Open Enrollment happens during the Holidays. We know you'll be busy with Thanksgiving, Christmas, and New Year's, and so please schedule your appointments early.

Each appointment can take up to an hour when we update your Marketplace application.

Our hours are Mon through Friday, 9 AM to 5 PM



We will close our office in observance of Thanksgiving, Nov 26 (at noon), 27th, and 28th

Christmas December 24, 25, and 26th

New Year's Eve, December 31 (at noon), and January 1st.



CHANGES IN THE LAW

You need to know about:

Key Changes for 2026

• Income Eligibility for Lawfully Present Immigrants: As of 2026, lawfully present immigrants with household incomes under 100% of the FPL will no longer be eligible for premium tax credits, even if they are ineligible for Medicaid. 
• New Income Verification Triggers: The FFM will require additional income documentation under specific circumstances: 
• If an enrollee projects their income to be below what would make them eligible for tax credits. 
• If government data indicates the enrollee's income is less than what would make them eligible for tax credits. 
• If an enrollee's projected income exceeds their actual income by at least 10%. 
• If tax data shows an enrollee's income is less than 100% of the FPL. 

• Increased Pre-enrollment Verification for SEPs: The FFM must conduct pre-enrollment verification for all special enrollment periods (SEPs) and at least 75% of new SEP enrollments for the 2026 plan year. 
• Removal of 60-day Extension: The 60-day extension to resolve data-matching issues is removed, with these changes effective from August 2025. 

What You Need to Do

• Review Your Projected Income: Carefully consider your projected income for the 2026 plan year, especially if you are a recent immigrant or have volatile income. 
• Gather Income Documentation: Collect recent pay stubs, W-2s, 1099s, and prior-year tax returns to be prepared to submit documentation. 
• Update Your Marketplace Profile: Ensure that your household size, dependent status, and mailing address are up to date in your Marketplace profile. 
• Be Aware of Special Circumstances: If you enroll through a special enrollment period (SEP), expect pre-enrollment verification. 
• Consider Catastrophic Coverage: If you are newly ineligible for advance premium tax credits, a hardship exemption may allow you to enroll in catastrophic coverage, which has lower monthly premiums.
•  Are your children turning 26? This triggers a special enrollment period, allowing them to enroll in a plan of their own.
• Do you have college-age children filing their own tax returns under your plan? They must agree to be claimed as a dependent. Speak with your tax advisor.
• Do you have adult children who are getting married or who are already married and are covered under your plan? You will need to know how to coordinate how each of your are to file your tax return, and your adult married children will also want to speak with a tax advisor.
• 2026 Renewal Packages for members with Exchange plans will NOT include a 2026 subsidy amount. YOU MUST call us to update your application.
• If you have had a $0 premium in the past, this year, we are being told that a minimum of $5 is required.
• Expect a renewal letter 60 days prior to your renewal date.

We will want to check that the Providers you see are still in the network, and have time to select a new provider if necessary.

Prescriptions are still covered, we want to check formularies and Tiers.

If you are on a marketplace plan and change plans, and are still enrolled in the same carrier's dental coverage, we need to re-enroll you in that dental coverage. Ask us about other Dental and Vision options.

Required Documents to confirm your household income.

The documents you submit to the Marketplace to confirm your household income must show a yearly income amount that closely matches the yearly income amount you entered on your application. For example, if you have a different job than you had last year, send the Marketplace recent pay stubs from your new job, instead of last year's tax return or W2.

• 1040 federal or state tax return. Must contain your first and last name, income amount, and tax year. If you file Schedule 1, you must submit it with your 1040.
• Wages and tax statement (W-2 and/or 1099, including 1099 MISC, 1099G, 1099R, 1099SSA, 1099DIV, 1099SS, 1099INT). Must contain your first and last name, income amount, tax year, and employer name (if applicable).
• Pay stub. Must contain your first and last name, income amount, and pay period or frequency of pay with the date of payment. If a pay stub includes overtime, tell us the average overtime amount per paycheck.
• Self-employment ledger documentation (can be a Schedule C, the most recent quarterly or year-to-date profit and loss statement, or a self-employment ledger). Must contain your first and last name, company name, and income amount. If you’re submitting a self-employment ledger, include the dates covered by the ledger, and the net income from profit/loss.
• Social Security Administration Statements (Social Security Benefits Letter). Must contain first and last name, benefit amount, and frequency of pay.
• Unemployment Benefits Letter. Must contain your first and last name, source/agency, benefits amount, and duration (start and end date, if applicable).
• Or, complete a written explanation form (PDF, 126 KB). To submit this form, select “Other” from the drop-down menu when you’re on the upload screen in the application.

