Open Enrollment is around the corner, and we know you want every detail to make a confident, money-smart decision for your family’s health insurance. If you’ve ever felt overwhelmed by jargon or worried about missing a deadline, you’re not alone—and you’re in the right place. Let’s walk through what’s new for 2026, which plans might fit your needs, how subsidies are changing, and what steps you should take right now (plus an inspiring story from one of our clients).
2026 Open Enrollment: Mark Your Calendar
Here’s the straight scoop on dates you need to know. Set a reminder so you don’t miss out:
· Open Enrollment Starts: November 1, 2025
· Deadline for January 1 Coverage: December 15, 2025
· Last Day to Enroll (Feb Coverage): January 15, 2026
What’s new? The extra “grace period” into January is on the way out. Starting in 2027, Open Enrollment will end December 15 for most states—so this year may be the last time you get the full November-to-mid-January window. We recommend enrolling by December 15th, just to be safe.
Big Change: Enhanced Subsidies Set to Expire
If you’re currently getting help lowering your premiums thanks to expanded tax credits, you need to pay attention this year. The special pandemic-era subsidies—also called “enhanced premium tax credits”—are set to expire at the end of 2025. Here’s what that means:
· Premiums May Go Up: Many families will face higher monthly costs unless Congress acts to renew these benefits.
· Middle-Income Families Most Affected: Households just above traditional subsidy cutoffs (around $62,500–$128,600 for a family of four) could see the biggest increases.
· Budget Now: Expect premium quotes to reflect these changes. If you relied on low premiums before, double-check what you’ll pay for 2026.
What can you do?
· Shop early. Compare your new premium options.
· Use the marketplace calculator to estimate your new subsidy.
· Ask us about off-market options if you lose eligibility for help.
Health Plan Choices: Find Your Best Fit
You’ll see several plan “metal” categories on your state marketplace. Here’s what they mean—and who they suit best:
| Plan Level | Who It’s For | Premiums | Out-of-Pocket Costs |
| Bronze | Healthy, just-in-case | Lowest | Highest (big deductibles) |
| Silver | Most families, moderate use | Moderate | Balanced; cost-sharing reductions available if you qualify |
| Gold | Frequent doctor visits | Higher | Lower—more predictable |
| Platinum | Ongoing health needs | Highest | Lowest |
| Catastrophic | Under 30, hardship only | Very Low | Very High, emergencies only |
Tip: Always check if your doctors and hospitals are in-network before you enroll. Each plan has its own network—even if the insurer name looks familiar.
What Else is New in 2026?
Tighter Income Checks
This year, the marketplace is taking a closer look at your income information to make sure everyone gets the right subsidy.
What to have ready:
· Your most recent tax return
· Pay stubs
· Social Security statements (if applicable)
If there’s a mismatch between what you report and the data the marketplace sees, you may need to supply extra documents up front. Start gathering paperwork now so enrollment goes smoothly.
Changes in Year-Round Enrollment
Special, ongoing enrollment for those earning under 150% of the federal poverty level will be paused in 2026. That means nearly everyone, even low-income households, must sign up during regular Open Enrollment.
Miss the window? Qualifying life events (like job loss, marriage, or having a baby) still open a Special Enrollment Period—but no more year-round sign-ups unless you qualify.
Updated Coverage and Costs
The out-of-pocket maximum for plans is going up this year:
· Individual coverage: $10,600
· Family coverage: $21,200
Make sure you budget for both your monthly premium and these potential maximum costs—especially if you have high healthcare needs.
Enrollment Tips: How to Get it Right
We want your Open Enrollment to be easy, not stressful. Follow these steps for a smooth experience:
1. Double-Check Deadlines
Don’t count on a January extension. Plan to finish your enrollment by December 15 so your coverage starts January 1. Mark it in your calendar, and set a couple of reminders.
2. Gather Your Paperwork Early
The biggest snag we see? Missing income docs. You’ll need:
· Last year’s tax return (Form 1040)
· Recent pay stubs or Social Security benefit letters
· Current healthcare cards (if you want to compare plans)
3. Compare Networks, Not Just Monthly Cost
Don’t just look at premiums. See if your preferred clinics, pediatricians, and hospitals are in the plan’s network. Use the “find a provider” link on each insurer’s website.
4. Use the Marketplace Tools
Plug your household info into the marketplace calculator. Many families miss out on subsidies they qualify for or pick a plan with a bigger deductible than needed.
5. Ask for Help
You can always reach out to us or a certified navigator. Don’t let confusion lead to missed savings or gaps in coverage. Sometimes answers you find online (or from well-meaning friends) just aren’t right for your state or situation.
Client Story: How One Family Mastered Open Enrollment
Simon and his wife in Jacksonville were having their first child just as Open Enrollment was kicking off. Simon browsed forums and tried the HealthCare.gov site, but felt lost in the details—especially with a baby on the way.
“We looked at plans, but it was hard to know what counted as out-of-pocket, and what would be covered for the newborn,” he said. With all the complexity, Simon was nervous about making a costly mistake.
When Simon called us, we walked through every option—side by side. We covered:
· How to budget for newborn costs
· What coverage his hospital accepted
· What paperwork he needed for a smooth enrollment
In just a call or two, Simon felt confident he was getting the right plan for his growing family. When his daughter was born, everything worked as planned. “We didn’t have to worry about insane prices for healthcare costs, so that was a lot of stress taken off of me,” Simon told us. “I would recommend this for anyone who wants less hassle and a confident solution.”
Simple Start’s Pro Tips for 2026
· Set calendar reminders for November 1 and December 15.
· Gather your paperwork now—don’t wait for the last minute.
· If your 2026 premium jumps, see if other plans meet your needs—or ask us to check off-market options.
· Check your network: Your favorite doctor might be covered in one plan, but not another.
· Ask questions: We welcome all of them—there are no silly questions when it comes to your health.
Let’s Make Open Enrollment Easy—Together
Open Enrollment doesn’t have to be a source of stress. At Simple Start Insurance, we help you find the right plan with zero jargon and no surprises. If you want friendly advice, questions answered, or just a double-check that you’re making the best choice for your family, we’re always here.
Ready to get started?
· Mark your calendar for November 1.
· Reach out to us now for a free coverage review.
· Feel confident you’ll be protected in 2026.
Your peace of mind is what matters most. Let’s make this your simplest Open Enrollment yet.
