UPDATE!

What’s changing about Affordable Care Act benefits in 2026?

2026 brings immediate policy changes:

• no automatic re-enrollment

• a shorter open enrollment period

• paused special enrollment opportunities

• tougher verification processes—all coinciding with subsidy expiration

• Everyone will need to verify income

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Download Income Verification Form here:

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Documents to confirm your household income

The documents you submit to the Marketplace to confirm your household income must show a yearly income amount that closely matches the yearly income amount you entered on your application. For example, if you have a different job than you had last year, send the Marketplace recent pay stubs from your new job, instead of last year's tax return or W2.

• 1040 federal or state tax return. Must contain your first and last name, income amount, and tax year. If you file Schedule 1, you must submit it with your 1040.

• Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Must contain your first and last name, income amount, tax year, and employer name (if applicable).

• Pay stub. Must contain your first and last name, income amount, and pay period or frequency of pay with the date of payment. If a pay stub includes overtime, tell us the average overtime amount per paycheck.

• Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). Must contain your first and last name, company name, and income amount. If you’re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss.

• Social Security Administration Statements (Social Security Benefits Letter). Must contain first and last name, benefit amount, and frequency of pay.

• Unemployment Benefits Letter. Must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable).

• Or, complete a written explanation form (PDF, 126 KB). To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

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Download Instructions to edit income here:

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2027 builds upon these reforms:

• new eligibility restrictions (DACA recipients and no longer eligibile)

• shorter enrollment windows

• documentation requirements​​

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UPDATE!

These changes in RED after 2026 are due to the New law signed July 4 2025

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What’s changing about Affordable Care Act benefits in 2023?

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#1: Standardized plan options will help make shopping easier.

For the 2023 plan year, however, all insurance companies that sell plans on the federal marketplace will have to offer standardized plans. This means they’ll have to offer standardized plans for each service area, plan type (such as HMOs), and metal level (bronze, silver, gold and platinum) where they also offer non-standardized plans. And those standardized plans will be highlighted on the website to make shopping easier. If you have standardized plans available, you may not need to comparison shop as much for your plans as you did in the past.

 

#2: Your plan will have to guarantee you reasonable access to providers.

Since the ACA was signed into law in 2010, insurance companies offering health plans have had to offer “adequate” provider networks. That means if you buy a plan, your health care network would have to be large enough to provide you with reasonable access to in-network health providers.

The rules will get even clearer in 2024, when appointment wait times take effect. Starting then, you must be able to get an appointment with a primary care doctor within 15 business days and an appointment with a specialist within 30 days.
 

#3: If you live in a hard-to-reach area, you may have more health care options.

Just as you can expect reasonable access to health care providers, in 2023 a new rule will address what are known as essential community providers (ECPs). These are providers that focus on low-income and medically underserved individuals. 
Historically, qualified health plans had to contract with at least 20% of the ECPs in their service areas. As of 2023, that number increases to 35%. 

 

#4: You might be denied coverage for old bills that are past due.

Previously, an insurance company could decline coverage if you owed them monthly bills that were past due. You might have to pay them along with your first bill for the new plan year.
 

Past-due bills can still be referred to a collection agency. The idea is that denying you coverage goes against what the ACA stands for in the first place: guaranteed health benefits. You might loose protection that you had before.

Biden-Harris Administration Announces Record-Breaking 16.3 Million People Signed Up for Health Care Coverage in ACA Marketplaces During 2022-2023 Open Enrollment Season. Millions of working families saved an average of $800 on their health insurance premiums last year. This might go away in 2026-2027

The new laws allow those higher earners to qualify for subsidy that would not have in previous years. Example 2018 a couple making $70,000 a year would receive no subsidy and if they received one they would be on the hook from the IRS to pay it all back. Now in 2023 Married couples making $180,000 can still receive a subsidy and if they made less than $90,000 could choose a $0 premium plan option.
This might go away in 2026-2027

Additionally if your employer sponsored insurance to add family members is about 9.96% of your income then your family can apply for health care on the ACA Marketplace and qualify for a subsidy.

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UPDATE!

These changes in RED after 2026 are due to the New law signed July 4 2025

 

Documentation

Documents to confirm your United States (U.S.) citizenship

• U.S. passport

• Certificate of Naturalization (N-550/N-570)

• Certificate of Citizenship (N-560/N-561)

• State-issued enhanced driver's license (available in Michigan, New York, Vermont, and Washington)

• Document from federally recognized Indian tribe that includes your name and the name of the federally recognized Indian tribe that issued the document, and shows your membership, enrollment, or affiliation with the tribe. Documents you can provide include:

  • A tribal enrollment card

  • A Certificate of Degree of Indian Blood

  • A tribal census document

  • Documents on tribal letterhead signed by a tribal official

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If you don’t have any of the documents above, you can submit 2 documents — one from each list below.

