10 key things to know about health insurance in 2026

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It’s important to look at all options and get some form of health coverage. Free unbiased help is available. Read the full article here.

Resources:

Michigan Medicine Patient Financial Counselors

Washtenaw Health Project

healthcare.gov

Healthcare.gov: Find Local Help

ACA plans that U-M Health’s hospitals, health centers and providers in SE Michigan will accept in 2026

List of plans accepted at UM Health-Sparrow

VA: Expanded eligibility criteria for veterans

Coverage Calculator & Qualifying Income

Healthy Michigan Plan

MIChild program & its equivalent in other states

Catastrophic Health Plans

Understanding Health Savings Accounts

Healthcare.gov: Immigration Status Information

Federally Qualified Health Centers

For more on this story and for others like it, visit the Health Lab website where you can subscribe to our Health Lab newsletters to receive the latest in health research and information to your inbox each week. Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can listen to Health Lab wherever you get your podcasts.

All Health Lab content including health news, best practices and research insights are for informational purposes only and are not a substitute for professional medical guidance. Always seek the advice of a health care provider for questions about your health and treatment options.

Transcript 

Host: 

Welcome to Health Lab, your destination for news and stories about the future of healthcare. 

Today: With worries about health insurance topping the list for many Americans heading into 2026, it’s important to look at all options and get some form of health coverage. No matter what happens in Washington, D.C., free, unbiased help for navigating health coverage is available. 

Just a quick note that any resources mentioned in this episode will be linked in the show notes. 

If you buy your own health insurance, or had planned to for next year, you might have seen news stories and social media posts going around about health insurance costs going up soon - and not just going up a little but, but going up a lot.

You also might have heard that extra government funds to help people afford health insurance have expired and might not be replaced.

And all of this may have left you feeling confused and worried, especially with deadlines coming up soon.

You may even think you should just try to go without health insurance to save money.

But University of Michigan Health experts have some important timely advice: Don’t make any decisions until you have explored all your options.

There is still money available to help some people with their health care costs, but exactly who and how much depends on Congress and the president.

Whatever you do, the experts say, don’t go without health coverage if you are able to afford an available plan, and get help finding the best available option for you.

A. Mark Fendrick, M.D., director of the U-M Center for Value Based Insurance Design and a professor at the U-M Medical School explains, “For 15 years, people who don’t get health insurance from an employer, and don’t qualify for Medicaid, Medicare or other plans, have had the option to buy their own coverage under the Affordable Care Act, or ACA. This year, there’s uncertainty about who exactly will get help from the federal government to reduce the cost of coverage, and how much they will get, which has raised a lot of worry,” he added.

He goes on, “But what we know from the days before the ACA is: Being uninsured is hazardous to your physical and mental health, and could dramatically impact your financial health. Before you decide that it is just too expensive to enroll in a health plan, it’s worth checking out the options and considering cutting costs in other areas of your budget to afford health insurance,” he said, “because one unexpected illness, injury or operation could spell financial ruin if you don’t have coverage.”

Alena Hill and her team of Michigan Medicine Patient Financial Counselors have heard a lot of worry in recent weeks since the enrollment period began.

They run a toll-free helpline that anyone in Michigan can call – whether or not you’re receiving care at U-M Health – to talk through their options. If you live in Michigan, the team can be reached by phone at 877-326-9155 or by email at [email protected] between 8 a.m. and 4 p.m. Monday - Friday.

Hill says, “We want to help people, and we hope they’ll call us, or our partners at the Washtenaw Health Project, or other unbiased trained counselors near them.”

If you are closer to Lansing or Grand Rapids, Hill also notes that there are also trained counselors at who are part of the U-M Health regional network at UM Health-Sparrow who can be reached at (517) 364-6060, and at UM Health-West who can be reached at (616) 252-7110.

For people who live outside Michigan, she notes that counselors who are listed as “assisters” in the “Find Local Help” section on healthcare.gov are not paid by health insurance companies, and they offer independent advice.

And as we approach the new year, here are 10 key things to know about health insurance in 2026:

1. Act soon.

If you want your coverage to begin January 1st, you have until December 15th to commit to a plan and pay your first bill. 

If you don’t do it by then, you can still sign up and pay before January 1st and have coverage, but your coverage won’t start until February 1st.

If you miss the January 1st enrollment deadline entirely, you may qualify to enroll later in 2026 if you experience a significant life change such as losing a job; getting married, getting divorced or widowed; moving to another state; or having or adopting a child.

If Congress and the president don’t make a deal about government assistance for insurance costs by December 14th, it’s up to you whether you want to enroll on December 15th for the best plan you can afford, or wait to see if they make a deal by December 31st, enroll by then, and just go without coverage until your plan kicks in on February 1st.

2. Don’t assume anything.

The healthcare.gov insurance marketplace has five tiers of coverage: catastrophic, bronze, silver, gold and platinum.

Because of weird quirks in the way health insurance on the individual market is priced, you may actually pay less for a higher-level plan than a lower-level plan, especially gold vs. silver.

At every level, Hill advises to consider the total costs.

Don’t stop at what it will cost you each month, which is also called the premium, but also look at the deductible, which is how much you’ll have to pay for care before your insurance kicks in, and the co-pay and co-insurance amounts you’ll have to pay when you get care.

Also, check the network of hospitals and providers that are considered “in network” and the list of medications a plan will cover, especially if you have a doctor you like or a prescription you rely on.

A list of ACA plans that U-M Health’s hospitals, health centers and providers in southeast Michigan will accept in 2026 will be linked in the show notes for this episode, along with a list of all plans accepted at UM Health-Sparrow.

If you currently have insurance that you bought on the Healthcare.gov site or a state marketplace, you may be tempted to just automatically let the system re-enroll you for next year.

