What You Need To Know About The Changes to the Health Insurance Marketplace Starting August 26

Starting August 26, several key changes will take effect in the Health Insurance Marketplace, following the Final Marketplace Program Integrity and Affordability regulation (passed June 25) and the One Big Beautiful Bill Act (passed July 4). These updates may affect how people qualify for coverage, maintain their coverage, and enroll in new plans. If you or someone you know relies on Marketplace insurance, here’s what you need to know:

1. No More Special Enrollment Period Based on Income

   In the past, certain low-income individuals could get a Special Enrollment Period (SEP) to sign up for coverage outside of the normal enrollment window. Starting August 26, the Marketplace will no longer offer an SEP based solely on income. This means you’ll need to qualify for a different type of SEP (such as losing other coverage, moving, or having a baby) or wait until the regular Open Enrollment Period to apply.

2. DACA Recipients Will Lose Marketplace Coverage and Tax Credits

   If you’re a recipient of Deferred Action for Childhood Arrivals (DACA), you will no longer be eligible for Marketplace coverage or the premium tax credits that help make insurance affordable. Current enrollees will be dropped from coverage. It’s important to start exploring other health coverage options as soon as possible, such as through an employer, a spouse’s plan, or community health programs.

3. Required Income Verification if No Tax Data Is Available

   If the Marketplace can’t verify your income using your latest tax return, you’ll now be required to submit proof of your income. This might include pay stubs, W-2 forms, or other official income documents. Without this proof, you could lose your tax credits or coverage. Signed statements will still be acceptable. They should include household income information and an explanation for the income projection. 

4. Less Time To Fix Data Issues

   Previously, the Marketplace allowed 90 days to fix issues with your application, sometimes with extensions. Starting August 26, the 90-day window still exists, but extensions will only be granted on a case-by-case basis and must be requested. If you receive a notice about missing documents or unresolved information, it’s more important than ever to act quickly.

5. Past-Due Premiums Must Be Paid Before New Coverage Starts

   If you owe back premiums to your insurance company from a previous plan, you may be required to pay those past-due amounts before you can start new Marketplace coverage. This change gives insurance companies the option to collect unpaid premiums before approving new enrollment.

These new rules make it more important than ever to stay on top of your Marketplace account, respond quickly to requests for information, and keep your income and household information up to date. Missing deadlines or not providing documents could mean losing your coverage or paying more for your plan.

If you’re unsure how these changes affect you, don’t wait. Get help now. Certified Navigators and enrollment assisters can help you review your options, gather documents, and stay informed.