US Health Insurance Market Annual Update
Annual US Health Insurance Market Update
As we approach the ACA/Obamacare open enrollment period for 2026 individual health insurance and the annual renewal for most small business group health plans, I am providing information regarding changes that are happening in the market in 2026 to help you get prepared to find the BEST possible health plan for your situation and needs.
I also know that if you are on an ACA/Obamacare individual plan you may have already received your current plan’s renewal information for next year, so I hope this also provides some context to the planned rate increases or decreases, plan changes and cancellations, etc. that you are seeing.
Below you will find changes that are happening at the federal level as well as links to more information in the states where US Insurance Solutions is currently licensed. Click the link for your home state to get more information about what is happening where you live.
Please review this information and then, if you haven’t already done so, go to my online calendar (and at the bottom of this page) and set an appointment for us to talk about your options for next year.
General Update
In 2026 the focus of the current presidential administration is to expand on consumer choice, reverse some changes made by the previous administration and generally take the ACA/Obamacare rules back to those originally included in the law. The biggest move so far towards expanding choice was to choose not to enforce the previous administration’s rule to limit the term of Short Term Medical plans to a maximum of 4 months per person per insurance company per year. That has led to all three of our companies offering Short Term Medical plans going back to allowing policy lengths of up to 12 months with renewals of up to 36 months in the states that allow this. So, as of August 15, 2025, we can offer these longer term plans again in states that allow them.
In the ACA/Obamacare market there are many things happening which I will discuss more below. Probably the two biggest issues are 1. The high requested rate increases by insurance companies nationwide. There are only 4 states where the average requested increase in the state is less than 10%. 2. The expiration on 12/31/2025 of enhanced tax credit subsidies in the ACA/Obamarcare marketplace and whether they will be extended or allowed to expire.
Alternative Health Plan Solutions Updates
As noted above, Short Term Medical plans are once again included in our Health Insurance Buffet program. This maximizes choice for people looking for alternatives to ACA/Obamacare plans.
We will also continue to offer our off-marketplace/exchange comprehensive major medical plans that are compliant with ACA/Obamacare mandates. These plans each utilize a nationwide PPO network, so they offer a much better choice of providers than most ACA/Obamacare plans.
Off Exchange ACA Compliant Major Medical Individual Plans
One of the programs is available to self-employed people, independent contractors and small business owners. That program also offers plans with much lower maximum out of pocket limits than ACA/Obamacare plans. The other program is available to anyone with a unique approach of offering research projects for compensation to people that apply, which makes them contract employees eligible for the insurance.
The standard rates for these plans are competitive with the full price without a subsidy on current, similar ACA/Obamacare plans for people in the 45-64 age range who do not qualify for a tax credit subsidy to purchase ACA/Obamacare plans.
Both programs are health underwritten and applicants can be approved or declined.
I will be reaching out to current and former clients that I have identified who could benefit from changing to one of these plans. However, if you read this and you want to learn more about these plans, please reach out to me.
Health Insurance Buffet – Alternative Individual Plans
Primary (Main Course) plans – The comprehensive plan options mentioned above are now included as primary options. In addition, we will once again offer longer term Short Term Medical plans currently from Allstate, Pivot Health and United Healthcare along with our two main Fixed Benefit plan companies, Philadelphia American and Manhattan Life plans in many states.
Supplemental (Side Dish) plans – We also have expanded plan offerings and enhancements to available accident, critical illness and hospital indemnity plans. You can see many of these on our US Supplemental Coverage page.
Your Health Insurance “Plate” – We always work to provide you with the most comprehensive coverage we can offer to fit in your budget. We do that by combining the available Primary and Supplemental plans in your state into the best available package.
As noted on our US Insurance Solutions home page, if you are looking for a better, more affordable individual/family health plan and make too much money to get a tax credit subsidy from the government, one of our NAHP alternative individual health plan solutions may be just what you need!
Alternative Small Group Health Plans
If you own (or work for) a small business with under 50 employees, and meet certain criteria, one of our NAHP alternative group health plans could be a better option than an ACA/Obamacare, fully insured group health plan.
NOTE: We are seeing more companies that have traditionally offered fully insured small group plans offering alternative, Level Funded small group plan options.
Again, click on the link for your home state (below) to learn more about the alternative health plan changes and updates where you live.
