Health Insurance Is Changing Next Year
Here's what to do now
Key points:
Big health-care changes are coming in 2026.
If you buy coverage on the Affordable Care Act (ACA) marketplace, your costs may rise if your income is over the subsidy line.
Medicare is not going away, but there could be pressure on access and payments in the future.
Health Savings Accounts (HSAs) get a little easier to use with more plan types.
The smart move: review your coverage and your 2025–2026 income plan now so you aren’t surprised later.
I’m here to help, step by step.
What’s changing
ACA subsidies (“premium tax credits”)
During COVID, Congress boosted ACA subsidies so more people qualified and many paid less.
That extra help is set to end after December 31, 2025, unless Congress extends it.
In 2026, the old “subsidy cliff” likely returns: if your income is above ~400% of the Federal Poverty Level (FPL), you could lose credits and pay full price.
That’s why planning your 2026 income (MAGI) matters.
Read more here.
Medicare
Medicare Parts A, B, C, and D remain.
Good news: Part D prescriptions now have a hard annual out-of-pocket cap, which makes big-ticket meds more predictable. (The cap is already in place under recent law.) More details here.
Looking ahead, the 2025 budget law could trigger automatic “PAYGO” cuts that reduce Medicare payments to providers by up to 4% in some years from 2026–2034, unless Congress steps in as it often has in the past.
That could mean tighter access in some areas, especially rural.
We’ll keep an eye on it and plan accordingly.
HSAs (Health Savings Accounts)
Starting in 2026, all Bronze and Catastrophic marketplace plans will count as HSA-eligible, and direct primary care (DPC) fees can be paid from an HSA (within limits).
Note: once you’re on any part of Medicare, you can no longer contribute to an HSA (you can, however, still spend your HSA on eligible costs).
Who should pay close attention
Early retirees (pre-65) on the ACA. If your 2026 income crosses the subsidy line, premiums can jump. In many districts, a 60-year-old couple just over 400% of FPL could see costs at least double without the enhanced subsidy.
Medicare households in smaller or rural communities. You’ll want to check doctors and networks each year in case local choices change. (My team can help you do this during your open enrollment window or as you approach age 65.)
Anyone who loves their HSA. More plans will be HSA-eligible in 2026, and DPC fees can qualify — helpful if you’re not on Medicare yet.
What to do now (so 2026 doesn’t surprise you)
1) Run a 2026 “what-if” for health insurance.
My team can help you price a worst-case (full price) and a best-case (with credits). If there’s a gap, we’ll plan for it.
2) Shape your 2025–2026 income (MAGI) on purpose.
ACA credits are based on MAGI.
If we can keep 2026 MAGI under the line, you may keep credits. This is a great example of a proactive tax planning opportunity.
If not, we budget for full freight and compare off-exchange options.
3) Consider Roth conversions.
It may make sense to convert more in 2025 (while enhanced credits still apply) and less in 2026 to stay under the line. We can evaluate taxes, IRMAA, and cash needs — not just subsidies.
4) Use your HSA wisely.
On HSA-eligible plans, contributions lower your MAGI and build a tax-free health fund. If Medicare is around the corner, we’ll stop new HSA contributions on time to avoid penalties, and we can consider using existing HSA dollars for eligible Medicare costs.
5) For Medicare clients: schedule your annual review.
Each fall my health insurance team can help you check doctors, drugs, and networks. Invest a little time now = fewer headaches later.
6) Don’t wait for “maybe.”
Congress might extend some ACA help — or not. We’ll plan for the stricter case and celebrate if it gets easier.
Quick FAQs
“Will my ACA premium definitely go up?”
Not for everyone. But if your income is above the subsidy limit in 2026, it likely will.
“Do I need to switch my Medicare plan?”
Maybe not. Still, it’s smart to review doctors and drug formularies every year.
“Can an HSA help me qualify for ACA credits?”
Yes. HSA contributions can lower MAGI (if you’re on an HSA-eligible plan and not on Medicare).
“Should I move all my Roth conversions to 2025?”
No. We’ll balance taxes, IRMAA, cash needs, and subsidy impact, then act.
How I’ll help
My job is to help you manage your financial resources and live a great life. This includes your health-care costs. Here’s the plan:
Review your current coverage and map 2026 best/worst-case costs.
Plan your 2025–2026 MAGI so you’re not surprised.
Right-size Roth conversions and HSA moves.
For Medicare, confirm coverage for doctors, drugs, and networks during open enrollment which starts in mid-October.
Set reminders so we handle open enrollment early — not at the last minute.
Bottom line
You don’t need to memorize rules and regulations.
You need a clear path and a steady guide.
We’ll make a simple plan, adjust as rules evolve, and keep you protected without overpaying.
I wil be reaching out to all my clients soon to plan for health coverage reviews going into 2026.
If you’d like help to review your health coverage and income plan for 2026, let me know.
We’ll keep it easy, calm, and focused on your life.
The Medicare enrollment period opens up on October 15th and runs through December 7th.
ACA open enrollment begins November 1st and runs through January 15th, 2026, but you’ll need to sign up for coverage by December 15th if you want coverage to start on January 1st, 2026.
Note: some states that run their own health insurance exchanges have different dates.
Through my partneship with Move Health, I can help you review your existing coverage and/or enroll in coverage.
If you worked with Move Health last year, Jaclyn will be reaching out soon to schedule your coverage review during this year’s open enrollment.
If you’d like to talk to Jaclyn at Move Health, let me know and I can get y’all connected.
I appreciate your continued readership.
Please let me know if you have any feedback or suggestions for future essays.
Until next Wednesday,
Russ