Determining Your Income:

Household income link to the Marketplace

• Household Income: The Marketplace uses your expected household income for the year you want coverage. 
• MAGI: This includes income for yourself, your spouse, and any dependent you claim on your federal tax return, using a measure called Modified Adjusted Gross Income (MAGI). 
• Countable Income: MAGI starts with your Adjusted Gross Income (AGI) from your tax return and includes other items like untaxed foreign income, non-taxable Social Security benefits, and certain retirement income. 

Starting August 25, 2025, for the 2026 plan year, self-attestation of income will not be accepted if there's no tax data available or if projected income is above 100% of the Federal Poverty Level (FPL) while federal data shows income below that level. Applicants must then submit documentation within 90 days to resolve the DMI and prove their projected income. 

Household Size Coverage

Income amounts have changed for the Federal Poverty Level:

This change can impact your existing subsidy.

Medicare open enrollment for 2026 starts on October 15th and runs through December 7.

Schedule your appointment before the deadline

Scope of Appointment Forms are required, and must be renewed annually

During the annual open enrollment period, beneficiaries can review and change their Medicare coverage options, including Medicare Advantage and prescription drug plans.

Original Medicare - If you are enrolled in a secondary Medicare supplement/Gap plan, such as Plan F, G, or N, there is no open enrollment period. If you are satisfied with your plan, the only Open enrollment pertaining to your upcoming year is the Stand-Alone Part D for prescriptions.

Please see the upcoming changes in the Prescription Part D starting January 1, 2026.

CHANGES CHANGES CHANGES

Higher Costs

• Part B Premiums and Deductibles: You can expect both the standard monthly Part B premium and the annual deductible to increase in 2026. 

• The Standard premium is now $206.50 per month, which represents an increase of $21.50 (or 11.6%) from the 2025 premiums of $185.

• Part D Deductible and Out-of-Pocket Cap: The annual deductible for Part D prescription drug coverage will rise, as will the maximum out-of-pocket limit, which is set at $2,100 for 2026. An increase of $100.

• Increased Income-Related Surcharges: There may be adjustments to the premium surcharges for Part B and Part D that depend on your income.

Prescription Drug Benefits (Part D)

• Negotiated Drug Prices: Medicare will begin to negotiate prices on certain high-cost prescription drugs, which should lead to lower overall drug costs. 

• Insulin Cap: Your monthly costs for covered insulin products will be capped at $35 or 25% of the negotiated drug price, whichever is less. 

• Adult Vaccines: Recommended adult vaccines under Part D will be provided with no cost-sharing (no deductible or copay). 

• Prescription Payment Plans: There will be an auto-renewal option for your prescription payment plan if you use one. 

Medicare Advantage (MA) 

• Fewer Extras: Some Medicare Advantage plans might offer fewer supplemental benefits in 2026.

• Increased Prior Authorization: There will likely be an expansion of prior authorization requirements for certain services within Medicare Advantage plans.

How to Prepare

• Call Diane to review Your Plan Details: Carefully review the information from your health insurance provider during the open enrollment period (October 15 to December 7) to see specific changes to your plan. 
• Consider Your Options: Look into switching to a different Medicare Advantage plan or enrolling in a supplemental insurance plan to help manage potential cost increases. Some Medicare Advantage plans will be discontinued; therefore, we would like to review your plan closely.
• IF YOU ARE ON A MEDICARE SUPPLEMENT, THAT WON'T CHANGE, AND THE ONLY THING TO REVIEW IS THE STAND-ALONE PART D PRESCRIPTION DRUG PLAN.

• Seek Assistance: Contact Diane Eller for personalized guidance on your 2026 Medicare options. 

Disclaimers: For 2024, CMS has proposed reinstating the 48-hour Scope of Appointment (SOA) timeframe, which prohibits personal marketing appointments from taking place until 48 hours after a potential enrollee completes an SOA. Under the new rule, SOAs must be obtained at least 48 hours in advance and will remain valid for six months from the date of the beneficiary's signature.

"We do not offer every plan available in your area. Any information we provide is limited to those plans we offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."

"All Calls are required to be recorded and maintained for ten years per center for Medicare and Medicaid. If you do not wish to have your call recorded, the call may cease. This is required for all Medicare Advantage and Part D products."



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