• You can submit one of these documents:

• U.S. public birth certificate

• Consular Report of Birth Abroad (FS-240, CRBA)

• Certification of Report of Birth (DS-1350)

• Certification of Birth Abroad (FS-545)

• U.S. Citizen Identification Card (I-197 or the prior version I-179)

• Northern Mariana Card (I-873)

• Final adoption decree showing the person’s name and U.S. place of birth

• U.S. Civil Service Employment Record showing employment before June 1, 1976

• Military record showing a U.S. place of birth

• U.S. medical record from a clinic, hospital, physician, midwife, or institution showing a U.S. place of birth

• U.S. life, health, or other insurance record showing U.S. place of birth

• Religious record showing U.S. place of birth recorded in the U.S.

• School record showing the child’s name and U.S. place of birth

• Federal or state census record showing U.S. citizenship or U.S. place of birth

• Documentation of a foreign-born adopted child who received automatic U.S. citizenship (IR3 or IH3)

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Documents to confirm your immigration status

• Permanent Resident Card, "Green Card" (I-551)

• Reentry Permit (I-327)

• Refugee Travel Document (I-571)

• Employment Authorization Card (I-766)

• Machine Readable Immigrant Visa (with temporary I-551 language)

• Temporary I-551 Stamp (on Passport or I-94/I-94A)

• Foreign passport

• Arrival/Departure Record (I-94/I-94A)

• Arrival/Departure Record in foreign passport (I-94)

• Certificate of Eligibility for Nonimmigrant Student Status (I-20)

• Certificate of Eligibility for Exchange Visitor Status (DS-2019)

• Notice of Action (I-797)

• Document indicating a member of a federally recognized Indian tribe or American Indian born in Canada

• Certification from U.S. Department of Health and Human Services (HHS) Office of Refugee Resettlement (ORR)

• Document indicating withholding of removal (or withholding of deportation)

• Office of Refugee Resettlement (ORR) eligibility letter (if under 18)

• USCIS Acknowledgement of Receipt (I-797C)

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Documents to confirm self-employment income

• 1040 SE with Schedule C, F, or SE (for self-employment income)

• 1065 Schedule K1 with Schedule E

• Tax return

• Bookkeeping records

• Receipts for all allowable expenses

• Signed time sheets and receipt of payroll, if you have employees

• Most recent quarterly or year-to-date profit and loss statement

• Or, complete a written explanation form (PDF, 126 KB). To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

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Documents to confirm unearned income

• Annuity statement

• Statement of pension distribution from any government or private source

• Worker’s compensation letter

• Prizes, settlements, and awards, including court-ordered awards letter

• Proof of gifts and contributions

• Proof of inheritances in cash or property

• Proof of strike pay and other benefits from unions

• Sales receipts or other proof of money received from the sale, exchange, or replacement of things you own

• Interests and dividends income statement

• Loan statement showing loan proceeds

• Royalty income statement or 1099-MISC

• Proof of bonus/incentive payments

• Proof of severance pay

• Pay stub indicating sick pay

• Letter, deposit, or other proof of deferred compensation payments

• Pay stub indicating substitute/assistant pay

• Pay stub indicating vacation pay

• Proof of residuals

• Letter, deposit, or other proof of travel/business reimbursement pay

• Or, complete a written explanation form (PDF, 126 KB). To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

Get more details for other income situations (PDF, 1 MB).

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Documents to confirm American Indian or Alaska Native status

• Tribal Enrollment/Membership card from a federally recognized tribe

• Document issued by Bureau of Indian Affairs (BIA) recognizing you as American Indian/Alaska Native

• Authentic document from a federally recognized tribe declaring your membership

• Certificate of Degree of Indian Blood

• Certificate of Indian status card

• I-872 American Indian Card (Texas and Oklahoma Kickapoo American and Mexican members)

• Document issued by Indian Health Service (IHS) showing that you were/are eligible for IHS services as an American Indian/Alaska Native

• U.S. American Indian/Alaska Native tribal enrollment or shareholder documentation

• Letter from the Marketplace granting a tribal exemption based on tribal membership or Alaska Native shareholder status.

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Documents to confirm you don’t have minimal essential job-based coverage

Submit one of the documents below if you need to confirm that your job-based coverage isn’t qualifying health coverage.

• Completed Employer Coverage Tool (PDF, 125 KB) and a cover letter signed by the employer

• Letter or other documentation from an employer or other documentation with this information:

  • Statement that the employer doesn’t currently offer you (or your family member) coverage

  • Statement that the employer doesn’t provide coverage that isn’t qualifying health coverage

  • Statement showing the cost of your share of the premium for the lowest-cost self-only plan that meets the 

    minimum value standard

     (factoring in wellness incentives), if offered

• Health insurance letter that contains confirmation of health coverage and expiration dates for coverage received outside of the Marketplace.

