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What’s Changing with ACA Marketplace Health Insurance Plans in 2026

The upcoming plan year brings some key shifts for Affordable Care Act (ACA) Marketplace coverage. It’s important to understand what’s changing with ACA plans in 2026, so you’re prepared now that open enrollment has started.


Smiling family of four under "2026 Open Enrollment" text, surrounded by leaf graphics on a beige background.

What Changes with ACA Plans Can You Expect in 2026?

1. Premiums and Subsidies

  • Across the country, the average premium for the lowest-cost Marketplace plan (after tax credits) is projected at ~$50/month for eligible enrollees for 2026.

  • HOWEVER: Many of the enhanced premium tax credits that have been available will expire at the end of 2025 unless Congress acts.

  • With fewer subsidies (or smaller ones) available, some people will see their net premiums go up — even if they stay in the same plan.

  • Utah’s data: For plan year 2026, the average proposed premium increase (before subsidies) in Utah is about +14.2%.

    • Good news: That increase is moderate when compared to some states where increases are higher.

    • Caveat: The full insured-premium increase doesn’t always translate directly into what you pay if you qualify for subsidies.


2. Plan Benefits and Design

  • One reassuring piece: In Utah, many of the benefits in the Marketplace plans will remain the same or very similar for 2026.

    • For example, one insurer’s 2026 benefit chart specifies: “These plans are designed by CMS. Benefits will be the same or similar to other standardized plans from other carriers.”

  • What this means: The core coverage (essential health benefits) isn’t being completely overhauled here in Utah — so if you had a good plan in 2025 and were satisfied, your 2026 plan for the most part will look familiar.


3. Enrollment & Documentation Changes

  • This year you’ll see tighter rules around eligibility, verifying income, and special enrollment periods.

  • You might need to verify your income or loss of coverage this year, even if that wasn’t required before.


What This Means for You (and your family)

  • Review now: Don’t wait until the last week of open enrollment. Get your income estimate, projected household size, and check for any changes (job, marriage, dependents) that may affect eligibility for subsidies.

  • Compare plans: Even if you liked your current plan, you should compare other options. Because premiums rise and subsidies may shift, another plan may now be more cost-effective.

  • Focus on your total cost: Monthly premium is important, but also consider deductible, out-of-pocket maximums, network of providers, and how often you access care. Staying in a familiar plan may be worth the cost for continuity.

  • Call Lion's Pride Insurance: As your trusted guide, your agency can help you interpret the subsidy changes, verify your eligibility, check plan participation in your county, and ensure you’re renewing or enrolling optimally.

  • Act within the window: Enrollment for 2026 begins November 1. For Utah, to have your coverage start January 1, you’ll want to enroll by December 15.

  • Stay informed: Because some of the subsidy rules are in flux (pending legislation), be alert to updates. Although benefits are largely similar, the cost you pay (after subsidies) may shift.


Final Thoughts

The 2026 Marketplace plan year offers both familiarity and change. The good news: benefits and plan design will largely retain the same structure, giving your clients stability. The caution: premiums are rising, and subsidy rules may shift, which could affect out-of-pocket costs.

As your partner in coverage, Lion's Pride Insurance is ready to walk you through your options — review your current plan, compare new ones, help you understand how the subsidy changes impact you, and ensure you enroll in a timely fashion.



References

  1. Centers for Medicare & Medicaid Services (CMS). Plan Year 2026 Marketplace Plans & Prices Fact Sheet.https://www.cms.gov/newsroom/fact-sheets/plan-year-2026-marketplace-plans-prices-fact-sheet

  2. Healthcare.gov. Health Insurance Marketplace Coverage & Enrollment Dates.https://www.healthcare.gov/coverage/

  3. HealthInsurance.org. Utah and the ACA’s Health Insurance Marketplace.https://www.healthinsurance.org/aca-marketplace/utah/

  4. SelectHealth. 2026 Utah Individual & Family Plan Summary.https://selecthealth.org/content/dam/selecthealth/individual-family/PDFs/individual-planspread-utah-2026.pdf

  5. MarketplaceHealthInsurance.org. Open Enrollment for Health Insurance 2026 – Utah.https://www.marketplacehealthinsurance.org/health-insurance/health-insurance-marketplace/open-enrollment-for-health-insurance-2026-utah/

  6. Anthem Blue Cross Blue Shield. ACA Changes Coming in 2026.https://www.anthem.com/individual-and-family/insurance-basics/health-insurance/aca-changes-2026

  7. UnitedHealthcare (UHC). ACA Marketplace Updates and Subsidy Information.https://www.uhc.com/individuals-families/aca-marketplace/aca-changes

  8. Action Benefits Blog. CMS Finalizes Off-Cycle ACA Marketplace Rule Tightening Enrollment and Subsidy Eligibility.https://blog.actionbenefits.com/cms-finalizes-off-cycle-aca-marketplace-rule-tightens-enrollment-and-subsidy-eligibility

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