The official 2026 Open Enrollment Information + FAQs

Completely happy Open Enrollment 2026! 🎉 We could also be a number of the solely individuals who deal with Open Enrollment as a serious vacation. We will not assist it. We love this time of yr! However we perceive that not everybody shares our enthusiasm, so we produced this brief information that can assist you navigate Open Enrollment. If that is your first time shopping for particular person medical insurance, this text might be your finest pal.

Up to date for Open Enrollment 2026! 

Yearly, we hear lots of the identical questions from people similar to you who’re having to navigate the well being care system exterior of a conventional group plan. Don’t be concerned! We now have many sources, together with this information, that can assist you.

As you find out about subjects like Open Enrollment, particular person insurance coverage, and HRAs, please keep in mind that our platform will stroll you thru all the course of and assist you to select a plan that won’t solely be just right for you however one which can even work along with your HRA for 2026.

Listed below are a couple of of the high-level questions, in addition to a number of related questions, this information addresses intimately: 

Our platform will stroll you thru all the course of and assist you to select a plan that won’t solely be just right for you however one which can even work along with your HRA.

In the event you’re over 65 and enrolled in Medicare, you get a head begin from October fifteenth by means of December seventh to overview and make any adjustments to your Medicare protection, which can go into impact January 1st .

Why is Open Enrollment restricted to particular dates?

Well being insurers restrict the open enrollment interval to forestall opposed choice.  Hostile choice occurs when sick folks join a well being plan, however wholesome folks don’t, which throws the quantity of threat a well being plan takes on out of steadiness when insuring somebody.

The place can you purchase particular person insurance coverage?

Throughout open enrollment, insurance policy can be found from main medical insurance coverage corporations to buy from “{the marketplace}” or “trade.” These plans are known as  “on-exchange” plans. Most states use the federal trade, Healthcare.gov. Some states, like California, New York, Pennsylvania, and some different states, have their very own state-run exchanges and enrollment methods. 

Once you store at Healthcare.gov, you’re solely seeing “on-exchange” plans. Nonetheless, insurance coverage corporations solely make a fraction of their plans obtainable “on trade.” In the event you go on to an insurance coverage firm’s web site, you’ll see their “off-exchange” plans.

The Take Command platform is a good place to start out purchasing as a result of you possibly can take a look at ALL of the obtainable plans facet by facet (together with “off-exchange” plans) to match – and see which plans are “Straightforward-Enroll”. True to the identify, Straightforward Enroll plans have simple, quick enrollment (Take Command takes care of it!) and our crew can assist you with the Provider! Search for the Straightforward Enroll tag for added peace-of-mind.

In the event you’re prepared to start out purchasing, you possibly can view all your choices facet by facet on our platform.

What’s “{the marketplace}” or “trade”? 

The Reasonably priced Care Act created a medical insurance trade, or on-line market, the place people can store for particular person medical insurance plans and examine their well being plan choices. That is recognized to most as Healthcare.gov. People are solely eligible to obtain premium subsidies and cost-sharing reductions in the event that they buy their protection by means of the trade.

Why is Open Enrollment vital for me?

As a result of your employer is providing you a well being reimbursement association, now’s the time to buy your plan for protection beginning on January 1st, 2026. It is essential to notice that you will have to enroll by December fifteenth, 2025 for protection that begins January 1st, 2026. Open enrollment continues by means of January fifteenth for February 1st begin dates. As talked about above, the dates could range barely in some states.

Open Enrollment is the time when you should purchase a compliant plan that’s certified in your HRA (both a certified well being plan for ICHRA or a Minimal Important Protection plan for QSEHRA). In the event you’re a consumer already utilizing our platform, there might be a to-do record in your dashboard. If you’re new right here, we are going to stroll you thru onboarding which can embody looking for a plan. After Open Enrollment begins in November, you may obtain an electronic mail to log in and get began looking for particular person medical insurance.