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Documents to confirm you don’t have qualifying health coverage through Medicaid or the Children’s Health Insurance Program (CHIP)

Submit one of the documents below if you need to confirm that you don’t have coverage through Medicaid or CHIP.

Note: Some Medicaid and CHIP programs are known by names specific to that state. Find the name of Medicaid & CHIP programs in your state.

• Letter or statement from a Medicaid or CHIP agency that shows that you or your family members aren’t enrolled in or eligible for Medicaid or CHIP

• Letter or statement from a Medicaid agency showing that you or a family member are enrolled in a Medicaid program that’s not considered qualifying health coverage

• You can find more detailed information about Medicaid programs that don’t provide qualifying coverage. If you send document(s) verifying enrollment in one of these programs, you may be able to continue your financial help for your Marketplace coverage:

  • Medicaid coverage only for pregnancy-related services

  • Medicaid coverage only for family planning services

  • Medicaid coverage only for tuberculosis coverage

  • Medicaid coverage only for emergency treatment

  • Medicaid Demonstration Projects that cover a limited range of benefits

  • Medicaid coverage for “medically needy” individuals whose income is too high for traditional Medicaid and cover a limited range of benefits. These programs are sometimes known as “Share of Cost” or “Spend Down” programs.

• A letter describing your recent health coverage including:

  • The name of the Medicaid/CHIP program you were enrolled in and when your coverage ended, or

  • That you were never enrolled in Medicaid/CHIP coverage, or

  • The name of the Medicaid/CHIP program with limited benefits that you’re enrolled in that would still allow you to enroll in the Marketplace with help paying for coverage.

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Documents to confirm Social Security Number (SSN)

Documents must include your first name, last name, and SSN.

• Social Security card

• 1040 Tax Return (federal or state versions acceptable)

• W2 and/or 1099s (includes 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099S, 1099INT)

• W4 Withholding Allowance Certificate (federal or state versions acceptable)

• 1095 (includes 1095A, 1095B, 1095C)

• Pay stub documentation

• Social Security Administration documentation (includes 4029)

• Military record

• U.S. Military ID card

• Military dependent’s ID card

• Unemployment Benefits (Unemployment Benefits Letter)

• Court Order Granting a Name Change, that must have your original first and last name, new first and last name, and SSN

• Divorce decree

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For updated information please visit: https://www.healthcare.gov/help/how-do-i-resolve-an-inconsistency/#household-income

 

 

10 Facts You Didn’t Know About Obamacare

 

1. ACA Marketplace made some big changes to health insurance plans

There's a lot more to the Affordable Care Act than health insurance, subsidies for lower-income households, and the expansion of Medicaid.

 

2. Minimum essential coverage includes all marketplace coverage. It does not include short-term health insurance.

These requirements include:

• Hospitalization services.

• Ambulatory services.

• Urgent and emergency care.

• Prescription medications.

• Maternity and breastfeeding support.

• Laboratory services.

• Preventative and wellness benefits.

• Mental health and drug abuse services.

• Pediatric services, including dental and vision care for kids.

 

 

3. The majority of Obamacare subsidies go to the middle class

Despite the popular misperception that Obamacare just helps the poor, the facts say otherwise. Between 2015 and 2024. These subsidies go to families earning $47,000 to $94,000 per year, the heart of the middle class.

 

4. Obamacare does not give health insurance to illegal immigrants

Illegal immigrants are not eligible to receive subsidies to buy health insurance on the exchanges.

 

5. You can ONLY purchase qualifying private medical insurance during open enrollment. Usually fro November 1 through January 30. The only exception is if you’ve recently had a major life change like moving, getting married, or losing your job.

 

6. You can’t be charged more based on gender or health status, and you can’t max out annual or lifetime dollar limits.

 

7. When you choose a health plan, in most cases you’ll have to keep that specific plan until the next open enrollment period. Make sure to choose a plan that meets all your needs.

 

8. No matter what plan you get, most basics – like an annual checkup, immunizations, preventive tests, and more – will be covered with no out-of-pocket costs.

 

9. As the law stands now, the “employer mandate” says that large employers with over 50 full-time equivalent employees had to cover their full-time workers starting in 2016.

 

10. If your employees health insurance for a spouse or family cost more than 9.12% of your income then they can obtain insurance on the ACA Marketplace with a subsidy. I have a client who’s insurance from work was estimated at $1,200 per month for his wife and child. The insurance obtained from Elkin Insurance had a lower deductible and cost approximately 10% of his employers coverage.

 

You will want to have a personal agent who will help enroll you in the right plan for your needs. The agents at Elkin Insurance do not charge you for enrolling. E get paid directly from the insurance company. They have helped thousands enroll in health plans. Why not let them help you?