ACA Open Enrollment FAQ
1) When is Open Enrollment?
● Nov 1 – Jan 15. BUT you need to enroll by Dec 15 for Jan 1 coverage!
● Enrollment submitted between Dec 16–Jan 15, coverage will start Feb 1.
2) Are the ACA subsidies still available?
● Yes, but eligibility has changed. ACA subsidies depend on age, location, income
and if you have the option for health insurance elsewhere (Medicaid, through an
employer, etc). Please reach out to us and we’ll assess your eligibility for
subsidies based on your personal situation.
3) What’s my deadline to renew or pick a new plan?
● Ideally by Dec 1. If it’s set to automatically renew, the system will auto renew it on
Dec 1 with last year’s application info and renewal files are sent to the insurance
companies for processing.
● You have until Dec. 15 to enroll in a plan for Jan. 1 BUT if you wait until after Dec 1.
○ The renewal would have to be cancelled first and then the new plan
submitted – this can create delays/ errors in system processing and billing.
○ Any update to info after Dec. 1 would be the same – an updated file will be
sent out after the renewal file and can delay processing and confusion in
the billing system.
4) I’m set up on autopay, will it continue to draft for 2026 automatically?
● This depends on the company, plan and how you have autopay set up at your
bank.
○ It’s always best practice to set a reminder for your autopay and to log into
your member account to verify that it’s set to draft or if you need to
reauthorize the autopay at the new price – especially if there’s been a
change in price or plan
○ If you enrolled with a new insurance company: the payment will have to be
manually set up with the new company
5) What’s new/important for this Open Enrollment?
● HSA eligible health plans changing and changes in funding for subsidies. Please
reach out to a broker to go over your 2026 eligibility and plan options.
● Maximum Out-of-Pocket (MOOP) limits for most plans:
○ 2025: max $9,200 individual / $18,400 family.
○ 2026: max $10,600 individual / $21,200 family
6) Can I enroll in an insurance plan year-round?
● No, open enrollment is from November 1- December 15th for January effectives
and until Jan. 15th for February effective plans. Outside of open enrollment, you’ll
need a standard qualifying life event (moving states where your current health
insurance doesn’t provide coverage, marriage, divorce, birth, loss of coverage,
etc.)
7) Will my plan auto-renew?
● Some Marketplace plans auto-renew if you do nothing, but your subsidy and net
premium can change. Always update income/household and compare
plans—especially in years when rules or subsidies shift like 2026.
8) What documents should I have ready for OEP?
● An estimate for your household’s 2026 MAGI (Modified Adjusted Gross Income),
household size, preferred doctors/hospitals, and (if applicable) employer offer
details to test affordability/ eligibility of the household.
It’s based on 2026 income information – if you don’t know exactly please provide
the closest estimate you can.
9) What are some changes happening in 2026?
● The subsidy cliff has returned (Please check the other link in the email for more details on the changes to the 2026 subsidies). Colorado will implement their own state premium assistance program (CPA – Colorado Premium Assistance) for qualifying individuals/families.
● All Bronze and Catastrophic plans are now considered HSA eligible. If you have an HSA or are considering an HSA plan, please let me know.
10) My doctors are all in network this year, will they still be in network for 2026?
● It’s always best to check with your doctor’s office to confirm there haven’t been any changes for 2026 and that they don’t have any changes starting 2026. Sometimes changes happen mid year and unfortunately that doesn’t allow you to change plans mid year if a doctor drops insurance. It’s always best to check that they don’t plan on making changes to their contracted insurance companies, plan to retire, sell their practice etc.
11) How do deductibles, copays, and max-out-of-pocket work together?
● Your copays ($) are what you pay before you reach your deductible. If you don’t
have a copay, you pay deductible first, then typically coinsurance (%) until you
reach your MOOP (Max out of pocket). After MOOP, the plan pays 100% of covered
services for the rest of the year.
12) My employer or my spouse’s employer offers health insurance, can I still enroll in a marketplace plan?
● Anyone and everyone can enroll in a plan at FULL COST. However, if they’d like to
see if they qualify for a substitute (tax credit financial assistance), then we have to
check the affordability eligibility based on the cost of the offered employer plan
vs. the household income.
● If it’s considered “affordable” per the IRS guidelines, then you aren’t eligible for
financial assistance or monthly tax credit but can still enroll in a plan at full cost. If
it’s NOT considered “affordable” per the IRS guidelines and you qualify for a
monthly tax credit based on income, then you’d be eligible.
*Affordability is based on the IRS guidelines
13) What if I don’t need my plan for 2026? Do I need to do anything?
● Yes, if it’s set to automatically renew in the system, then it will. It’s always best
practice to cancel the renewal or check that it’s not set to automatically renew in
the system.
14) What about the “family glitch”?
● Dependents/ Spouses can qualify for Marketplace subsidies if the family premium for employer coverage is unaffordable under the revised IRS rule. Check again if you were previously ineligible – reach out to me regarding eligibility if you or your spouse is offered health care through an employer.
Quick To-Do Checklist
- Mark your dates: Shop between Nov 1–Dec 15 for your new plan to start Jan 1, 2026
- Update your application: Income for 2026, household, address, doctors, no longer claiming a dependent, etc.
- Compare plans: Check premiums and 2026 coverage details
- If you have the option for healthcare through your employer or spouses’ employer, please let me know and we’ll check your eligibility and cancel your marketplace plan if you go with your employer’s health plan.
- Previously blocked by the family glitch? Recheck eligibility.
Total Care Insurance 