Health Literacy Month 2025

Health care costs are rising for millions of Americans. In 2026, premiums, deductibles, co-pays, and coinsurance are expected to increase for ACA Marketplace plans, employer-sponsored coverage, and many Medicare Advantage plans. Many Americans will face even higher out-of-pocket expenses this year, and understanding these changes is critical to protecting your health and finances.

Be Aware of Changes to Care

Health care is already a top financial worry for many Americans. ACA subsidies and protections that keep costs down are set to end or shrink and employer-sponsored plans are expected to increase significantly. We all need to be aware and engaged to avoid surprise costs.

Shocking Cost Increases

• ACA Marketplace premiums are projected to rise sharply in 2026.
• Maximum annual out-of-pocket costs for Marketplace plans will be higher than previously planned (e.g., $10,600 for individuals).
• About half of adults who rely on ACA coverage are small business owners, employees of small businesses, or self-employed.
• Higher deductibles, rising co-pays, and steeper co-insurance are expected.

Employer-Sponsored Plan Increases

• Employer-sponsored coverage is also seeing significant cost increases.
• Employers are shifting more costs onto workers through higher deductibles, rising premiums, and greater cost-sharing.
• Families covered by these plans may face higher out-of-pocket costs even if premiums remain the same.

Growing Costs of Medicare Advantage (MA)

• In 2026, many Medicare Advantage plans are expected to increase premiums and out-of-pocket costs.
• During open enrollment, beneficiaries should review the specifics of their plan to understand any changes to provider networks, co-pays, deductibles, and monthly premiums.
• Reviewing your plan carefully can help avoid unexpected costs and ensure access to preferred providers and services.

Auto-Renewal Changes

• $0 premium auto-renewals may no longer stay $0. Consumers could be charged at least $5/month unless they update their account.

Silver Plan Benefits

• Marketplace enrollees eligible for cost-sharing reductions will not be switched from Bronze to Silver automatically.
• Consumers must actively choose a Silver plan to receive these benefits.

Medicare Part D Protections

Medicare Part D “saving and smoothing options” are one bright sport in the health insurance landscape.

What does this mean for Medicare Part D enrollees?

• Medicare Part D recipients will never pay more than $2,100 in total out-of-pocket costs in 2026 for prescription drugs. Once this cap is reached, beneficiaries will not pay additional co-pays or coinsurance for covered medications for the rest of the calendar year.
• Those who opt into the Medicare Prescription Payment Plan, also called “smoothing,” will have their prescription costs divided into predictable monthly bills, helping prevent large pharmacy bills up front.
• Monthly bills are calculated based on the patient’s cost sharing to date and remaining months in the plan year, in addition to any standard monthly premiums.

Who will benefit?

• All Medicare Part D beneficiaries benefit from the $2,100 out-of-pocket cap.
• The Medicare Prescription Payment Plan is available to all enrollees who opt in.
• It is especially helpful for those who anticipate high medication costs early in the year.

How do I sign up?

• You can opt in through your Part D or Medicare Advantage plan directly. It is best to opt in during open enrollment as it may take time to process the election if a patient opts in during the plan year.
• Visit Medicare.gov/prescription-payment-plan or call 1-800-MEDICARE to learn more.

Preventive Care and Vaccine Coverage

Consumers should review insurance policies to understand what preventive services and vaccines are covered. Staying informed about these protections helps maintain health and avoid surprise costs.

Open Enrollment Dates for 2026 Coverage

Understanding your health care options is crucial during Open Enrollment for 2026 coverage. Annual Open Enrollment for Medicare prescription drug coverage (Part D) and Medicare Advantage runs from October 15 to December 7, 2025, for coverage beginning January 1, 2026. Open enrollment is also underway for many employer-sponsored plans, so check with your employer for specific dates. Enrollment for ACA Marketplace plans begins November 1, 2025, and runs through January 15, 2026.

Take Action

Health care coverage is becoming more complicated and costly. Reviewing your options, updating your information, and choosing the right plan during open enrollment is more important than ever. Staying informed helps avoid surprise bills and ensures access to care. For more information, visit Healthcare.gov for Marketplace plan details, subsidies, and preventive care coverage, Medicare.gov to compare Part D and Medicare Advantage plans, understand out-of-pocket caps, and enroll in the Prescription Payment Plan.