2026 Open Enrollment Checklist
Rick Notter
| 5 min read
Rick Notter is vice president, Individual Business U...
Key Takeaways
- For most people open enrollment begins in November, and there are four health insurance plan categories: Bronze, Silver, Gold, Platinum and Catastrophic plans.
- The most common types of plans include HMOs, PPOs, EPOs, HDHPs and POS plans.
- Enhanced premium tax credits – which lowered how much people had to pay for ACA Marketplace plans – are set to expire at the end of 2025.
- Shopping around, looking into qualifications for other programs or expansions and taking advantage of HSAs are options to explore if enhanced premium tax credits expire.
Open enrollment – also known as annual enrollment – is a time each year when health plans allow members to enroll in a new plan or make changes to their existing coverage for the upcoming year. Occurring each fall – typically in November – it's the main time to sign up for health insurance, either through an employer or in the health insurance marketplace.
This toolkit is designed to help individuals make informed decisions for the 2025-2026 coverage year.
When is the open enrollment period?
Open enrollment dates depend on how people get their health insurance. Whether that be through an employer, the individual marketplace on healthcare.gov or through Medicare, here is what the open enrollment window looks like for everyone:
- Coverage through Affordable Care Act (ACA) marketplace plans on healthcare.gov: Nov. 1, 2025 to Jan. 15, 2026, in most states.
- Coverage through plans offered by work: Employers will set this open enrollment period. Human resource departments will have specific dates for each employer, typically in the fall.
- Coverage through a Medicare plan: Medicare’s annual enrollment period is from Oct. 15, 2025 to Dec. 7, 2025. Initial enrollment in a Medicare plan occurs when an individual turns 65.
What are the different plan options offered during open enrollment?
There are four health insurance plan categories: Bronze, Silver, Gold, Platinum and Catastrophic plans. These categories break down how the individual and the plan share costs. Plan categories have nothing to do with quality of care.
Whether individuals stick with the plan they had last year or prepare to choose a new plan, it’s important to evaluate these plans and their network types, how they differ and what best fits each person’s needs.
The most common types of plans include:
- Health maintenance organization (HMO): This plan is a good fit for those who have fewer health care needs and see a primary care provider (PCP) for an annual physical. Primary care providers coordinate care and require referrals to see specialists in this plan.
- Preferred provider organization (PPO): This plan is best for those with more complex needs or those who want flexibility in seeking care. It allows patients to see doctors at any in-network facility and see specialists without a referral.
- Exclusive provider organization (EPO): This is a managed care plan in which individuals can only see a specific network of doctors and health professionals except in emergency or urgent care. Those with fewer health needs who want a lower premium may choose this plan.
- High-deductible health plan (HDHP): This plan has higher out-of-pocket costs and lower monthly premiums, which may be desirable for those with fewer medical expenses and individuals looking to pair it with a health savings account (HSA).
- Point of service (POS): This is like an HMO and PPO hybrid plan. Point of service plans allow individuals to choose a PCP from the POS network to manage health care needs. Visiting a provider in the POS network comes with a lower deductible and coinsurance. It’s still possible to see an out-of-network provider with this plan, but it will result in a larger share of the bill.
What to know about the expiration of enhanced premium tax credits
Enhanced premium tax credits (ePTCs) – which lowered how much people had to pay for ACA Marketplace plans – are set to expire at the end of 2025, unless lawmakers agree to extend them. Although ePTCs are set to expire at the end of 2025, many individuals will still be eligible for Advanced Premium Tax Credits (APTCs) in 2026. Advanced Premium Tax Credits are less generous than ePTCs, but can still significantly reduce or eliminate premium costs for eligible individuals.
Without ePTCs, many of the approximately 24 million people who receive coverage through the Marketplace will see significantly higher premiums in 2026. Those who fall into this category should evaluate their expected income for 2026, their current budget and any medical costs they expect to incur ahead of open enrollment. Here are a few more tips:
Shop around: Closely compare full-premium Marketplace plans, including Bronze-tier plans with the lowest premiums and highest deductibles. High-deductible health plans eligible for HSAs are also worth researching. Additionally, it may be helpful to check on eligibility for:
- Employer-sponsored insurance plans, either for oneself or their partner
- Medicaid or the Children's Health Insurance Program (CHIP), which provides low-cost health coverage to children and pregnant women in families that earn money to qualify for Medicaid
- Medicare for those age 65 or older, or those who are disabled
Looking into qualifications for other programs or expansions: Michigan has a few state-specific programs worth exploring, especially for families. One is the Healthy Michigan Plan, which is available to low-income adults who are at or below 138% of the Federal Poverty Level (FPL). To meet this requirement, individuals must not be pregnant or enrolled in Medicare or other Medicaid programs.
Another option for those who have or expect to have children under the age of 19 is MIChild, a children’s health insurance program. Adults who lose ePTCs may have children who qualify for coverage under MIChild. This option has a higher income limit than other Medicaid programs and requires a low monthly premium. It’s worth a look for those with a household income that is too high for traditional Medicaid for kids.
Take advantage of health accounts: Relying on a pre-existing HSA to pay for medical expenses becomes especially important for those who lose their ePTCs, because the money accrued in an HSA is untaxed. Individuals can set aside money for health care expenses today, tomorrow or in retirement with an HSA. It’s a great way to manage costs for common or unexpected health care expenses and the money in it can be used to pay for health expenses for oneself and eligible dependents. Plus, any contributions made by either the employee or an employer lower one’s taxable income.
In 2026, HSA limits are $4,400 for individual coverage and $8,750 for family coverage. People age 55 and older can contribute an additional $1,000 annually. Health savings Accounts come with a triple tax advantage, in that contributions are tax-deductible, funds grow tax-free and withdrawals for qualified medical expenses are also tax-free.
Rick Notter is the Vice President of Individual Business at Blue Cross Blue Shield of Michigan. For more health tips and information, visit MIBlueDaily.com.
Related reading:
- What to Do if Your Health Insurance Plan is Changing
- What’s Changing in Michigan’s Health Insurance Market — and What It Means for You
- Why Is My Health Insurance So Expensive?
Photo credit: Getty Images
