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Open Enrollment 2025: What You Need to Know for 2026 Coverage 


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Hey everyone! 

 Open Enrollment 2025: What You Need to Know for 2026 Coverage 

“Hi, this is your friendly reminder that Open Enrollment is about to start… please hold while we explain things that might change your life—or at least your premiums!” 

Open Enrollment for health coverage through the Affordable Care Act (ACA) begins November 1, 2025, and runs through January 15, 2026. This is your chance to enroll in a new plan or update your current coverage. 


 Key Dates 

  • Nov 1, 2025 – Open Enrollment begins1  

  • Dec 15, 2025 – Last day to enroll or change plans for coverage starting Jan 1, 2026 2 

  • Jan 15, 2026 – Final day to enroll or change plans for coverage starting Feb 1, 20263 

Note: After Jan 15, you can enroll only if you qualify for a Special Enrollment Period due to a life event (like marriage, moving, or losing other coverage). 


 Premiums Could Rise in 2026 

If the enhanced ACA subsidies expire at the end of 2025, many people could see their health insurance costs go up significantly.4 

How Much Could Premiums Increase? –  

  • 60-year-old earning $40,000 → $1,640 → $2,878 per year5   

  • 40-year-old earning $30,000 → $1,200 → $2,200 per year6 

 That’s an average 75% increase if subsidies are not extended. 


Who’s Most Affected? – 

Older, middle-income enrollees7 –  

Those facing a “subsidy cliff”, where premiums jump suddenly8 (kff.org)  


Where It Matters Most –  


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Premium increases vary by state and county depending on local insurance markets9 


What You Can Do  

1. Check your current plan – 

Is it going to be available next year and how will it change 


2. Compare plans – 

Explore options on HealthCare.gov or your state marketplace   


3. Plan for higher costs –

Be prepared if subsidies expire -ask us about other options 


 Marketplace Changes: Insurers Leaving & Entering 

Some insurers are leaving certain areas, while others are expanding or entering new markets.10 

❌ Insurers Leaving 

 - Aetna (CVS Health): Exiting the marketplace in 17 states (~1 million people affected) 

 - Cigna: Leaving some counties and three states  

- UnitedHealthcare: Ending Medicare Advantage plans in 109 counties (~180,000 members) 

➕ Insurers Entering or Expanding  

- Existing insurers expanding: Adding coverage areas, giving more options 

 

UnitedHealthcare 

  • Expansion Overview: UnitedHealthcare is expanding its ACA Individual & Family Plans to four new states—Indiana, Iowa, Nebraska, and Wyoming—bringing its total footprint to 30 states. Fierce Healthcare 

  • Plan Highlights: UnitedHealthcare's 2025 plans feature benefits such as $0 virtual urgent care, $0 fitness classes, dental and vision coverage, and up to $150 in rewards for completing health-related tasks. Fierce Healthcare 


 Oscar Health 

  • Expansion Overview: Oscar Health is expanding its ACA Individual & Family Plans to 165 new counties across 13 states, including Arizona, Florida, Georgia, Illinois, Iowa, Kansas, Missouri, North Carolina, Ohio, Oklahoma, Tennessee, Texas, and Virginia. Oscar 

  • Plan Highlights: Oscar's 2025 plans include tailored options for chronic conditions, such as a "Breathe Easy" plan for members with COPD and asthma, as well as enhanced programs for Spanish-speaking members. 


What This Means for You  

1. Check your plan options early – If your insurer is leaving, choose a new plan  

2. Compare premiums and coverage – Prices may increase, so find the plan that fits your needs and budget  

3. Stay informed – Monitor policy changes, including subsidies, as they affect costs 


✅ Tips to Prepare for Open Enrollment 

  • Review your current plan and coverage 

  • Gather income estimates, tax, and other necessary documents 

  • Start comparing plans early to avoid last-minute decisions 

  • Enroll by Dec 15, 2025 to ensure coverage begins Jan 1, 2026 


Stay Informed, Stay Covered Open Enrollment is your chance to secure health coverage for 2026. With potential premium increases and insurer changes, reviewing your options early is more important than ever. 


 Need Help? Contact Our Agency 

Our team is here to guide you through Open Enrollment and help you find the best coverage for your needs. 

Phone: (800) 578-3940 

Office Hours:  

Mon–Fri: 8 AM – 4 PM MST 

9 AM – 5 PM CST     

10 AM – 6 PM EST 

7 AM – 3 PM PST 

Sat: By special appointment only

Sun: Closed 

We can assist with plan comparisons, subsidy questions, and enrollment support.

Don't wait—reach out today! 

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State-Based Health Insurance Marketplaces in the United States 


 State-Based Marketplaces (SBMs) 

These states operate their own health insurance marketplaces, providing residents with tailored enrollment options and support. 


 States Transitioning to State-Based Marketplaces 

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These states are moving from the federal marketplace (HealthCare.gov) to their own state-based systems: 


 States Using the Federal Marketplace 

These states continue to use the federal Health Insurance Marketplace: 

  • Alabama 

  • Alaska 

  • Arizona 

  • Arkansas (state-federal partnership) 

  • Delaware 

  • Florida 

  • Georgia 

  • Hawaii 

  • Indiana 

  • Iowa 

  • Kansas 

  • Louisiana 

  • Michigan 

  • Mississippi 

  • Missouri 

  • Montana 

  • Nebraska 

  • New Hampshire 

  • North Carolina 

  • North Dakota 

  • Ohio 

  • Oklahoma 

  • South Carolina 

  • South Dakota 

  • Tennessee 

  • Texas 

  • Utah 

  • West Virginia 

  • Wisconsin 

  • Wyoming 

 
 
 

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