07 Oct Worried About Affording a Marketplace Health Plan in 2026? Tips for Shopping Smart During Open Enrollment

October 7, 2025 ~ Open Enrollment for Marketplace health insurance plans starts November 1, 2025. These plans – also known as Affordable Care Act (ACA) plans – are available at HealthCare.gov or through your state’s Health Insurance Marketplace.

With rising health care costs, you may be wondering if you will still be able to afford a health insurance plan for 2026.

Also, the additional financial assistance in a pandemic-era law, that lowered monthly premiums for most people, is expiring on December 31, 2025, unless Congress takes action to extend it. Without an extension, health insurance premiums are expected to go up significantly.

This blog helps you understand your options if you are concerned about the cost of a Marketplace plan and describes some other ways to pay for health care.

What Will a Marketplace Health Insurance Plan Actually Cost You for 2026?

Figuring out the most you will have to pay for a Marketplace health plan during the year is actually very simple: Multiply the monthly premium amount by 12 and add it to the plan’s annual out-of-pocket maximum.

For example, if you want to know the most you would pay for a Gold plan that has a $300 monthly premium and an annual out-of-pocket maximum of $2,500, here’s how you do the math.

• Step 1: $300 (monthly premium) x 12 = $3,600
• Step 2: $3,600 (total amount of premium costs per year) + $2,500 (out-of-pocket max) = $6,100 total maximum cost for the year

Remember that cost isn’t the only consideration when picking a plan. Also check to make sure that your providers, facilities, and prescription drugs are all covered by any plan you choose.

To help you do the math to understand a plan’s costs and confirm it covers the things you need, use Triage Cancer’s Health Insurance Comparison Calculator & Worksheet.

Although the future of the additional financial assistance for Marketplace plans is uncertain at this time, you may still qualify for some financial help to reduce the cost of your plan in 2026, based on your income level.

There is also an online calculator to get an estimate of what a Marketplace plan will cost you for 2026, if the additional financial assistance is not extended.

Should I Consider a High Deductible Health Plan?

A High Deductible Health Plan (HDHP) generally has a lower monthly premium but higher out-of-pocket costs before your insurance begins to pay. In 2026, HDHPs will have a minimum deductible of $1,700 for individuals, or $3,400 for a family plan. Additionally, in 2026, the total annual out-of-pocket expenses cannot be more than $8,500 for individuals, or $17,000 for a family plan.

A HDHP can be paired with a Health Savings Account (HSA), where you can:

• Set aside pre-tax dollars (in 2026, you can set aside up to $4,400 for individual coverage, and up to $8,750 for family coverage)
• Use the money for qualified health expenses, including deductibles, co-payments, prescriptions, and more
• Carry over unused funds year to year

Starting in 2026, all Bronze Marketplace plans as well as Catastrophic plans (discussed in more detail below) will qualify as a HDHP and be eligible to use with an HSA.

If offered by your employer, another way to save pre-tax dollars for health expenses is through a Flexible Savings Account (FSA), although these may have stricter rules about how you can use the funds and limited rollover options after the plan year ends.

For more details about how HSAs and FSAs can help reduce the cost of having a HDHP, read Triage Cancer’s Quick Guide to High Deductible Health Plans, HSAs, & FSAs.

When Are Catastrophic Plans a Good Option?

Catastrophic plans may seem like a good option because of their low monthly premiums, but there are some big downsides. They aren’t sold in every state, not everyone qualifies, and in 2026, you’ll have to pay a $10,600 deductible before your insurance starts covering most care.

However, if you are not able to afford another type of plan in the Marketplace, they will provide some level of coverage.

For those with a plan available in their area, here’s who qualifies:
1. people under 30

2. those with an affordability exemption (the lowest-priced coverage you can buy on the Marketplace or through your employer would cost more than 7.97% of your annual household income)

3. those with a hardship exemption for reasons such as you:

• live in a state that didn’t expand Medicaid and are ineligible for other Medicaid programs,
• have substantial debt from unpaid medical expenses,
• experienced hardship buying medical insurance, including not being eligible for premium tax credits,
• had another hardship, such as filing for bankruptcy, experiencing domestic violence, or experiencing homelessness

See the complete list of health coverage exemptions, and how to apply.

