Marketplace Insurance changes for 2026

[sandyut]

Heads up to all on marketplace ins...

Called my broker after reading that Anthem was leaving my state in 2026. She confirmed this info. She also said rates are going "way up" next year. Google says about 18% on average. Both pieces of info are upsetting AF!

Just a heads up, you know who caused this.

 

[tallbm]

Heads up to all on marketplace ins...

Called my broker after reading that Anthem was leaving my state in 2026. She confirmed this info. She also said rates are going "way up" next year. Google says about 18% on average. Both pieces of info are upsetting AF!

Just a heads up, you know who caused this.

That sucks.

In my state no doctors really want to accept anything but Blue Cross Blue Shield and I don't get any discounts from the marketplace so I just go with Blue Cross Blue Shield personal-individual plans (plans not offered through employers).

I work for myself and have done the song and dance with the marketplace and my state. Even when getting non marketplace personal-individual plans doctors in my state really don't want to accept anything but Blue Cross Blue Shield.


Another really important thing I learned about the marketplace is that you cannot trust what is listed for doctors that accept the various providers (Aetna, Humana, etc.) plans.
You MUST MUST MUST contact your doctor's office and then beat them over the head with the fact that it is a marketplace or personal-individual plan and get them to 1000% confirm they will accept that plan before you get it, or else you will now be in the hunt for a new doctor.

I ran into all of these issues in my journey.

So hopefully folks can learn from my trials and tribulations and not have to go a year with insurance where you cannot actually find a doctor that will take it. I am lucky I don't have any major health issues and didn't get sick during the 3 consecutive years I went through figuring out all this nonsense.

I also hope you are lucky enough to have insurance providers in your state that offer personal-individual plans and that your doctor will accept since what is on the marketplace and what are provider personal plans are not exactly the same and does give a little bit of variety in options... not much but maybe at least 1 plan will work and your doctor will accept it.

 

[sandyut]

That sucks.

In my state no doctors really want to accept anything but Blue Cross Blue Shield and I don't get any discounts from the marketplace so I just go with Blue Cross Blue Shield personal-individual plans (plans not offered through employers).

I work for myself and have done the song and dance with the marketplace and my state. Even when getting non marketplace personal-individual plans doctors in my state really don't want to accept anything but Blue Cross Blue Shield.


Another really important thing I learned about the marketplace is that you cannot trust what is listed for doctors that accept the various providers (Aetna, Humana, etc.) plans.
You MUST MUST MUST contact your doctor's office and then beat them over the head with the fact that it is a marketplace or personal-individual plan and get them to 1000% confirm they will accept that plan before you get it, or else you will now be in the hunt for a new doctor.

I ran into all of these issues in my journey.

So hopefully folks can learn from my trials and tribulations and not have to go a year with insurance where you cannot actually find a doctor that will take it. I am lucky I don't have any major health issues and didn't get sick during the 3 consecutive years I went through figuring out all this nonsense.

I also hope you are lucky enough to have insurance providers in your state that offer personal-individual plans and that your doctor will accept since what is on the marketplace and what are provider personal plans are not exactly the same and does give a little bit of variety in options... not much but maybe at least 1 plan will work and your doctor will accept it.

Its a pisser for sure, I have health issues and all kinds specialists set up and I like them. Hopefully they will adjust so I dont need to start over.

100% agree on the online provider look up-not accurate at all. which honestly seems really stupid.

 

[tallbm]

Its a pisser for sure, I have health issues and all kinds specialists set up and I like them. Hopefully they will adjust so I dont need to start over.

100% agree on the online provider look up-not accurate at all. which honestly seems really stupid.

Fingers crossed brother! It doesn't hurt to get prepped and know what providers they will actually accept that way when the time comes you can narrow down your search to those providres. I would still then eyeball a plan and get the doctors offices to actually look exactly at the plan you are eyeballing and confirm it.

I've found that telling them over the phone isnt enough, but providing some ID for the plan and pictures or even going there and having them pull it up to confirm (this is the most foolproof) works much better.

 

[Jim_C]

We are fortunate in that the wife and I have Kaiser here in California. I know there are folks who would not give Kaiser the time of day, but we have had them for years and have been satisfied. We have used their specialists quite a bit.

The Senior Advantage Plus (includes dental) is $86 a month, and the rates didn't increase in 2025. The equivalent plan through my pension is $246 a month. That's without dental, and that's after the RDMA allowance is applied. Dental through the pension plan added another $750 a year.

I quit the pension medical and dental plans and joined Kaiser directly.

 

[sandyut]

We are fortunate in that the wife and I have Kaiser here in California. I know there are folks who would not give Kaiser the time of day, but we have had them for years and have been satisfied. We have used their specialists quite a bit.