On the other hand, for individuals who are eligible for a tax credit subsidy to help pay their premium and/or have significant health issues I can help find the best ACA/Obamacare individual plan.
Also, for small businesses who don’t have enough people for an alternative plan and/or have people with significant health issues in their group, I can help find the best fully insured ACA/Obamacare small group plan. Please review the following…
Federal ACA/Obamacare Changes
The following are some of the main changes and updates happening with ACA/Obamacare plans.
Individual Plans
Preliminary Rate Increase Requests
Before I get into the changes for the coming year, it is important to point out that insurance companies across the country are asking for much larger rate increases for 2026 as compared to previous years. Across all states and the District of Columbia, 46 states have an average rate increase request across all companies above 10%. With the highest average increase of nearly 49%. Only Alaska has an average decrease of 0.1%.
New Law and Finalized Rule
With the finalization of the CMS Marketplace Integrity Rule and the passage of the One Big Beautiful Bill Act in July, 2025 there are several changes for 2026 and beyond. There is also one big question mark that remains to be determined. Many of the changes are designed to move the ACA rules back to the original rules established by the law.
Repayment of Excess Tax Credit – Currently if a person has a higher adjusted gross income (AGI) than what they estimated in their application, they will have to pay back a portion of the excess subsidy they received. The amount is calculated based on what your AGI is as a percentage of the FPL. Here are the current chart limits. Beginning in 2026, if your actual income is above your estimated income, you will pay back ALL the excess subsidy you received. So, it will be more important to keep your income updated throughout the year.
90-day Verification limit for Data Matching Issues (DMI) – CMS has discontinued the automatic 60-day extension currently granted in addition to the standard 90-day period for resolving income-related Data Matching Issues (DMIs). Under this change, enrollees will have a single 90-day window — beginning upon receipt of the temporary eligibility notice, typically at the time of enrollment — to submit required income verification documents. This reduces the total timeframe from 150 days to 90 days and represents a return to prior ACA policy.
Elimination of Special Enrollment Period (SEP) for income under 150% of the poverty level (FPL) – Members with income ≤150% of the Federal Poverty Level (FPL) will no longer be able to switch plans or carriers monthly. Members that meet standards for other qualifying life events would still be eligible for other SEPs. To get or keep coverage, these members must enroll during the annual Open Enrollment Period (OEP). This change is only eliminated through 2026. It is scheduled to return January 1, 2027.
HSA Eligibility for all Bronze/Catastrophic plans on the Marketplace – For 2026 all Bronze and Catastrophic plans will be eligible to pair with a Health Savings Account (HSA). This means that if you have a Bronze plan, you can open and fund an HSA up to the annual maximum (see below). That means that even if your plan has copays for office visits, prescriptions and other services, you can pay those copays with pre-tax dollars out of your HSA. I will be recommending that everyone with a Bronze plan go ahead and open an HSA to take advantage of this new rule.
HSA funds to Direct Primary Care providers – Another positive change to HSAs is the ability to pay the monthly subscription fee for direct primary care with pre-tax funds out of your HSA.
Pre-Enrollment SEP verification – As of September 15, 2025 this provision is PAUSED due to an ongoing lawsuit. On October 4, 2025 a federal judge ruled that this change can go forward. So, it may be back in depending on additional appeals.
Past Due Premiums Payback – As of September 15, 2025 this provision is PAUSED due to an ongoing lawsuit. On October 4, 2025 a federal judge ruled that this change can go forward. So, it may be back in depending on additional appeals.
Failure to File and Reconcile (FTR) – As of September 15, 2025 this provision is PAUSED due to an ongoing lawsuit. On October 4, 2025 a federal judge ruled that this change can go forward. So, it may be back in depending on additional appeals.
Verification required for Advanced Premium Tax Credit (APTC) – As of September 15, 2025 this provision is PAUSED due to an ongoing lawsuit. On October 4, 2025 a federal judge ruled that this change can go forward. So, it may be back in depending on additional appeals.
The big question mark is regarding the following:
Enhanced Tax Credit Subsidy expiration – Enhanced tax credit subsidies that were put in place under the Biden administration after COVID and extended in the Inflation Reduction Act are set to expire December 31, 2025. They provided subsidies for people with incomes above the law’s original maximum of 400% of the poverty level (FPL). For this open enrollment 400% of the FPL for an individual is $60,240 and a family of 4 is $124,800. Here is a more detailed FPL chart where you can see the amounts for all family sizes and percentages of the FPL.
