Your Insurance News
Recent Healthcare Changes You Should Know About
Healthcare regulations continue to change, and staying informed helps you make confident coverage decisions. Below is a summary of important updates affecting Medicare, ACA Marketplace plans, and health insurance for individuals under 65. Please review the details and refer to the official resources provided for more information.
Medicare Updates for 2026
Part D Drug Cost Redesign and $2,000 Cap
The previous Part D coverage gap, often called the “donut hole,” has been eliminated under the redesigned prescription drug benefit. Beneficiaries now move through the deductible and initial coverage phases until reaching a $2,000 annual out-of-pocket maximum. Once this limit is met, no additional copayments or coinsurance are required for covered medications for the remainder of the year.
Medicare Prescription Payment Plan
Beneficiaries may spread their out-of-pocket prescription drug costs over the calendar year through the Medicare Prescription Payment Plan, helping create more predictable monthly expenses.
Insulin Cost Cap
Covered insulin products remain capped at $35 per month per prescription. A three-month supply will cost no more than $105.
Expanded Drug Price Negotiation
Beginning in 2026, Medicare will implement negotiated pricing for certain high-cost prescription drugs under the Inflation Reduction Act. The first 10 negotiated drugs will have new prices effective January 1, 2026, with additional medications scheduled for future years. The program targets drugs without generic competition and is intended to reduce out-of-pocket costs for beneficiaries and overall Medicare spending. Additional drugs are expected to be added in 2027 and beyond as the program continues to expand.
Preventive Services
Many preventive services remain available at no additional cost, including annual wellness visits, screenings, and vaccines recommended by the Advisory Committee on Immunization Practices.
Part B Premiums and Deductibles
For 2026, the standard Medicare Part B premium is $202.90 per month, and the annual deductible is $283. After the deductible is met, Part B generally covers 80% of Medicare-approved outpatient services. Higher-income beneficiaries may pay Income-Related Monthly Adjustment Amounts (IRMAA), resulting in increased monthly premiums based on prior-year income.
For official information, visit Medicare.gov or call 1-800-MEDICARE (TTY 1-877-486-2048).
Affordable Care Act (ACA) for 2026
Enhanced Subsidies Expiration
The temporary enhanced ACA premium tax credits expired on December 31, 2025. Beginning in 2026, subsidies returned to pre-2021 levels, which may result in higher premium contributions for some Marketplace enrollees. Individuals above 400% of the Federal Poverty Level may no longer qualify for financial assistance, and lower-income households may see increased out-of-pocket costs. While premium tax credits remain available, they are less generous than in recent years.
Marketplace Integrity Rule Changes (Proposed)
Beginning with the 2026 plan year, CMS has strengthened Marketplace eligibility verification and subsidy oversight. Changes include stricter pre-enrollment verification for certain Special Enrollment Periods, removal of the year-round SEP for individuals under 150% of the Federal Poverty Level, and stronger enforcement of Advance Premium Tax Credit (APTC) reconciliation requirements. These updates are intended to reduce improper enrollments and ensure accurate subsidy eligibility.
APTC Reconciliation
The timeframe to reconcile Advance Premium Tax Credits may be shortened. Failure to reconcile could impact future subsidy eligibility. Beginning in late 2024, Marketplace regulations require termination of Advance Premium Tax Credits (APTC) for individuals who fail to reconcile their premium subsidies for two consecutive tax years. If Form 8962 is not filed with your federal tax return to reconcile the credit, eligibility for future premium assistance may be suspended. This could result in the loss of financial help for coverage.
Special Enrollment Period (SEP) Changes (Proposed)
Beginning in late 2025, several changes to ACA Special Enrollment Periods (SEPs) are being implemented. The year-round enrollment option for individuals at or below 150% of the Federal Poverty Level has ended, and stricter pre-enrollment verification requirements are being introduced for certain enrollments. Additional updates include increased oversight of auto-renewals and a proposed shorter Open Enrollment period beginning with the 2027 plan year. Some provisions have faced legal challenges, but enhanced verification standards are moving forward.
$5 Passive Renewal Premium (Proposed)
Consumers who do not actively confirm income during renewal may face a small monthly premium beginning in Plan Year 2026, depending on final rule adoption. Under proposed 2025 rules, individuals enrolled in $0 premium ACA plans who rely on automatic renewal may be charged a $5 monthly premium if they do not actively update their income and eligibility during Open Enrollment. The goal is to encourage active renewal and verify subsidy eligibility. The fee may be removed once information is updated.
Open Enrollment Period (Proposed Shortening)
CMS has proposed shortening Open Enrollment to November 1 through December 15. CMS has finalized a rule to shorten the Affordable Care Act (ACA) Open Enrollment Period to November 1 through December 15, effective for the 2027 plan year. This means beginning in late 2026, consumers will have a shorter window to enroll in or change Marketplace coverage.
Important Reminder
ACA Marketplace plans remain guaranteed issue and may qualify for premium tax credits and cost-sharing reductions based on income and household size.
For official Marketplace information, visit Healthcare.gov or your state exchange.
Under 65 Healthcare Updates for 2026
Healthcare regulations for individuals under age 65 continue to evolve. Below are the confirmed federal updates and proposed Marketplace changes affecting coverage options.
Short-Term Health Insurance (Confirmed Changes)
Short-term health insurance provides temporary coverage for individuals between jobs, waiting for employer benefits, or transitioning to Medicare.
For 2026, federal regulations limit short-term plans to a maximum of four months, including renewals. Availability and duration may vary by state.
Short-term plans are typically lower in cost than ACA Marketplace plans but do not meet ACA coverage standards. These plans often:
• Exclude pre-existing conditions
• Limit coverage for maternity and mental health
• May not include prescription drug benefits
• Require medical underwriting
They are best suited for short coverage gaps and are not a replacement for comprehensive major medical insurance. State availability and regulations vary and may be more restrictive.
For complete and up-to-date information, visit: Centers for Medicare & Medicaid Services (CMS): cms.gov