• Main medical plans: Main Medical plans are these compliant with the Reasonably priced Care Act (ACA) and qualify as Minimal Important Protection. In the event you bought your plan by means of Healthcare.gov or your state’s public market, your plan is a Main Medical plan, and your reimbursement by means of QSEHRA might be tax-free.
• Pupil insurance coverage
• Your partner’s plan (varies by QSEHRA plan): In the event you’re coated by your partner’s group insurance coverage plan there are some nuances to know concerning premium reimbursement. First, solely the portion of the group premium that’s  not paid for by your partner’s firm is eligible for reimbursement. Second, most group plans are already paid on a pre-tax foundation out of your partner’s paycheck. That is nice! Nonetheless, the IRS doesn’t need you to “double dip” and likewise get a pre-tax QSEHRA reimbursement, so your QSEHRA declare in your premium could also be paid on a taxable foundation (plan relying). In the event you can confirm that your premium is paid post-tax by your partner (very uncommon), then you possibly can nonetheless be reimbursed tax-free by means of QSEHRA!
• Authorities plans: Medicare, Medicaid, CHIP (youngsters’s medical insurance applications), TRICARE, and VA Care are all eligible healthcare plans and qualify as Minimal Important Protection. If you’re on considered one of these plans and pay a month-to-month premium out of pocket, these could be reimbursed by means of QSEHRA tax-free.
• Dental Insurance coverage & Imaginative and prescient Insurance coverage Plans: Month-to-month premiums paid for particular person and dental insurance policy could be reimbursed tax-free by means of QSEHRA. When you have dental and imaginative and prescient advantages by means of your partner’s employer, solely the portion of the group premium that’s  not paid  for  by your partner’s firm is eligible for reimbursement. As well as, in case your partner pays the premiums in your dental and insurance policy pre-tax, you possibly can solely be reimbursed for these premiums on a taxable foundation. 
• Restricted Profit Plans: Restricted Profit Plans are often considerably cheaper than Main Medical plans however solely present a set quantity of advantages (vs. limitless advantages). These plans embody short-term plans, mounted indemnity plans, accident plans, and another plan that pays a medical profit. So long as you even have a Minimal Important Protection well being plan, and the restricted profit plan pays a medical profit to the supplier (not a money profit to you), the premiums on these plans could be reimbursed tax-free by means of QSEHRA. 

Here’s a submit on plans that combine with QSEHRA and plans that combine with ICHRA that can assist you weigh your choices. 

Confused?

Here is the excellent news: Any plan that you simply buy on the Change might be compliant along with your HRA. Main medical off-exchange plans which might be obtainable throughout Open Enrollment will qualify as properly.

And this is extra excellent news: our platform will maintain your hand by means of this complete course of. 

Professional-tip: To see if a plan integrates along with your HRA, examine for a metallic tier (silver, platinum, bronze) within the identify or description of the plan. That is a very good signal. 

What if I am on Medicare with my HRA?

Nice information! Medicare is reimbursable along with your HRA. Bear in mind, you have to have protection of Half A and Half B collectively or Half C.  Half B by itself would not qualify.

To make this simpler, we have partnered with Chapter to make the Medicare enrollment course of a breeze. Chapter is a white glove service that may assist you to discover the appropriate Medicare Benefit and Medicare Supplemental plans which might be designed to assist cowl the prices of varied deductibles, co-payments and coinsurance prices that Medicare alone doesn’t embody.

All you may must do is select a protection possibility from main insurance coverage corporations based mostly on the place you reside and your particular person wants, then submit proof of protection to Take Command, together with receipts for eligible care, and get reimbursed tax-free.

Be taught extra on our Medicare partnership with Chapter right here.

Vital: Medicare Open Enrollment runs October fifteenth to December seventh. That is the time to judge present Medicare protection and your probability to make adjustments to your Medicare protection.

What are some issues it is best to keep away from whereas looking for a plan?