There is currently much back and forth on both sides of the political aisle right now regarding whether to extend these subsidies. If they are NOT extended, then the maximum income eligible for any subsidy will revert to the original 400% of the FPL. I am reading that without extension, insurance companies around the country are estimating an additional 4-5% in their rate renewal requests to account for the estimated amount of people who will drop coverage.
IMPORTANT NOTE: If your income will be above 400% of the FPL in 2026, we will need to talk about your options. If you are healthy enough to qualify, one of the ACA alternatives mentioned above will likely provide better coverage with a lower maximum out of pocket, broad nationwide PPO network at a lower price than similar ACA plans.
2026 Open Enrollment
There are no changes to the 2026 open enrollment. The 2026 Open enrollment begins on November 1, 2025 and ends on January 15, 2026. A health plan must be purchased by December 15, 2025 to have coverage effective January 1, 2026. A plan must be purchased by January 15, 2026 for a February 1, 2026 effective.
Changes in the open enrollment as part of the OBBBA will begin for the 2027 open enrollment. At that time people will have from November 1st to no later than December 31st to choose a plan that will start January 1st. It will be up to each state as to whether they will allow people to sign up all the way to the 31st or cap it at December 15th or some other date.
Changes to out-of-pocket limits and deductibles
In 2026 the maximum deductible and out of pocket limits for Obamacare compliant plans are going up $1,400 per person per year for non-HSA plans! Plans that are HSA qualified will go have the maximum limit rise by $200 per person per year. The government sets a limit on how much these maximums can be. Family maximums can be twice as high as the maximum amount in a plan covering just one person (a “self-only plan”).
For 2026, the self-only maximum deductible and out of pocket limit can be up to $10,600 and the family maximum, up to $21,200. For high-deductible plans that are compatible with Health Savings Accounts (HSAs) they are lower with limits up to $8,500 for individuals and $17,000 for families.
The maximum contribution limits to an HSA are $4,400 for an individual and $8,750 for a family. As always, there is an additional $1,000 “catch up” contribution amount for each individual age 55 and above.
Standardized Plans Required on Federal Marketplace
In 2026 CMS is still requiring all carriers to offer plans on the Federal Marketplace to include four standardized plans. There will be two Bronze, one Silver and one Gold standard plan. This is only for states utilizing the Federal Marketplace. State based exchanges are not subject to this requirement. However, some states have their own standardized plans.
Insurance companies participating in ACA/Obamacare individual markets
The following is information on the 2026 markets for most companies we represent.
Aetna – In 2026 Aetna will exit the ACA in all states:
Ambetter – Ambetter is in currently in 27 states: AL, AR, AZ, FL, GA, IA, IL, IN, KS, KY, LA, MI, MO, MS, NC, NE, NV, NH, NJ, OH, OK, PA, SC, TN, TX and WA. In 2026 Ambetter Health will not be offering health plans in Detroit, Michigan. As a result, Ambetter Health will be exiting Macomb, Monroe, Oakland and Wayne counties for plan year 2026.
Cigna – In 2026 Cigna will be in 11 states (AZ, CO, FL, GA, IL, IN, MS, NC, TN, TX, and VA).
Medica – Medica currently offers their individual/family plans in 9 states ((IA, KS, MN, MS, MO, NE, ND, OK and WI).
Molina Healthcare – (CA, CT, FL, ID, IL, KY, MS, NM, OH, SC, TX, UT, WA).
Molina currently offers their individual/family plans in 15 states. In 2026 Molina will exit Michigan and Wisconsin leaving the 13 states above.
They will add three counties in FL. They will leave 25 counties and add 1 in KY. They will exit 4 out of 7 counties in NV. They will add 2 counties in OH. They will exit 8 counties in SC. They will add 5 counties and leave 16 in TX. They will exit 11 out of 13 counties in UT. All remaining states will see no change. Click the state abbreviation to see a detailed map of counties.
Oscar Insurance Corp – Oscar currently offers their individual ACA plans in the following states**: AZ, FL, GA, KS, IA, IL, MI, MO, NJ, NC, NY, NE, OH, OK, PA, TN, TX, and VA. View and download Oscar’s full 2026 National footprint.