There are some benefits to Catastrophic plans, despite the high out-of-pocket costs, including that they:

• cover the same 10 essential health benefits as other Marketplace plans;
• provide the same preventive services with no cost-sharing as other Marketplace plans;
• pay for 3 primary care visits before you have to meet your deductible, although co-pays may apply; and
• the out-of-pocket maximum is the same as the deductible, so you won’t have any more out-of-pocket costs once you’ve paid that $10,600 deductible.

But before you choose a Catastrophic plan, do the math! Another Marketplace plan may be more cost-effective, even if the monthly premium is higher. Here are some examples of how that could be the case:

Comparison Example:

Plan Type	Premium	Deductible	Out-of-Pocket Max	Total Cost/Year
Catastrophic	$275	$10,600	$10,600	($275 x 12) + $10,600 = $13,900
Bronze	$375	$7,000	$8,500	($375 x 12) + $8,500 = $13,000
Silver	$500	$5,500	$6,500	($500 x 12) + $6,500 = $12,500

The savings from other Marketplace plans can be even bigger because Bronze, Silver, Gold, and Platinum plans may qualify for financial help to lower monthly premiums, but Catastrophic plans never do.

Another downside is that Catastrophic plans may not last all year. Some hardship exemptions cover 12 months, such as if you would qualify for Medicaid but are ineligible because your state hasn’t expanded its Medicaid program.

But most hardship exemptions only cover the time of the hardship plus the months right before and after. If your hardship ends mid-year, your Catastrophic plan could end too. You’d likely qualify for a Special Enrollment Period to switch to another Marketplace plan, but you would have to start over with a new deductible and out-of-pocket maximum.

Finally, if you have a chronic or serious condition and need health care services throughout the year, it may be very difficult to pay a $10,600 deductible before your insurance begins to pay.

Starting November 1, 2025, the Marketplace will make applying for a Catastrophic health plan easier. If you apply online and request financial assistance, you will be automatically screened to see if you qualify for a Catastrophic plan. You can also use a paper application to apply based on affordability or any kind of hardship.

What if Someone Offers to Sell Me an Off-Marketplace Plan?

Those who don’t qualify for financial help to buy a Marketplace plan sometimes wonder if they have other options outside the Marketplace.

A huge benefit to buying from the Marketplace is that all plans sold there include the Affordable Care Act’s (ACA) consumer protections. If an insurance agent or broker offers to sell you a plan that complies with the ACA even though it’s not on the Marketplace, here are some things you should ask:

• There should be a Summary of Benefits and Coverage – can I see it?
• There should not be any limits or exclusions for pre-existing conditions – are there any?
• There should not be any lifetime or annual dollar limits – are there any
• The same Essential Health Benefits required by the ACA should be included in this plan – are they?
  • Compare against the full list of the ACA’s Essential Health Benefits
• The same no-cost preventive health services required by the ACA should be covered by this plan – are they?
  • Compare against the full list of the ACA’s preventive health services
• Coverage should be allowed for children under 26 – is it?
• Rescissions (canceling coverage retroactively) should be prohibited – are they?
• Renewals should be guaranteed – are they?
• In 2026, the out-of-pocket maximum should be no more than $10,600 for an individual and $21,200 for a family – can you confirm that the out-of-pocket maximum for this plan is at or below those amounts?
• All money paid towards deductibles, co-pays, and coinsurance for both medical care and prescription drugs must count towards the out-of-pocket maximum – are all these costs included?

Why Should I Avoid Short-Term Plans, Even If They’re Cheaper?

Short-term or “limited duration” plans are designed to offer temporary coverage during times of transition, such as when you change jobs. These plans are often tempting because they may seem less expensive than other types of plans, but that’s because they don’t have to comply with the same ACA consumer protections that Marketplace plans do.

These plans often:

• Don’t cover pre-existing conditions
• Don’t renew your coverage if you are diagnosed with a serious medical condition
• Don’t cover all essential health benefits (e.g., can exclude things like chemotherapy or prescription drugs)
• Have dollar limits on coverage

You can spot a short-term limited duration plan if it includes a disclosure that says it is “NOT comprehensive health coverage.”

Even though these plans may seem cheaper up front, they can leave you with huge medical bills because of all the things they don’t cover. To learn more, read Triage Cancer’s blog.

To find out if your state has any laws related to the sale of short-term limited duration plans in your state, please see Triage Cancer’s Chart of State Laws for Health Insurance Options.

What About Health Care Sharing Ministries?

Health care sharing ministries (HCSMs) are organizations where members agree to share the cost of each other’s medical care. Members usually pay a monthly membership fee to be a part of the ministry, and may be asked to contribute more money to help cover expenses when a member needs care.

