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Below is an edited-for-clarity transcript of a discussion between Robert Powell and Jae Oh, author of Maximize Your Medicare, about the 2026 open enrollment period for the Affordable Care Act health insurance plans. Robert Powell: Open enrollment for Affordable Care Act (ACA) health insurance plans for 2026 begins on November 1, 2025. This period generally runs until January 15, 2026, though specific state-based exchanges may have different deadlines. It’s important to check local timelines since they may vary. Here to talk with us about what consumers need to know is Jae Oh, author of Maximize Your Medicare. Jae, welcome. Jae Oh: Here we go again, Bob. Thank you for having me. Robert Powell: Here we go again, indeed. Where should we begin? Plan Options and How to Choose Wisely Jae Oh: Well, you already covered a lot of the basics. The national rule is that open enrollment starts November 1, and you can preview plans now on Healthcare.gov. To qualify for the Advance Premium Tax Credit (APTC), often called the subsidy, you must meet certain income criteria based on the federal poverty level (FPL), household size, and age. If you earn less than 150% of the FPL, you’re eligible for the APTC. But the real complexity lies beneath the surface. The number of available plans has exploded — more than 100 in cities like Atlanta and Tampa. The real work is in choosing the right one for your health needs, network preferences, and budget. How ACA Metal Tiers Work Robert Powell: Let’s start with the basics — bronze, silver, gold, and platinum. Bronze plans are the least expensive, platinum the most. What do people need to know about these tiers, and how do they interact with the tax credits? More Health Care: How AI Could Monitor Brain Health and Find Dementia Soone Health insurers make a major move older Americans won’t like How the government shutdown affects Social Security, Medicare Jae Oh: These “metal” levels are simply categories used by CMS to group plans based on how much of your healthcare costs they cover. Bronze covers the least, platinum the most. But don’t assume platinum is always better. The network and provider access matter far more. You don’t want to pick a platinum plan only to find your doctor doesn’t accept it, especially if a lower-cost bronze plan would have worked just as well. If you qualify for the APTC, some silver plans also include lower deductibles and out-of-pocket maximums, making them a strong option. The nuances can make a big financial difference. HMO, PPO, or EPO: What’s the Difference? Robert Powell: When you talk about networks, we’re usually referring to HMO, PPO, and EPO plans, right? Jae Oh: Exactly. And it’s gotten complicated. In many areas, PPOs aren’t even available. Both HMOs and EPOs require you to choose a primary care physician who coordinates your care and refers you to specialists. The differences between HMO and EPO are subtle, but what matters most is ensuring both your primary doctor and any specialists you rely on are in-network. Changes to the Advance Premium Tax Credit Robert Powell: You mentioned earlier that the APTC will still be available for those under 150% of the FPL. But the enhanced version expires this year. Is that right? Jae Oh: That’s correct. As it stands, once your income exceeds 150% of the FPL, your tax credit drops off sharply. Previously, the enhanced APTC extended subsidies up to 400% of the FPL. That meant even higher-income households — say a couple earning $100,000 — still received help. But now, absent legislative action, those benefits will disappear. This could be a big shock for early retirees who use IRA or 401(k) withdrawals to fund living expenses, because those withdrawals count as taxable income — and that income directly affects your subsidy eligibility. Premium Increases and Who Feels the Pinch Robert Powell: There’s concern about steep premium hikes. What are you seeing so far? Jae Oh: It’s pretty much what I expected — significant increases. The hardest hit will be middle-class couples in their 50s and early 60s who must buy insurance before Medicare. We’re talking $20,000 or more in annual premiums for some households. It’s a huge burden for people who are comfortable but not wealthy. Planning For ACA Coming Changes Robert Powell: So, some consumers could be in for a nasty surprise. Jae Oh: Yes, but there’s still time to plan. People can manage cash flow strategically, tapping non-taxable sources of income in 2026 to preserve as much of their APTC as possible. Tax-Time Repayments and Tighter Verification Rules Robert Powell: KFF recently warned that some enrollees could owe more at tax time because of how the credit works. Thoughts? Jae Oh: Yes, that’s possible. In the past, if you received too much in advance tax credits, you only had to repay up to a capped amount. That cap is gone. Additionally, verification rules have tightened. Enrollees will need to confirm their income within narrower windows to keep their credits. The government is cracking down on both intentional and unintentional errors. Trade-Offs Between Premiums and Deductibles Robert Powell: KFF also noted that higher premiums may push consumers toward cheaper bronze or catastrophic plans with higher deductibles. Jae Oh: That’s right, and it’s not new. Lower premiums usually mean higher out-of-pocket maximums. Some people know they’ll hit the out-of-pocket max every year, so it’s worth calculating the total annual cost — 12 months of premiums plus the out-of-pocket maximum. If you’re healthy, a lower-premium plan may make more sense. But if you need a lot of care, be prepared for high deductibles. End of Year-Round Enrollment for Low-Income Consumers Robert Powell: Another change: low-income consumers can no longer sign up year-round. True? Jae Oh: Correct. Previously, those under 150% of the FPL could enroll at any time. That ended last year. Everyone must now enroll during the regular open enrollment window. Cuts to Navigator Funding Robert Powell: What about navigator funding — the grants that help nonprofits and community groups assist consumers? I understand that’s been cut significantly. Jae Oh: Yes, by as much as 90%. Some community volunteers may still help, but fewer resources are available. This will make it harder for people — especially those who already find health insurance confusing — to get guidance. ACA Court Challenges, Regulatory Delays Robert Powell: KFF also mentioned that some planned regulatory changes were blocked by a federal court. Could that affect 2026 enrollees? Jae Oh: Unlikely. Even if the courts eventually side with the administration, carriers have already locked in their plans and pricing for 2026. It’s rare for changes to apply retroactively once applications are accepted. Bigger Picture: Taxes and Healthcare Intertwined Robert Powell: We’ve covered a lot. Anything we missed — or anything worth reemphasizing? Jae Oh: Yes. This year more than ever, people are realizing how connected taxes and healthcare costs are. Your taxable income directly affects your health insurance premiums. These aren’t separate issues — they’re intertwined. Households that plan holistically, considering taxes, healthcare, and income together, will be in a far stronger position. Silver Lining: Opportunity Means Smart Planning Robert Powell: Right — these aren’t silos. They’re interconnected, often with painful consequences for those who forget that. Jae Oh: Exactly. But I don’t want to sound overly negative. With proper planning, these same connections can actually open doors. For instance, careful income and tax management can make early retirement possible. Robert Powell: That’s so true. Before the ACA, one of the biggest barriers to early retirement was, “How will I afford health insurance before Medicare?” The ACA changed that.
