Stay ahead of ACA changes
Major changes to the Affordable Care Act could significantly impact how your agency operates during Open Enrollment 2026. One thing is for certain, reaching out to your clients early will be crucial to your success during OE.
This page is your go-to resource for tracking the latest information and getting tools, training, and support from HealthSherpa to help you navigate these changes with confidence.
Start learning now
It will be important to prioritize active renewals for plan year 2026. Here's a quick refresher course on active and passive renewals.
Preparing early will be key for OE 2026! Here are steps to start taking now so your OE is a success.
POLICY UPDATES
What is changing
Deferred Action for Childhood Arrivals (DACA) recipients lose ACA eligibility
Effective: August 25, 2025
Special Enrollment Period ends for individuals at or below 150% FPL
The monthly Special Enrollment Period (SEP) for individuals at ≤ 150% FPL will be discontinued.Effective: August 25, 2025
- This change will restrict SEP eligibility for individuals unless they experience a Qualifying Life Event (QLE).
- Many agents may decide to shift their work to a more seasonal operation vs a year-round operation.
Open Enrollment Period stays the same (Nov 1–Jan 15)
- There will be no change to the annual Open Enrollment Period (OEP) for PY26.
- OEP will shorten to Nov 1-Dec 15 with PY27.
Pre-enrollment verification required for Special Enrollment Period enrollments (this change likely paused)
Consumers are often asked to submit documentation proving they’ve experienced a qualifying life event (QLE) in order to verify their eligibility for a Special Enrollment Periods (SEPs).Effective:
- May 16, 2025 for consumers reporting a loss of health coverage. See which documents are accepted to confirm loss of coverage.
- Other SEPs: PY26 (November 1st, 2025)
- If the Marketplace can’t verify your client’s SEP, they may lose eligibility to enroll outside of OE.
- Collect the proper documentation to avoid SEP verification issues.
- Use HealthSherpa to manage SEP pre-enrollment verification. Learn how to identify clients and easily collect and upload follow-up documents.
Expiration of enhanced subsidies (eAPTC)
Extended APTC (eAPTC) will expire at the end of 2025 without further legislative action.Effective: January 1, 2026
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Premium payments for subsidized enrollees will increase nationwide when eAPTC subsidies expire. eAPTC expiration will affect all FPL tiers.
Check back often for the latest information and resources from HealthSherpa. We're working hard to help you navigate these signficant changes.
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