Marketplace Insurance in 2026: What You Need to Know Before Big Changes Hit

. Premium Tax Credits Expire After 2025

• The enhanced tax credits introduced by the Inflation Reduction Act will end December 31, 2025, returning to pre-pandemic subsidy levels. Unless they are voted to be extended.

• This means individuals and families could see net premiums rise 25%–100%, with gross premiums also increasing by 4%–8% to offset healthier people leaving the pool

Open Enrollment Period Shortened

• For the 2027 plan year (sign‑up held late 2026), enrollment will run Nov 1–Dec 15. Previously, it ran through Jan 15

• This 44-day window (instead of ~76 days) may make it harder to enroll or compare plans

Stricter Eligibility Verification

• Applicants via Special Enrollment Periods (SEP) will face pre‑enrollment income verification for at least 75% of new enrollments in 2026 (on HealthCare.gov; later states may follow)

• Monthly low-income SEP paused for the 2026 plan year

• If claimed income doesn’t match IRS data, proof may be required

Flexible Plan Designs and Cost‑Sharing

• CMS is allowing more flexibility in Actuarial Value (AV) ranges (±4% for most plans) in 2026. This could allow insurers to design lower‑cost plans that still qualify as Bronze/Silver.

• Expect adjusted cost‑sharing limits and premiums, using updated inflation- and market‑based formulas

What This Means for You

Challenge	Tips
Higher costs starting 2026	Review budgets, consider changing plan tiers.
Shortened SEP & stricter rules	Be proactive in checking and verifying your info.
Coverage gaps for some groups	DACA/TGNC individuals should seek legal and policy updates.
More complex plan design	Compare plans carefully—check deductibles, out-of-pocket, AV.

Action Steps

• Mark your calendar: Open enrollment for 2027 begins November 1, 2026, and ends December 15, 2026.

• Update income and household details early to avoid verification delays or fees.

• Research plan designs—expanded AV flexibility may offer better value.

Are you confused about what all this means? That's what Pierce Insurance is here for and why so many Iowa families choose to work with us for their Marketplace insurance.

Call us today at (515) 257-6663 to schedule your Marketplace Insurance review today!