In 2026 Oscar will be expanding into two new states. Alabama and Mississippi. In Alabama Oscar is entering Huntsville and Birmingham, covering 5 counties. In Mississippi Oscar is entering Jackson and Northern Mississippi, covering 11 counties.
United Healthcare – In 2026, United Healthcare will be available in 28 states (AL, AZ, CO, FL, GA, IA, IL, IN, KS, LA, MD, MI, MO, MS, NC, NE, NJ, NM, OH, OK, SC, TN, TX, VA, WA, WI and WY)
They will be expanding to more counties in some states and exiting counties in others. Here is that information:
Arizona – Santa Cruz county in Tuscon area is being added.
Illinois – 7 additional counties added for 2026: Cass, Effingham, Logan, Mason, Menard, Morgan, and Scott, for a total of 31.
Indiana – Exiting Marion, Hamilton, Hendricks, and Howard counties
Kansas – Exiting RAs 4-7 including Allen, Barber, Barton, Bourbon, Butler, Chase, Chautauqua, Cherokee, Cheyenne, Comanche, Cowley, Crawford, Decatur, Elk, Ellis, Gove. Graham, Greeley, Greenwood, Harper, Harvey, Hodgeman, Kingman, Kiowa, Labelle, Lane, Logan, Marion, McPherson, Montgomery, Neosho, Ness, Norton, Osborne, Phillips, Prawnee, Pratt, Rawlins, Reno, Rice, Rooks, Rush, Russell, Scott, Sedgwick, Sheridan, Sherman, Smith, Stafford, Sumner, Thomas, Trego, Wallace, Wichita, Wilson and Woodson counties.
Michigan – 3 additional counties added for 2026: Branch, Hillsdale, Van Buren
Oklahoma – 43 counties added for PY26: Alfalfa, Atoka, Beaver, Blaine, Bryan, Caddo, Cotton, Delaware, Dewey, Ellis, Garfield, Garvin, Grant, Greer, Harmon, Harper, Haskell, Hughes, Jackson, Jefferson, Kay, Kingfisher, Kiowa, Latimer, Love, Major, Marshall, Mayes, McCurtain, McIntosh, Murray, Noble, Nowata, Okfuskee, Ottawa, Payne, Pottawatomie, Pushmataha, Roger Mills, Seminole, Tillman, Woods, Woodward
South Carolina – Exiting Bamberg, Barnwell, Beaufort, Charleston, Chesterfield, Dillon, Florence, Georgetown, Greenville, Jasper, Lexington, Marion, Orangeburg, Richland, Spartanburg, and York counties for PY26.
Tennessee – 8 additional counties added for PY26: Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi, and Washington to create statewide presence.
Texas – Re-entering Corpus Christi for PY26 with Aransas, Bee, Jim Wells, Kleberg, Live Oak, Nueces, Refugio, and San Patricio counties. Wise is being added to Dallas/Ft. Worth market for PY26.
Virginia – expansion to Scott, Washington and Bristol city for PY2026
Washington – 3 additional counties added for PY26: Grays Harbor and Thurston in Seattle-Tacoma, and Spokane in Spokane.
Antidote Health – Antidote will continue to offer plans on the federal marketplace in AZ and OH. They are expanding into more counties in each state.
Mending – Mending (formerly Taro Health) plans are built on the foundation of free, unlimited primary care and mental health visits. In 2026 Taro will offer plans in ME, OK and GA (new in 2026).
**Not all markets in all states
Small Group Plans
While it looks like there are companies having small increases or small decreases in rates in the ACA/Obamacare small group market there seem to be more companies with rate increases near or over 10%.
I am continuing to see more companies and plan administrators offering alternative Level Funded health plan options. Including many of the traditional fully insured plan companies.
NOTE: In the State Changes section below I have outlined all the proposed rate changes I could find in your state for both individual and small group health insurers.
State by State Changes and Updates
As noted above, please click on the link for your state for more details on what is happening with both the Alternative Health Plans market and ACA/Obamacare plans where you live.
U.S. Insurance Solutions is here to help
Remember, you are NOT in this alone…I am here to help! As your Personal Health Insurance Advisor, my goal is to make your life easier by taking the hassle out of finding the right health plan for your situation and needs.
To discuss your health insurance options and make sure you have the best possible health plan for your situation, please go to my online calendar and schedule a call with me on a day and time that works for you, and I will call you to review your options.