A proposed rule would restrict “eligibility, enrollment and affordability” in plans under the Affordable Care Act, health policy analysts say.
A shorter open enrollment period, less help choosing a plan, higher health insurance premiums for many people — those are just a few changes now brewing that could affect your health insurance for 2026 if you have coverage through the Affordable Care Act marketplace. One shift is the scheduled end of more generous financial subsidies that, in recent years, have allowed many more people to qualify for marketplace plans with lower or no monthly premiums.
What’s more, the Trump administration, through the Centers for Medicare and Medicaid Services, proposed a new rule on March 10 involving about a dozen changes affecting enrollment and eligibility in the marketplaces. The agency, which oversees the marketplaces, said the rule was intended to improve affordability while “maintaining fiscal responsibility.”
Some health insurance experts, however, say the changes could make it more challenging for people to enroll in or renew coverage. If it becomes final, the rule will “restrict marketplace eligibility, enrollment and affordability,” according to an analysis in the journal Health Affairs that was co-written by Katie Keith, director of the Health Policy and the Law initiative at Georgetown University Law Center.
The public still has a few weeks to comment on the proposal. The administration is likely to move quickly to write a final version because insurers are now developing rates for health plans for 2026, Ms. Keith said.
Here are some of the possible changes to look out for.
Why is extra financial help for premiums set to end?
Enhanced premium help, first offered in 2021 as part of the federal government’s pandemic relief program, was extended through 2025 by the Inflation Reduction Act. The more generous subsidies increased aid to low-income people who already qualified for financial help under the Affordable Care Act, and added aid for those with higher incomes (more than $60,240 for individual coverage in 2025 coverage) who didn’t previously qualify.
The extra subsidies, given in the form of tax credits, helped marketplace enrollment balloon to some 24 million people this year, from about 12 million in 2021. The average enhanced subsidy, which varies by a person’s income, is about $700 per year, said Cynthia Cox, a health care expert at KFF, a nonprofit research group.