Big Changes Coming to Health Insurance: What Patients Need to Know
Imagine this: It’s 2026. Your health insurance premium jumps. A safety net you relied on? Gone. These aren’t just policy updates — they’ll affect your care, your wallet, and your peace of mind. Here’s what’s changing, how it could impact you, and what steps to take now.
What’s Changing (and Why It Matters)
🔻 Enhanced Premium Tax Credits (eAPTCs) Expire 12/31/25
These subsidies currently lower your monthly premium. When they end, millions could see higher costs — and some may lose coverage entirely.
➡️ Projected average premium hike: 4–10% depending on your state and plan.
Stricter SEP (Special Enrollment Period) Rules
You now must provide documentation (like proof of job loss) to activate your coverage — and it could take 15–30 days for the Marketplace to verify it.
⚠️ Until that happens, your plan won’t start… and you can’t pay your first bill (binder payment).
Low-Income SEP Ending (≤ 150% FPL)
If you’re low-income or a lawfully present non-citizen (Package E), you may lose the ability to enroll or change plans outside open enrollment. This safety net disappears soon.
Open Enrollment Windows Are Changing:
✅ For 2026:
- Nov 1 – Dec 15 = Coverage starts Jan 1
- Dec 16 – Jan 15 = Coverage starts Feb 1
✅ For 2027:
- Nov 1 – Dec 31 = Coverage starts Jan 1
Real-World Cost Impacts
With Subsidies:
A 27-year-old making $30,000 might pay ~$86/month for a Silver plan.
Without Subsidies:
That same person could pay double or more, depending on the plan and state. Some families may see costs increase by $3,000–$5,000/year.
Many Americans already spend 10–25% of their income on healthcare. Without subsidies, that percentage could spike.
What You Can Do to Protect Yourself
✅ 1. Check Your Current Plan & Subsidy
Use KFF’s calculator to see how much your premium might increase.
✅ 2. Prepare SEP Documentation Now
Lost your job? Moved? Had a baby? Gather your proof before you apply — things like:
- Coverage termination letters
- Pay stubs
- Immigration documents
✅ 3. Enroll During Open Enrollment (if possible)
Don’t rely on SEP unless you must. Mark your calendar for November 1 and enroll early.✅ 4. Talk to a Hospital Navigator or Community Assister
Not sure what to do? There’s help. Local navigators and hospital financial teams can guide you through your options.
Final Thoughts
These changes are about real lives, not just policy.
👩⚕️ People will delay care.
💰 Bills might pile up.
😟 Stress will rise if coverage lapses or premiums spike.
The more you prepare now, the better protected you’ll be in 2026 and beyond.
RevOne helps hospitals support patients through insurance transitions like these — with empathy, guidance, and technology that simplifies the complex.
📌 Want help navigating what’s next? We’re here for you.