The Senior Advantage Plus (includes dental) is $86 a month, and the rates didn't increase in 2025. The equivalent plan through my pension is $246 a month. That's without dental, and that's after the RDMA allowance is applied. Dental through the pension plan added another $750 a year.

I quit the pension medical and dental plans and joined Kaiser directly.

My mom has Kaiser here, she likes it. But, she is fading mentally so its hard to know what she is told. Feels like I get about 10% of what they tell her. She says some odd things about what they say...thats my only experience with them here.

 

[SherryT]

Well, I'm on Medicare now, so I don't have to deal with it anymore.

 

[sandyut]

Well, I'm on Medicare now, so I don't have to deal with it anymore.

My wife is too, cant wait to get there! So dreamy compared to Marketplace ins.

 

[JIMSMOKES]

If it wasn't for the insurance cost. I'd tell my work I'm done! (61)
Been asked to give a 18-24 notice of intent to retire

 

[ajbert]

I'm on Tricare Prime and my wife is on Medicare with Tricare for Life. So glad I decided to make a career out of the Navy when I had nine years in and was deciding to get out or re-enlist.

 

[BrianGSDTexoma]

Well Crap! I getting a new Broker this year. Last one changed me to Mexican two years ago and last year changed me to female! Mine went from $65 a month to $250 last year. I have one more year left. I will switch to Medicare in June but still have to keep my income down to end of year. Just living off SS right now until end of next year than can finally take IRA withdraws.

 

[Up_In_Smoke]

If it wasn't for the insurance cost. I'd tell my work I'm done! (61)
Been asked to give a 18-24 notice of intent to retire

Just before the Christmas break in 2020, I told my boss I was only coming back for 1 day in 2021 and then I was done.

Tell them to take their notice and stuff it where the sun doesn't shine.

If they were going to fire you or lay you off, how much notice would they give you?

 

[sandyut]

If it wasn't for the insurance cost. I'd tell my work I'm done! (61)
Been asked to give a 18-24 notice of intent to retire

the full price is insane, but the income based credit can be significant...at least through this year.

I dont recall exactly how far back they looked when I started on it...I think it was the previous tax return and I started mid year so thats a factor. A broker could run the numbers if you havent already.

So far our taxable income is very low with no jobs and we are only pulling a small amount of taxable money out. Our adviser makes sure of that.

 

[thirdeye]

Marketplace rates in rural states are rising faster, but 18% is shocking.

I started with the early version of ACA, where you had a minimum income and an income cap that was strictly enforced with a penalty. I had some touch and go moments with unexpected capital gains in December.

My last year on ACA, The American Rescue Plan Act of 2021 and the Inflation Reduction Act of 2022 set the income cap at 8.5% of your income. I did have a small repayment that year.

 

[Fueling Around]

After my wife retired I got stuck on COBRA for a couple months. If you want to complain about costs give COBRA a try
Finally was able to get a marketplace coverage and it was very little as it was based solely on my income

Well, I'm on Medicare now, so I don't have to deal with it anymore.

I’m on Medicare too
Do you have Medi-Gap or an Advantage plan?

My wife is too, cant wait to get there! So dreamy compared to Marketplace ins.

Medicare is about double what my marketplace insurance cost

 

[SherryT]

After my wife retired I got stuck on COBRA for a couple months. If you want to complain about costs give COBRA a try
Finally was able to get a marketplace coverage and it was very little as it was based solely on my income

I’m on Medicare too
Do you have Medi-Gap or an Advantage plan?

Medicare is about double what my marketplace insurance cost

Nope.

After my wife retired I got stuck on COBRA for a couple months. If you want to complain about costs give COBRA a try
Finally was able to get a marketplace coverage and it was very little as it was based solely on my income

I’m on Medicare too
Do you have Medi-Gap or an Advantage plan?

Medicare is about double what my marketplace insurance cost

No, nothing but Medicare.

 

[SherryT]

Nope.


No, nothing but Medicare.

I have NO IDEA how I screwed up my reply...sorry about that!

 

[BrianGSDTexoma]

Medicare is about double what my marketplace insurance cost

I going to have to figure this out next year. The broker I got also does Medicare which is why I got her. Going to be a bit tricky switching from ACA to Medicare.

 

[sandyut]

Medicare is about double what my marketplace insurance cost

not here. ACA ins varies alot by region I believe and the tax credit.

 

[thirdeye]

Finally was able to get a marketplace coverage and it was very little as it was based solely on my income

Isn't Marketplace insurance based on household income?

I going to have to figure this out next year. The broker I got also does Medicare which is why I got her. Going to be a bit tricky switching from ACA to Medicare.

For our first year on Medicare, we visited a Senior Patient Advocate, who is also an insurance agent. The switch over was very easy, but where the big money savings came into play was the drug plan. She was able to compare prices from 30 or 40 pharmacies.