July Agency Insights
Important Changes to ACA Health Coverage in 2026
Big changes are coming to Marketplace health insurance starting this fall and they’ll directly affect how you enroll (or renew) your coverage for 2026. At Insurance Benefit Navigators, we want to make sure you’re prepared, protected, and supported every step of the way.
Overview: What’s Changing for 2026?
- Auto-renewals are ending for most plans. You must re-enroll manually to keep your coverage.
- $0 premium plans will now renew at $5/month unless you update your information.
- Tighter rules around income verification and Special Enrollment Periods (SEPs).
- Past-due premium rules are back: You may have to pay outstanding premiums before starting a new plan.
Other Key Changes
Past-Due Premium Enforcement
Insurers may now require payment of past-due premiums before allowing clients to enroll in new plans.
Income Verification Requirements
Automatic 60-day extensions are being eliminated. Clients must submit proof of income if IRS data is missing or inconsistent within 90 days.
SEP Rules Are Tightening
Most Special Enrollment Period applications will now require pre-verification. The monthly SEP for low-income enrollees is ending for 2026.
Plan Switching Removed
Clients will no longer be automatically moved to upgraded plans (such as being switched from Bronze to Silver). You must choose and confirm the right plan for you.
Broker Accountability
CMS is enhancing oversight for licensed agents, improving standards and safeguards for clients.
Open Enrollment Update
Although CMS originally announced a shortened Open Enrollment Period starting in 2026, they have officially delayed that change until 2027. For the 2026 plan year, Open Enrollment will remain from November 1 to January 15, with a December 15 deadline for January 1 start dates
Why is CMS Making These Changes?
CMS (Centers for Medicare & Medicaid Services) is implementing these new rules to strengthen program integrity and reduce fraud across the Marketplace system. Over the past few years, automatic renewals, lax documentation, and low-barrier enrollments created vulnerabilities in the system.
These updates are designed to:
- Ensure only eligible individuals receive premium subsidies
- Encourage consumers to actively participate in plan selection and enrollment
- Reduce errors, duplicate enrollments, and unpaid premiums
- Promote more accurate data reporting and streamlined plan administration
- Increase transparency and accountability among agents, brokers, and insurance carriers
While these steps add more responsibility to both consumers and agents, they ultimately aim to stabilize the ACA Marketplace and make it more sustainable long-term.
What Do You Need to Do?
- Keep your contact info current with us so we can remind you when it’s time to act.
- Watch your mail, email, and voicemail for updates from our team.
- Be ready to re-enroll between
November 1 and December 15 — don’t wait until the last minute!
How Insurance Benefit Navigators Is Preparing?
We understand these changes may seem overwhelming, but we’re prepared to support every client through the process. Our approach includes:
- Proactive outreach to every ACA client
- Scheduling systems for easy appointment booking
- Clear reminders and communication throughout Open Enrollment
- Personalized guidance from experienced, licensed agents
- CRM updates to ensure your contact information and policy details are accurate
We’re Here to Help
Don’t panic — there’s nothing you need to do right now!
Our licensed agents at Insurance Benefit Navigators are prepared and trained on the new CMS rules. We’ll walk you through the entire process and make sure you don’t miss a beat.