HCSMs are often attractive to consumers because they are advertised as a less expensive and easier way to pay for health care.

If you are considering joining a HCSM, know that these plans are:

• not health insurance
• not legally required to pay for your care
• not regulated by state insurance departments
• don’t have to comply with the ACA’s consumer protections
• often deny coverage for pre-existing conditions or services they don’t agree with (like mental health or reproductive care)
• may not have a way to appeal or challenge coverage denials

Before joining a HCSM, make sure that you understand the details and that you are comfortable with the arrangement. Use Triage Cancer’s Resources by Location page for your state’s insurance agency if you would like information before joining a HCSM.

What If I Can’t Buy a Marketplace Plan Because of My Immigration Status?

To buy a Marketplace health plan, you must be a U.S. Citizen, or be a “lawfully present” immigrant. The rules for who is considered “lawfully present” to buy a Marketplace plan are changing.

Right now, lawfully present immigrants include Green Card holders (Lawful Permanent Residents), Asylees, Refugees, people with certain visas, and others. You can see the full list of eligible immigration statuses for who can buy a Marketplace plan here.

Even if you are lawfully present and can buy a plan, new rules created by Public Law No: 119-21 (i.e., the “One Big Beautiful Bill”) will soon limit who can get premium tax credits (the financial help that lowers monthly premiums) when buying a Marketplace plan.

• Starting in 2026: Only lawfully present immigrants with income above 100% of the federal poverty level (FPL) will qualify for premium tax credits.
• Starting in 2027: Only Green Card holders, Cuban and Haitian entrants, and people from Micronesia, Palau, or the Marshall Islands living in the U.S. will qualify for premium tax credits.

These changes will make it harder for many immigrants to afford Marketplace coverage, even if they are eligible to buy a plan.

What if I am Going to be Uninsured in 2026?

If you have a Marketplace plan not, but will not be able to afford a plan in 2026, and do not qualify for Medicaid or Medicare, there are some practical steps that you can take before the end of the year.

• Schedule appointments now – book routine checkups, immunizations, bloodwork, and important screenings, like mammograms, pap smears, and colonoscopies. Even if you will have health insurance in 2026, you can save yourself money by getting care now if you have already met your out-of-pocket maximum for 2025.
• Refill prescriptions early instead of waiting until you run out.
• Ask about 90-day prescriptions – check if your doctor or pharmacy offers 90-day prescriptions (usually through mail order) so you can stock up before your coverage ends.
• Save important documents – download or print copies of things like test results, medical records, and Explanation of Benefits (EOBs) in case you lose access to your health insurance plan’s online portal.

If you don’t have insurance, there are still places to get affordable or free care:

• Federally Qualified Health Centers (FQHCs): provide primary care on a sliding fee scale based on what you can pay. They cannot deny care because of lack of insurance. Find one at FindaHealthCenter.hrsa.gov.
• Rural Health Clinics (RHCs): provide care in rural communities, often with sliding fee scales. Search for one near you online.
• Community Clinics: many free or low-cost clinics are available for people without insurance. Visit the National Association of Free & Charitable Clinics to find one.
• Charity Care at Hospitals: Nonprofit hospitals must offer free or discounted care for patients who qualify based on income. Visit DollarFor.org, a nonprofit that helps people check eligibility and apply. They can even help with bills you’ve already received.

Ways to save on prescription drugs:

• Compare prices: Check GoodRx.com to find the lowest cost in your area. Pharmacies sometimes match competitor prices if you ask.
• Use free drug discount cards: Triage Cancer partners with NeedyMeds to offer a free discount card you can download and use without insurance.
• Look for patient assistance programs: Some drug companies offer coupons, discount cards, or even free medications if you qualify. Visit CancerFinances.org for help with managing prescription drug costs.

Check out Triage Cancer’s Quick Guide to Health Care Options When Uninsured for more information.

How Can I Stay Informed?

Shopping for health insurance can feel overwhelming, especially when money is tight. For more guidance, visit TriageCancer.org/HealthInsurance.

Sign up for Triage Cancer’s Blog or Podcast to stay up-to-date about the latest changes to our health care system and health insurance options.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through events, materials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

We're glad you find this resource helpful! Please feel free to share it with your communities or to post a link on your organization's website. However, this content may not be reproduced, in whole or in part, without the express permission of Triage Cancer. Please email us at info@TriageCancer.org to request permission. © 2025 Triage Cancer