With the start of the Open Enrollment or enrollment period of the health marketplace in the United States, on November 1, the insurance specialist and CEO of CM Insurance Advisors, Carla Mendoza, warns the Hispanic community about the most important changes that will impact coverage and eligibility by 2026.
“Every year, the health marketplace introduces adjustments that may seem small, but have a big impact on eligibility, subsidies, and monthly premiums. This year, the modifications require more attention and professional accompaniment to avoid losing benefits or being left without coverage,” Mendoza said.
Among the changes confirmed by the federal government are the following:
1-DACA is no longer eligible: People covered under the Deferred Action for Childhood Arrivals (DACA) program will no longer be able to enroll in Marketplace plans.
2-Elimination of the special monthly income period ≤150% of the FPL: People with incomes below 150% of the federal poverty level will no longer have a monthly window to enroll outside of Open Enrollment.
3-“$5 per month” rule for $0 plans: Those who had $0 monthly premiums and do not actively renew may receive a symbolic charge of $5 per month until they verify their eligibility.
4-Stricter verification for special periods (SEP): From now on, it will be mandatory to present prior documentation that demonstrates the qualifying event (such as loss of coverage, marriage or moving). In addition, automatic 60-day extensions are eliminated, and applicants will have an exact 90-day window to submit verification documents.
5-Possible expiration of enhanced subsidies (eAPTC): Subsidies that have helped reduce premiums in recent years will expire at the end of 2025, unless Congress approves their extension. This could increase costs for millions of families.
6-Duration of Open Enrollment: For 2026, the registration period will remain from November 1 to January 15, but it has already been confirmed that for 2027 it will be shortened and end on December 15, with no additional extensions by state.
Some parts of the Marketplace Integrity and Affordability Rule are under judicial review, including issues related to gender requirements and transgender coverage, as well as the eventual extension of enhanced subsidies, which will depend on legislative decisions.
Carla Mendoza stressed that this panorama demands a personalized review of each case before the start of registration.
“Many customers assume their plan automatically renews unchanged, but this year that may mean paying more or losing benefits. It is vital to review income, documents and current plan with a certified counselor to ensure that they continue to qualify for subsidies and maintain adequate coverage,” he explained.
The specialist also recalled that, as with tax returns, income and family composition data are determining factors in qualifying for Affordable Care Act (ACA) subsidies. An error in the report can generate improper payments or even the loss of the subsidy.
“Health is an investment, not an expense. Taking the time to verify your eligibility and renew your coverage with professional advice can save thousands of dollars a year,” he concluded.
Carla Mendoza is a Venezuelan lawyer and social communicator, based in the United States since 2015. She is the founder and CEO of CM Insurance Advisors, with a presence in more than 42 states and a network of more than 5,000 agents. He has helped thousands of Hispanics protect their health and wealth through health, life, savings and investment insurance.
She is the author of the book “Life is a Sale”, which became a best seller on Amazon just three days after its release. Carla has been recognized among the “Top 12 Professional Women of Doral 2024” and also as an ‘Icon of Influence’ by the Miami-Dade Mayor’s Office for her impact on the Latino community and her commitment to financial and insurance education.
More information at:
www.cminsuranceadvisors.com
Instagram: @cm.insurance | @carlamendozaoficial