Mega Doctor News
The ONE BIG BEAUTIFUL BILL (OBBB), signed into law on July 4, 2025, introduces several important changes to the Affordable Care Act (ACA) Marketplace. These changes affect eligibility, re-enrollment, and subsidies for health insurance coverage purchased through the federal or state exchanges.
Starting January 1, 2026, eligibility requirements for enrolling in an ACA Marketplace plan will become stricter. Under the new law, individuals will need to provide updated income and residency information annually, with fewer grace periods and limited exceptions. The OBBB states: “The Department of Health and Human Services shall implement enhanced eligibility verification protocols for all ACA Marketplace applicants beginning plan year 2026.” This provision is designed to ensure that only those who meet the new criteria will be able to enroll or stay enrolled in coverage through the Marketplace.
Another major change is the removal of automatic re-enrollment. Until now, individuals who did not actively select a new plan during the open enrollment period were often automatically re-enrolled in their current plan or a similar one. Beginning in 2026, this will no longer happen. As described in the bill: “Automatic re-enrollment for ACA Marketplace plans shall be discontinued for all plan years beginning on or after January 1, 2026.” This means that all Marketplace enrollees must reapply for coverage each year or risk losing their health insurance.
Additionally, the financial subsidies that have helped lower premiums and out-of-pocket costs for many Marketplace users will end after 2025. These subsidies, officially known as advance premium tax credits, have been available to individuals and families with incomes up to 400% of the federal poverty level. According to the new law: “Premium tax credit subsidies authorized under the Affordable Care Act shall sunset effective December 31, 2025.” Without these subsidies, consumers may experience higher out-of-pocket premium costs in future plan years, starting with 2026.
The provisions introduced in the OBBB are currently set to remain in effect until December 31, 2029, unless Congress passes further legislation to extend or modify them.
People who use the ACA Marketplace for health insurance should be aware of these upcoming changes. It will be important to actively reapply for coverage during each open enrollment period, starting in fall 2025 for coverage in 2026. Additionally, individuals should prepare for the possibility of higher premiums due to the ending of subsidies and take steps to ensure they continue to meet the new eligibility requirements.
The Department of Health and Human Services is expected to issue detailed guidance about how the new rules will be implemented. State-based Marketplaces may also release state-specific instructions for residents impacted by these changes.
These updates reflect a significant shift in how ACA health coverage will be administered starting in 2026. Individuals who currently receive subsidized coverage or rely on automatic re-enrollment should review their options ahead of time to avoid any coverage gaps.
Always consult with a tax professional when making decisions that may affect your health insurance or tax obligations.
