ACA Marketplace healthcare enrollment due Jan. 15

The final deadline for healthcare consumers to enroll in an ACA Marketplace plan for 2026 is Thursday, Jan. 15.  Individuals who don’t act by that date may not get coverage for 2026 unless they qualify for a special enrollment period based on circumstances such as a loss of qualifying health coverage, change of income, becoming a parent or other specific factors. 

Delaware Department of Insurance Commissioner Trinidad Navarro and his staff are sharing insights with consumers in need of comprehensive health coverage. 

Many small business owners, older adults and self-employed individuals find themselves in a difficult situation, as Congress has thus far failed to deliver an extension of the enhanced premium tax credits that help more than 24 million Americans – including 42,000 Delawareans – afford health coverage. While most Marketplace consumers will still receive some level of tax credits to help pay for their coverage in 2026, the amount will be far less generous should Congress fail to act.

If the total annual income is less than $62,600 for an individual, $84,600 for a family of two, or $128,600 for a family of four, consumers may still be eligible to receive tax credits that assist in paying for their coverage in 2026.

Plans on the Marketplace are spread among different-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company. Bronze plans have low monthly premiums but higher costs when a person needs care; gold plans have high premiums but lower costs when a person needs care. In a silver plan, the insurer pays about 70% of medical costs and the consumer pays about 30%.

Depending on income levels, individuals and families with a silver plan may be eligible for extra savings called “cost-sharing reductions” that will lower the deductible and copays. Talking to a navigator or assister can help consumers learn more about cost-sharing reductions.

All plans on the Marketplace offer essential health benefits such as coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, pediatric care and reproductive health coverage. Also, coverage cannot be terminated due to a change in health status.

Regardless of a person’s situation, the Marketplace remains the best place to enroll in individual health plans that include legitimate, comprehensive coverage.

Here’s what consumers need to know as as they shop for coverage:

• It’s better to have reliable coverage than to face unpredictable costs down the line. Even if someone can only afford a bronze plan right now, enrolling in Marketplace coverage is still worthwhile. Non-comprehensive coverage plans that can be risky include Short-term Limited Duration Plans, Healthcare Sharing Ministries and others
• Any current Marketplace customer who has not yet made a decision about 2026 coverage should log into HealthCare.gov or CuidadodeSalud.gov and evaluate potential options immediately
• Those who do wish to re-enroll in ACA Marketplace coverage in 2026 should sign in and ensure they are enrolled in the right plan for their families in light of potential cost increases as a result of the expiring enhanced premium tax credits
• To avoid potential automatic re-enrollment and billing, those who do not plan to enroll in ACA Marketplace coverage in 2026 should sign back in and notify their current plans
• Anyone already enrolled in a plan that took effect Jan. 1 may still decide to change plans until Jan. 15. If Congress does pass an extension of the enhanced premium tax credits, consumer costs may change, and the Marketplace may reopen.

Those who aren’t current Marketplace customers, and who do not have an affordable offer of coverage through an employer or through Medicaid or Medicare, should consider enrolling in Marketplace. Anyone can get started with an application now and talk to a navigator or assister about their best options during open enrollment. After Jan. 15, individuals may not have the option to enroll in a Marketplace plan for the year.

Navarro urges Delawareans to work with the state’s official navigators or a verified insurance broker to find the best coverage for their needs and budget. “Buying health insurance can already feel overwhelming, especially with the wide range of plans and companies out there. We’ve developed a Smart Buyer’s Guide to Individual Health Insurance to help you simplify the process and spot deceptive tactics or misleading language,” he said.

The Department of Insurance has noted a rise in predatory and deceptive activity around ACA Open Enrollment, including scammers enrolling residents in coverage without their knowledge to obtain commissions, and the use of lead generators to bombard residents with efforts to sell non-comprehensive coverage. The guide assists consumers in verifying if coverage is comprehensive and if contact is from a legitimate entity, and it offers questions to consider during the process.

Delawareans who need help enrolling in coverage will have access to free, in-person assistance from trained specialists at Westside Family Healthcare locations statewide. To learn more or enroll in Marketplace coverage, go to HealthCare.gov or call 1-800-318-2596.