Major subsidy changes are set to take effect in 2026, and your timely action during the 2025 Open Enrollment could save you money and protect your coverage.
Subsidies Are Scheduled to Change in 2026
The enhanced subsidies that have kept many premiums low—or even at $0—are scheduled to expire after 2025. Subsidy rules will revert to their pre-2021 levels. This means:
Subsidy amounts will shrink, leaving many families with much higher monthly premiums.
- A hard cutoff for income will return to 400% of the Federal Poverty Level (FPL).
- Households near the 400% FPL could see their premiums rise by hundreds—or even over a
thousand—dollars each month.
Note: Congress does have the authority to extend these enhanced subsidies, and discussions are still ongoing. However, unless lawmakers pass an extension before the 2026 plan year, the scheduled subsidy reductions will take effect.
New Rules for $0 Premium Plans
Beginning in 2026, if you are automatically re-enrolled in a plan that currently has a $0 premium:
- You must complete your renewal application, doing so ensures accurate subsidy calculation. This may result in your plan continuing at $0, or it may result in a higher premium, depending on your income and plan choice.
- You will be charged a $5 monthly premium, starting January 1, 2026
– If the $5 premium is not paid, your plan may be terminated for nonpayment, leaving you uninsured.
Income Documentation Required
Proof of income and eligibility documentation will once again be required. Before COVID-19, this was standard, and that requirement is coming back.
- Failure to provide income documentation could result in the loss of your subsidies or coverage.
- Submitting these documents early will help you avoid delays or unexpected costs.
What Do I Do Now?
Open Enrollment Checklist for 2026
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Re-Evaluate Your Plan
Premiums are projected to increase by an average of 20% in 2026. A different plan option may be more cost-effective for you. -
Project Your 2026 Income Carefully
Your subsidy eligibility will depend on your projected income. Estimating accurately now can help you avoid unexpected costs later. -
Schedule Your Renewal Appointment: Open Enrollment (Nov 1–Dec 15, 2025).
Phone Meeting: Meetings over the phone can be more convenient for some individuals. We have the tools to assist you on the phone just as easily as if you are in our offices.
In-Person Meeting: If you prefer to meet in person, we are always here for you.
Saturday and after hours appointments available upon request. -
Gather and Submit Income Verification Documents
Please have documents ready for your appointment so we can take care of this together.
Acceptable documents include but are not limited to:
Employees: Recent paystubs, prior year 1040, W-2, or Social Security benefit letter.
Self-Employed: Profit/loss statements (YTD or quarterly), prior year Schedule C, self-employment ledger, or the FFM’s annual income explanation form.
Note: For individuals with more complex tax situations, we recommend you consult with your tax accountant or financial planner to determine your estimated income.
