Important ACA changes to keep top of mind as you talk to clients during OEP
As we approach the 2026 plan year, we want to ensure you are equipped with information to guide your clients through upcoming changes impacting ACA members. Please review the summary changes, note action items required by members, and see the referenced regulatory materials for full details.
Reduction in enhanced premium tax credits
Enhanced premium tax credits, which have provided additional financial relief for many ACA members, will be reduced for the 2026 plan year. Members may see higher out-of-pocket premium costs as these enhancements are phased out. It’s important to prepare clients for the possibility of increased premiums and discuss budgeting strategies as needed.
Income verification requirement
Starting in 2026, members who have a $0 premium will need to verify their income to remain eligible for ACA subsidies. Passive renewal or inaction will not satisfy the requirement. This is a change from previous years’ income verification and is now a required step in the renewal process. Members with a $0 premium who do not complete this verification will be assessed an additional $5 monthly charge and may lose access to premium tax credits entirely. This is expected to be an annual process. Please emphasize to your clients the necessity of completing this requirement promptly.
HSA eligibility for bronze and catastrophic plans
Starting in 2026, bronze and catastrophic plans will be eligible for pairing with a Health Savings Account (HSA). Please note, however, that Blue KC does not offer HSAs for ACA plans. Members interested in opening an HSA will need to do so independently through another financial institution. This change provides more flexibility for those seeking the tax-advantaged savings that HSAs offer.
CMS finalizes definition of “lawfully present”
The Centers for Medicare & Medicaid Services (CMS) has finalized the definition of “lawfully present” for the purpose of determining eligibility to enroll in a qualified health plan through an exchange. As of August 8, 2025, CMS has removed “Deferred Action for Childhood Arrivals” (DACA) recipients from this definition. This change impacts the eligibility criteria for individuals seeking to enroll in health plans through the exchange.
Aetna exit opportunity and Broker Rollout reminder
As a result of Aetna’s exit from the marketplace, nearly 10,000 Aetna members in our service area will be seeking a new plan for 2026.
Blue KC will roll out new competitive plans for 2026, so please keep Blue KC in mind for your current and prospective clients. Our support is different because:
- We have a team of dedicated specialists to support your clients.
- Our broker customer service concierge team and two broker development and engagement specialists are dedicated to supporting you.
- We offer simplified enrollment through HealthSherpa.
