Everything You Need to Know for Marketplace Open Enrollment this Year

In the wake of the Republican health care cuts and the Trump administration's changes to ACA marketplace rules, and in the midst of a government shutdown due in part to Congress's lack of action to extend enhanced premium tax credits, people looking to purchase health insurance during the annual marketplace open enrollment period that begins on November 1 are likely to have a lot of questions.

Health care costs, including insurance premiums are rising significantly this year, and people planning to stay in their current plan may be faced with much higher costs than they expect. That is compounded by the fact that Congress is currently debating whether to extend tax credit enhancements that help make coverage more affordable for more than 90% of marketplace enrollees. If Congress does not act, most people's monthly payments will increase as the tax credits will be far less generous than they were over the last year.

This year's open enrollment runs from November 1 to January 15 and allows new and existing marketplace consumers to shop for the plan that works best for them and their family. There is no one-size-fits-all best option, but there are some key things that every consumer needs to know about this year's open enrollment:

1. If you're a current Marketplace customer, you should update your contact information and your annual income projection to ensure you receive timely information about your options, even if you aren't ready to make a selection just yet. You have until December 15 to choose a plan that goes into effect on January 1, 2026, and you have until January 15 to change plans if you decide to do so. If Congress acts soon and extends the enhanced tax credits, the price of coverage may decrease significantly from the prices you see now. Families USA and other advocates are doing everything we can to call on Congress to take immediate action to ensure premiums don't spike. But it is important to note that even if Congress does not extend the enhanced tax credits, most marketplace consumers will still receive some level of tax credits to help pay for their coverage in 2026, even though they will be far less generous. If your annual income is less than $62,600 for an individual, $84,600 for a family of two, or $128,600 for a family of four, you may still be eligible to receive tax credits that assist in paying for your coverage next year.
   1. Depending on your income, you and your family may be eligible for extra savings called, "cost-sharing reductions" with a silver plan, that will lower your deductible and copays. Talk to a navigator or assister, or learn more about cost-sharing reductions here.
2. If you aren't a current marketplace customer, and you don't have an affordable offer of coverage through an employer or through Medicaid or Medicare, consider enrolling. You can get started with an application now and talk to a navigator or assister about your best options. Revisit your plan choices in December to see if a different marketplace plan better fits your needs. Don't miss this open enrollment opportunity - after January, you may not have the option to enroll in a marketplace plan for the year.
3. It's better to have reliable coverage than to face unpredictable costs down the line. Even if you can only afford a bronze plan right now, it is still worthwhile to enroll through the marketplace. Preventive services without charge are guaranteed to you under any marketplace plan, you can't be excluded from coverage on the basis of pre-existing conditions, and the out-of-pocket maximum limit will protect you against medical debt from major medical events.
   1. Consumers should take note that due to the Marketplace Integrity and Affordability Final Rule, beginning in 2026, marketplaces will be prohibited from including gender-affirming care as an essential health benefit that is required for every marketplace plan to cover. However, insurance companies in the marketplaces may choose to cover these critical health services in their plans. You can contact a navigator (see below) to help find a marketplace plan that meets your coverage needs.
4. Beware of junk insurance plans and scams! You may see alternative plans sold outside the marketplace heavily advertised, such as association health plans, Farm Bureau plans, health sharing ministries, and short-term or limited-duration insurance. These "junk plans" will promise to cover you at a significantly lower cost, but they don't offer the level of benefits that most American families need. Junk plans may not cover services like prescription drugs, specialist visits, mental health, or even maternity care. They limit how much they will pay for your care and don't cap out-of-pocket spending, leaving you at risk of having to foot a massive bill for an expensive medical emergency or procedure.

If you have further questions about open enrollment or selecting a plan that's right for you, make a free appointment with a local navigator or assister for reliable assistance and education. You can find available navigators and assisters in person, over the phone, or online in your state or city here.