To start with, be an knowledgeable shopper. Obtain our PDF on “Well being Insurance coverage 101,” the place you may discover the essential definitions of key phrases you may have to know whereas looking for medical insurance (like formulary!). Understanding medical insurance jargon will preserve you out of bother and scale back these stress ranges. 

One other factor to pay attention to is that in case you are purchasing exterior of an trade, for instance by means of a dealer, be careful for plans that say indemnity or brief time period as they do not qualify for QSEHRA or ICHRA. For QSEHRA, some plans like this may be supplemented to qualify however they won’t work for ICHRA. 

Additionally essential: In the event you’re leaving an organization and COBRA is an possibility, 99% of the time, COBRA is a nasty deal. Don’t simply settle for it as a result of it’s simple. You could be billed for as much as 102% of the overall value of protection; 100% of the price of your earlier plan plus a 2% administrative charge! 

For QSEHRA: We are going to begin by explaining how QSEHRAs and Premium Tax Credit work collectively. Scroll right down to skip forward when you’ve got an ICHRA. 

Normally, QSEHRA allowance will scale back premium tax credit greenback for greenback.

Mainly the worker might be exchanging the tax profit from the federal government with the tax profit from the employer. The worker should still entry their tax credit if the profit is lower than the premium tax credit score obtainable to them. 

For instance, in case you are eligible for a $500 tax credit score and your employer affords a $400 QSEHRA allowance, your PTC might be decreased to $100 ($500-$400). 

It’s very essential that staff buying a plan by means of {the marketplace} and receiving a premium tax credit score notify their insurance coverage supplier instantly about their small enterprise HRA profit.  The insurance coverage supplier will recalculate the worker tax credit score with the QSEHRA profit. Failure to report the QSEHRA to your insurer will lead to having to pay again the tax credit to the IRS throughout tax time.

FOR ICHRA: When you have an ICHRA, this is what it is best to learn about PTCs and ICHRA.

Workers can select to take part in ICHRA or obtain a PTC. You can not have each.

A pleasant function of the particular person protection HRA is that as an worker, you could have the choice to take part in your employer’s ICHRA or opt-out yearly by means of the opt-out provision. That is completely different then ICHRA’s predecessor, QSEHRA, which doesn’t enable staff to opt-out. 

In the event you settle for the Particular person Protection HRA, you can’t declare any premium tax credit for the yr for both your self or any relations. In the event you opt-out of the Particular person Protection HRA for the yr, you might be able to declare premium tax credit.

The Change will then decide if the ICHRA supplied is deemed reasonably priced or unaffordable for you. In instances the place an worker has opted out of ICHRA and the HRA is taken into account unaffordable the worker is allowed to assert premium tax credit for themselves and dependents. In instances the place the worker has opted out of ICHRA and the protection is deemed reasonably priced the worker could not declare any premium tax credit for themselves or dependents. 

When people enroll in an Change plan, the Change will ask if the person is obtainable any protection by means of their employer. This consists of protection by means of the Particular person Protection HRA. Workers might be required to provide discover to the Change of their ICHRA providing. 

Throughout the onboarding course of with Take Command, we are going to assist you to perceive these nuances and decide what’s finest for you.

How will you get extra details about Premium Tax Credit?

First cease, take a look at your plan paperwork in your portal. The worker discover, particularly, can have nice data on what to do about your PTCs that is tailor-made to you and your precise plan. Additionally take a look at the next sources:

Try our useful weblog submit on what the metallic tiers imply for extra data. 

What are insurance coverage “premiums” and “deductibles”?

A premium is the month-to-month value in your medical insurance. The premium is what your month-to-month allowance for an HRA will cowl.

A deductible is the quantity of coated healthcare prices you pay earlier than your medical insurance begins to cowl the prices. When you have a $2,000 deductible, you may be paying $2,000 out of pocket earlier than insurance coverage kicks in. 

Professional-tip: Your month-to-month premium doesn’t rely towards your deductible. 

