Obamacare will undergo significant changes by 2026, according to an announcement by the CMS (Centers for Medicare & Medicaid Services), the federal agency that regulates all these issues.
From the verification of income declared on health insurance policies, the limitation of who qualifies based on their income, the removal of eligibility for DACA beneficiaries, to the shortening of the Obamacare Enrollment Period to just 45 days, a major "revolution" is anticipated in the Affordable Care Act, involving 24 million people who currently receive their subsidies.
At Dulcinea Insurance, we suggest you read this post about the changes in Obamacare for 2026, which will undoubtedly offer you accurate and of utmost importance information if you receive any of the benefits of this government program. Of course, to get a quote and enroll, you can dial 786-910-9487 and one of our licensed agents will help you completely free of charge.
Obamacare Changes for 2026: Everything You Need to Know
One of the most important changes in Obamacare for 2026 will be the elimination of the expanded credits approved by Joe Biden in 2021, which is expected to lead to a considerable increase in health insurance premiums for Obamacare. It is estimated that with these expanded subsidies, policyholders receive an extra financial aid of $700 annually, which, when eliminated, will go directly to people's out-of-pocket costs. We wrote an article on this momentous topic at Dulcinea Insurance that you can read here.
Below we are going to list and explain to you each of the changes in Obamacare for 2026 proposed by the CMS and by the Trump administration.
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Insured individuals will have to settle previous debts with insurers before enrolling with them.
Without a doubt, one of the measures aimed at stabilizing the insurance market is the protection of insurance companies, which will not register a client seeking to renew coverage if they owe money for previously unpaid premiums. This seeks to encourage health insurance companies to strengthen the criterion of the loyal client who maintains continuous coverage and thus avoid adverse selection (people who are ill and opportunistically seek insurance when the illness occurs).
CMS will change two rules used by health insurers
As part of the changes to Obamacare for 2026, CMS is also proposing to eliminate two types of rules that health insurance companies use to accept partial payments on a policy. One of these is the fixed-amount threshold, and the other is the gross percentage threshold. The current proposal is to establish a threshold based on the net percentage (for example, 25% of the actual cost after subsidies). The goal is to ensure that the customer always pays «some portion of their premium,» prevent improper enrollments, and protect the customer from unexpected debt.
Customers who are automatically enrolled will have a $5 liability
Members who are automatically enrolled by the Health Insurance Marketplace on December 15 will have a $5 amount to pay in the system in January until they verify eligibility. Once they have verified it, that debt is eliminated. This also prevents unauthorized enrollments by customers.
The Insurance Marketplace will not be prevented from changing from bronze to silver plans in automatic renewal.
Another CMS proposal is that the Insurance Marketplace cannot change a client's plan hierarchy without their authorization, as previously occurred, where for the client's own benefit during automatic renewal if they remain with the same insurance, same doctor directory, and have better coverage and a lower premium in the silver-tier health insurance.
Exclude DACA recipients as eligible immigration status for Obamacare
The CMS made a change to the definition of legally present to exclude DACA program beneficiaries. This leaves hundreds of thousands of people without the option of government subsidies.
Shorten the Obamacare Open Enrollment Period to 45 days
Another of the significant changes in Obamacare for 2026 is that the Open Enrollment Period for health insurance will now be from November 1st to December 15th. There will no longer be extensions until January 1st as has happened previously.
Those who had Obamacare and did not reconcile their tax credits on their taxes will not be eligible for subsidies in the future.
According to this rule, anyone who has previously received Obamacare subsidies and has not reconciled the tax credits on their taxes using Form 1095-A will no longer be able to qualify for Health Law credits until they file their taxes.
Only those earning between 100% and 400% of the Federal Poverty Table
This limitation will mean that millions of people who were receiving subsidies even when earning above 400% of the federal poverty level (paying up to 8.5% of their salary for health insurance) will no longer be able to qualify under the Law. Likewise, anyone earning below 100% (minimum income to qualify for Obamacare) will not be able to access this Government aid either, undoubtedly a hard blow for those with low incomes who do not qualify for Medicaid.
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The Insurance Market will redouble efforts to verify the income of insured individuals.
With this measure, the Marketplace seeks to prevent fraud that some individuals commit when declaring their Obamacare income, receiving subsidies they are not entitled to. This way, the entity will have a direct link with federal entities such as the IRS and other agencies, and if necessary, if the client's income is not verified, they will request proof for the insured to submit.
Limit eligibility for SEP (Special Enrollment Period)
The goal here is to get as many people as possible to enroll in health insurance during the Official Enrollment Period between November and December, to avoid opportunistic enrollments in the middle of the year. This way, the Insurance Marketplace will strictly review anyone who wishes to enroll in a medical plan outside of the official dates.
There will be stricter enforcement of the law against fraudulent insurance agents.
Without a doubt, one of the most frequent problems with Obamacare is the violations committed by many insurance agents in pursuit of commissions. Policy changes without customer consent, enrollments in companies without the customer's knowledge, and incorrect income figures are part of a long list of frauds. All of this must be controlled with a «firm hand from the Insurance Marketplace,» which will be able to punish violating agents more easily.
