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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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?

#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

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10 Facts You Didn’t Know About Obamacare

 

1. Obamacare 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?