But don’t assume that the plan you have now will be the best one for next year. Your current plan may not even be offered next year, or another plan may be better for you or cost less in monthly premiums, deductibles and co-pays.

3. Know what is available for veterans.

Check to see if you might be eligible for Veterans Health benefits as the criteria have expanded recently. Even if you didn’t qualify before, you may now.

4. Your exact income really counts this year.

That’s because federal help with insurance costs will no longer be offered for people with incomes over 400% of the federal poverty level.

But people with incomes below this cutoff will get at least some help with the cost of their insurance. How much help is up to Congress and the president.

In the show notes you can find a link to a calculator on healthcare.gov that will help you understand where your income falls based on how many people live with you, along with a list of what kinds of income count.

The income levels that the calculator shows for each household size are the 100%, 200%, 300% and 400% of the poverty level for that state.

If your income is just over the 400% line, even by a dollar, you may want to consider whether there are ways to reduce your income slightly in order to qualify for help, or you can contact insurance brokers and companies directly to see if you might be able to buy a plan directly for less than it would cost you on the healthcare.gov site.

5. If your income is between 200% and 399% of the federal poverty level, you may want to wait until Congress and the president act before choosing a plan.

That’s because you are in the bracket of income that will receive some sort of help with the cost of self-purchased health insurance, but exactly how much you’ll get is still up in the air.

Extra help is set to expire on New Year’s Eve unless Congress and the president renew it.

But remember, in order to have coverage on January 1st 2026, you need to sign up and pay your first payment by December 15th of this year.

6. If you have a low income, you will not face the high monthly costs that you might have heard about on the news. And Medicaid changes aren’t happening soon.

If your income is under 200% of poverty, you will definitely qualify for government help with the cost of your coverage.

If your income is below 138% of poverty for your state, you may qualify for Medicaid or a Medicaid expansion plan such as the Healthy Michigan Plan.

You may have also heard that changes are coming to Medicaid plans that require people to confirm twice a year that they still have a low income and that they are working, volunteering, going to school or caregiving in order to keep their benefits, but these changes aren’t taking effect immediately.

However, if you qualify for Medicaid, it is really important to make sure to update your phone number, email address and street address on file so that you won’t miss notifications about changes that are coming later.

Also, even if you make too much money to qualify for Medicaid, your children may qualify for the MIChild program in Michigan, or its equivalent in other states, which is free to the family. Children in Michigan families that make up to 217% of poverty are eligible for this program.

If you live in the 10 states that have not expanded Medicaid and your income is under the federal poverty level, but too high to qualify for your state’s Medicaid program, at this time you are not eligible for government help with the cost of buying health insurance.

7. Your age counts as well.

Insurance plans that people buy directly under the Affordable Care Act aren’t allowed to charge people more based on their health or disability status. But they are allowed to charge more based on age.

So if you’re in your 50s or early 60s, you may see the biggest rise in insurance costs. Make sure to talk with a trained and unbiased advisor to find the best option for you.

8. If nothing else, you can consider a catastrophic health insurance plan. 

These are stripped-down, bare-bones plans that have low monthly premiums but very high deductibles (meaning that you would have to bear the cost of the health care you receive until it reaches thousands of dollars).

You can only get these plans if you’re under age 30, or don’t qualify for any government assistance with your health insurance costs, or your insurance will cost more than 8% of your total income even if you do get help.

These are not the best insurance choice for most people; if you qualify for any federal help with your insurance costs, you’re better off choosing a higher-tier plan.

But if you don’t, or you can’t afford one of the plans available to you, catastrophic plans offer a way to get coverage for the worst-case scenarios like major accident or illness.

Plus, under the Affordable Care Act, they must cover 10 types of essential care, including three primary care visits and the cost of certain preventive care, before you’ve met your deductible.

If you get a catastrophic plan, be sure to put as much money as you can in a Health Savings Account. More information on HSAs will be linked in the show notes.

If you end up facing medical bills you can’t afford next year, hospitals and health systems usually offer financial help, but they usually have a requirement that you have the coverage you qualify for, and that you’re below income limits.

9. If you get a plan with a high deductible, open a Health Savings Account, or HSA.

Every bronze and catastrophic plan is eligible for HSAs, and some other higher-level plans may also be HSA-eligible, but you would have to check the plan’s details to confirm.

An HSA makes it possible for you to put money into a special account that doesn’t charge taxes when you take the money out and spend it on qualifying health expenses that your plan doesn’t cover, such as your costs up until you meet your deductible. You can keep the account from year to year, and let the money build up if you don’t use it.

10. If you’re an immigrant, it is important to check now to see if your immigration status makes you ineligible for health coverage.

There have been recent court cases and federal policy changes that limit which immigrants to the United States can buy health insurance on healthcare.gov.

People who used to be eligible, including the “Dreamers” covered under the DACA program, may no longer be eligible. Information about eligibility and where to get care will be linked in the show notes as well. 

Community health clinics, federally qualified health centers, and hospitals and health systems may offer free or reduced-cost care for people in these situations, and if you are in Washtenaw County, the Washtenaw Health Project also has options.

No matter what, Fendrick and Hill say it’s important to get help navigating health coverage, especially in this complicated year.

A reminder that all Health Lab content including health news, best practices and research insights are for informational purposes only, and are not a substitute for professional medical guidance. Always seek the advice of a health care provider for questions about your health and treatment options.

For more on this story and for others like it, visit michiganmedicine.org/health-lab where you can also subscribe to our Health Lab newsletters to receive the latest in health, wellness and medical research information to your inbox each week. Health Lab is a part of the Michigan Medicine Podcast Network, and is produced by the Michigan Medicine Department of Communication. You can subscribe to Health Lab wherever you listen to podcasts.