Open Enrollment (2025-2026)

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WHAT IS OPEN ENROLLMENT?

Open Enrollment is the one time of year that you can enroll in Individual Health Coverage on Healthcare.gov without a Qualifying Life Event (QLE). It begins annually on November 1st. Plans selected by December 15th, 2025 be effective on January 1st, 2026.

CHANGES TO NORTH CAROLINA FOR 2025-2026

This year, Aetna is leaving the individual marketplace. Plans for 2025 will continue until the end of the year, but when 2026 rolls around, you will have to change to another insurance carrier. If you are currently enrolled in health insurance under Aetna, it is crucial that you login to healthcare.gov during open enrollment to avoid being automatically enrolled under an insurance carrier that may be structured differently and not have your doctors in network.

There are also changes to Special Enrollment Periods (SEPs) for households earning less than 150% of the Federal Poverty Line (FPL). Since COVID and for most of 2025, individuals earning between 100%-150% of the FPL were able to enroll in medical coverage on healthcare.gov outside of Open Enrollment without a Qualifying Life Event. Since August 2025, the Special Enrollment Period for households earning between 100%-150% FPL has been removed. This means that you MUST have a Qualifying Life Event to enroll in coverage outside of the annual Open Enrollment Period.

Another big change for this year involves the continuation of coverage between plan years without confirming eligibility. Previously, if you had a $0 monthly premium (due to full premium tax credit subsidy), your coverage would roll over into the next plan year with the same $0 monthly premium without the need to go into healthcare.gov to confirm your eligibility. Effective for plan year 2026, you will now have a $5 monthly premium if you fail to confirm your eligibility before the start of the plan year. This means that anyone who currently has a $0 monthly premium needs to confirm their eligibility to avoid the $5 monthly premium and to ensure your health coverage does not terminate due to lack of payment. 

(Please note that this rule is currently being challenged in court and could be reversed)

SUBSIDIES 2025

Last year, subsidies were provided to households earning over 400% of the Federal Poverty Level. Beginning 2026, subsidies will no longer be provided to households earning 400% or more of the federal poverty line. This means healthcare costs will substantially increase for those households.

To qualify for a subsidy for the 2026 plan year, a household's income must be at least 100% and no more than 400% of the Federal Poverty Level. 

If you have any questions regarding these updates, we can connect you with an ACA Specialist who can provide information and provide guidance for these laws and how they apply to you.