Open enrollment changes for 2026: subsidies, networks, and plan design

What changed for 2026

A few things shifted between the 2025 and 2026 plan years that are worth knowing before you click "auto-renew."

• Premium tax credits were extended through 2027 with the same income bands. Households up to 400% of the federal poverty line still get sliding-scale subsidies.
• Maximum out-of-pocket ceilings rose to $9,650 individual / $19,300 family for non-grandfathered plans.
• Network adequacy rules tightened — carriers must list active providers within 30 minutes / 15 miles for primary care. In practice, always verify your doctor is still in-network. Directories lag by 60–90 days.
• Prescription tier reshuffles — several GLP-1s moved from Tier 3 to Tier 4 (specialty) on many bronze and silver plans. If you're on Ozempic or Wegovy, this is the year to compare.

Subsidy math, in plain English

If your household income is at or below ~$60,240 (single) or ~$124,800 (family of 4) in 2026, you'll likely qualify for a tax credit that caps your benchmark silver-plan premium at 8.5% of income or less. For many clients that means a $500/mo plan becomes a $180/mo plan.

If you earn just above the cliff, the "subsidy cliff" was softened: you no longer lose 100% of the credit at 401% of FPL. The phase-out is gradual.

Bronze, silver, gold — which actuarial level?

Important quirk: subsidies are calculated against the silver benchmark. If you qualify for cost-sharing reductions (CSRs), they only apply on silver plans — so going "down" to bronze can actually cost you more out of pocket.

How to read a network directory in 10 minutes

1. List your top 3 providers (PCP, any specialists, kids' pediatrician).
2. For each candidate plan, search the carrier's online directory by NPI number, not by name (names have typos; NPIs don't).
3. Call one of the offices and ask, verbatim: "Are you in-network for [plan name], plan year 2026, for new patients?" Get the rep's first name.
4. If two of three providers aren't in network, move on.

We do this for free

Marketplace plans pay licensed agents a flat fee from the carrier — your premium is identical whether you enroll yourself or through us. Send us your income range, your providers, and your prescriptions and we'll come back with the two or three plans that actually fit. Open enrollment closes January 15.