Healthcare rules are changing leading into 2026, especially for individual and family plans. There have been updates to the tax credit structure, which may increase monthly costs, and a new income verification will make it more difficult to change plans throughout the year. Here’s what you need to know.
Monthly Costs May Increase
Since 2001, enhanced Premium Tax Credits (PTCs) have helped thousands across the country maintain more affordable health insurance. But unfortunately, these tax credits are set to expire at the end of 2025, meaning health insurance premiums for both individual and family plans through the Affordable Care Act (ACA) will likely increase going into 2026. Some sources estimate that prices could go up by as much as 75%.
There’s still a chance that Congress can intervene and maintain these premium tax credits, nothing has been done as of yet. If you get your healthcare through the ACA marketplace, it’s a good idea to prepare for a higher monthly premium next year.
Income Verification
Because Affordable Care Act individual and family plans are meant to provide “more affordable care” — hence the name — the prices on the plans change depending on your income. New in 2026, those who shop for a plan through the ACA marketplace will have to verify their income.
Be ready to provide proof of income while shopping for a new plan this Open Enrollment period:
- Pay stubs
- Tax forms
- Social Security statements
If your reported income doesn’t match federal records, you may have to provide additional documentation.
Another small change to individual and family plans when it comes to income verification is that extensions to fix income verification issues are no longer automatic. If you need an extension, you need to request one.
Other Key Health Insurance Updates
In addition to the tax credits and income verification, there are also a few other changes to individual and family plans going into 2026.
First, the special enrollment rules are changing. Members with low income under 150% Federal Poverty Level (FPL) can no longer switch plans monthly. You can only change during the Open Enrollment Period, which lasts from November 1 – January 15, or a qualifying life event.
Deferred Action for Childhood Arrivals (DACA) recipients will also remain ineligible for Marketplace help going into 2026.
Find Induvial and Family Plans that Work for You
If you’re affected by any changes to individual and family plans going into 2026, the Centers for Medicare & Medicaid Services (CMS) will reach out to let you know. And if you happen to lose Marketplace support, you may still apply for coverage off-exchange.
Need help keeping up with health insurance changes or finding the perfect plan? Contact us at Health Benefits Associates. Our local advisors will walk you through your options to find a plan that works for your needs and budget. Call us today at 775-828-1216 to schedule an appointment.