maximums

Consider Alternative Coverage Options

• Explore employer-sponsored coverage if available
• Investigate association health plans or short-term coverage options
• Consider health-sharing ministry plans if they align with your values

Seek Professional Guidance

Working with experienced insurance professionals can help you navigate these complex changes and find the most suitable coverage for your family's needs and budget.

Moving Forward with Confidence

The 2026 changes to individual and family health insurance marketplace plans represent some of the most significant modifications to the ACA marketplace since its inception. While these changes present challenges, understanding them empowers you to make informed decisions about your family's healthcare coverage.

At Borde & Associates, we're here to help you navigate these changes with expertise and personalized guidance. Our team understands the complexities of health insurance and can help you find coverage solutions that work within your budget while providing the protection your family needs.

Don't let these changes catch you unprepared. Contact us today to discuss your options and create a healthcare coverage strategy that gives you peace of mind in 2026 and beyond. We're committed to helping you secure the comprehensive coverage your family deserves, regardless of the changing marketplace landscape.

Ready to explore your 2026 health insurance options? Contact our team for personalized guidance and support throughout the enrollment process.

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