WHAT HEALTH CARE CONSUMERS NEED TO KNOW ABOUT ACA MARKETPLACE COVERAGE FOR 2026

The following information was released by the State of Delaware:

Time is running out enroll for 2026 now. January 15 is the final deadline to enroll in an ACA Marketplace plan for 2026. Individuals who don't act by Jan. 15, 2026, may not get coverage for 2026 unless they qualify for a Special Enrollment Period based on circumstances such as a loss of qualifying health coverage, change of income, becoming a parent, or other qualifying factors. Insurance Commissioner Trinidad Navarro and the Department of Insurance are sharing insights with consumers in need of comprehensive health coverage.

Many small business owners, older adults, and self-employed individuals find themselves in a difficult moment, as Congress has thus far failed to deliver an extension of the enhanced premium tax credits that help more than 24 million Americans, and 42,000 Delawareans, afford health coverage. While most Marketplace consumers will still receive some level of tax credits to help pay for their coverage in 2026, the tax credits will be far less generous should Congress fail to act.

If your annual income is less than $62,600 for an individual, $84,600 for a family of two, or $128,600 for a family of four, you may still be eligible to receive tax credits that assist in paying for your coverage next year.

Plans on the Marketplace are spread among metal-level categories bronze, silver, gold, platinum and catastrophic and are based on how enrollees choose to split the costs of care with their insurance company. Bronze plans have low monthly premiums but higher costs when you need care; gold plans have high premiums but lower costs when you need care. In a silver plan, the insurer pays about 70% of medical costs and the consumer pays about 30%.

Depending on your income, you and your family may be eligible for extra savings called, "cost-sharing reductions" with a silver plan, that will lower your deductible and copays. Talk to a navigator or assister or learn more about cost-sharing reductions.

All plans on the Marketplace offer essential health benefits such as coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, pediatric care, reproductive health coverage. In addition, coverage cannot be terminated due to a change in health status.

Regardless of your situation, the Marketplace remains the best place to enroll in individual health plans that include legitimate, comprehensive coverage. Here's what you need to know as you shop for coverage:

1. It's better to have reliable coverage than to face unpredictable costs down the line. Even if you can only afford a bronze plan right now, enrolling in Marketplace coverage is still worthwhile. Short-term Limited Duration Plans, Healthcare Sharing Ministries, and other non-comprehensive coverage is risky.

2. If you're a current Marketplace customer and you have yet to make a decision about your 2026 coverage, you should log into HealthCare.gov or CuidadodeSalud.gov and evaluate your potential options immediately.

If you do wish to re-enroll in ACA Marketplace coverage in 2026, sign in and ensure you're enrolled in the right plan for your family in light of potential cost increases as a result of the expiring enhanced premium tax credits.

If you don't plan to enroll in ACA Marketplace coverage in 2026, sign back in and notify your current plan to avoid potential automatic re-enrollment and billing.

3. If you're already enrolled in a plan that will take effect on January 1, 2026, you still have until January 15, 2026, to change plans, should you decide to do so. If Congress does pass an extension of the enhanced premium tax credits, consumer costs may change, and the Marketplace may reopen.

4. If you aren't a current Marketplace customer, and you don't have an affordable offer of coverage through an employer or through Medicaid or Medicare, consider enrolling. You can get started with an application now and talk to a navigator or assister about your best options. Don't miss this open enrollment opportunity after January 15, you may not have the option to enroll in a Marketplace plan for the year.

Insurance Commissioner Trinidad Navarro urges Delawareans to work with the state's official navigators, or a verified insurance broker to find the best coverage for their needs and budget. "Buying health insurance can already feel overwhelming, especially with the wide range of plans and companies out there. We've developed a Smart Buyer's Guide to Individual Health Insurance to help you simplify the process and spot deceptive tactics or misleading language."

The Department of Insurance has noted a rise in predatory and deceptive activity around ACA Open Enrollment, including scammers enrolling residents in coverage without their knowledge to obtain commissions, and the use of lead generators to bombard residents with efforts to sell non-comprehensive coverage. The guide assists consumers in verifying if coverage is comprehensive, if contact is from a legitimate entity and offers questions to consider during the process.