What are the variations between the community sorts (HMO, PPO, EPO)?

An HMO (or “well being upkeep group”) is usually essentially the most reasonably priced, however least versatile community kind. Right here a couple of key ideas of a HMO:

• You’re required to pick a main care doctor (or the insurance coverage firm can assign one for you) who’s your first-stop for well being wants. You have to a referral out of your main care doctor to see a specialist.
• In the event you select to see a physician exterior of the community or and not using a referral, you’ll typically must pay all prices out-of-pocket until it’s a true medical emergency or you don’t have any different choices.
• The doctor community is native.

A PPO (or “most popular supplier group”) is usually essentially the most versatile, but costliest community kind. Right here a couple of key ideas of a PPO:

• You don’t want to pick a main care doctor and you do not want referrals to see a specialist.
• In the event you see an in-network supplier, you’ll solely be chargeable for paying a portion of the invoice (based mostly in your plan’s protection construction).
• In the event you select to see a physician who’s exterior the popular community, you’ll typically must pay a bigger portion of the invoice than you’ll for an in-network supplier.
• You’ll have entry to out-of-state suppliers which might be thought-about in-network.

An EPO (or “unique supplier community”) is a hybrid of a HMO and a PPO. Right here a couple of key ideas of an EPO:

• EPOs are extra versatile than an HMO, and are usually inexpensive than a PPO.
• Like a PPO, you do not want a referral to get care from a specialist.
• Like an HMO, you might be chargeable for paying out-of-pocket in the event you search care from a physician exterior your plan’s community.

A POS (or “level of service”) can also be a hybrid of a HMO and a PPO. Listed below are a couple of key ideas of a POS:

• POS plans are extra versatile than an HMO, and are usually inexpensive than a PPO.
• Like an HMO, you have to a referral out of your main care doctor with a purpose to see a specialist.
• Like a PPO plan, you should have entry to out-of-network suppliers (at an elevated value).

Can I alter medical insurance plans in the course of the yr?

You may solely change plans and purchase on-exchange plans throughout Open Enrollment (from November 1st by means of January fifteenth) until you meet sure circumstances that qualify you for a Particular Enrollment Interval. These circumstances embody having a child, getting married, getting divorced, or altering jobs. In different phrase, massive life adjustments.

If you’re supplied an HRA for the primary time out of your employer, that qualifies you for a Particular Enrollment Interval as properly, the place you may have 60 days to enroll in a well being plan that meets your HRA necessities. 

Professional-tip: We advocate you benefit from Open Enrollment to enroll in a plan. You will have extra choices.

Learn our posts on Particular Enrollment Intervals for QSEHRA or Particular Enrollment Intervals for ICHRA for more information. 

What about dental insurance coverage? 

There are two methods to enroll in dental insurance coverage.

1. The Market: Dental plans typically are included in well being plans offered on the Market or state-based exchanges. Once you examine plans on our window purchasing software and even on Healthcare.gov, you’ll see which of them embody dental protection. In these instances, your premium would cowl each well being and dental protection. 
2. Separate dental plans: In case your well being plan doesn’t embody dental protection, it’s possible you’ll to buy a separate dental insurance coverage plan. Simply bear in mind, in the event you choose a separate dental plan, you’ll pay a separate premium. That is along with the premium you pay in your particular person medical insurance plan. Typically, whenever you’re purchasing on the Change, you may see an possibility so as to add a dental plan. This may present additional choices for you. For our shoppers, we now have researched high quality particular person medical insurance plans by means of Renaissance and AmFirst that we advocate to make use of with an HRA. 

Here is a useful submit for extra details about our dental partnerships.

Subsequent Steps

That is an thrilling time, and we’re honored to part of this course of with you. When you have another questions as you start the method, please attain out. We’re right here that can assist you! And for these of you who’re able to being, please login to our portal and we’ll stroll you thru the method.

Completely happy Open Enrollment, everyone! 🎉