What is going to happen to my health insurance?

What is going to happen to my health insurance?

This is a tough question to answer as we are still discovering the intended and unintended consequences of the changes coming to your health insurance following new Marketplace rules, the passage of the “Big, Beautiful Bill,” and the proposed tariffs on the components that make up many of our prescriptions.

These are real challenges. Some estimates are that 700,000 of the 1.5 million Georgians could lose their coverages due to the cancellation of automatic re-enrollment; the tightening of application accuracy screens for things like income, tax filing history, citizenship and other eligibility information; and premium increases.

We’ve seen over the years that “data mismatches” can easily occur as life changes such as a divorce or the loss of a loved one who was the primary income earner can flag a mismatch in the information on your application vs. previous tax returns.

Some of the changes will be very good. We have had too many clients who have been stolen by bad actors using technology such as texting and social media marketing along with annoying call center solicitors who trick people into moving their health plan so they can make commission. We have had many people fooled into taking high deductible plans or plans that their doctors don’t accept as they were scammed by these health insurance pirates.

Here’s a partial list of changes and cuts:

• Eliminating eligibility for DACA recipients

• Eliminating subsidies for some lawfully present immigrants

• Anyone who didn’t file taxes in 2023, asked for an extension, or failed to reconcile their health insurance subsidies, will be ineligible to start a new plan

• Automatic enrollments will be changing. Clients can no longer automatically renew a $0 premium plan; at least $5 per month will be charged unless the plan is actively re-enrolled

• Shortening time for data mismatch corrections from 90 days to 30 days

• All previous years’ premiums must be paid before getting a new plan

• Elimination of special enrollment for households based on income for those between 100% and 150% poverty level

• Removal of cap on how much subsidy a tax filer will have to pay back if they underreported their income

• Special enrollment plans will not start without meeting new document requirements for things like the birth of a child, marriages, or loss of previous cover

• Shortening open enrollment by 45 days beginning in November 2026

• Locking out those denied Medicaid due to failure to meet work requirements

• Eliminating conditional eligibility for subsidies when documentation is required

We are prepared to help all of our clients as best as possible.

1. Since the law now eliminates automatic re-enrollment in many situations, we will be working hard to connect with you a little earlier than we have in the past. We will be calling and emailing and texting to get in touch with you between September 1st and December 15th.

   a.) There may be an opportunity in August-September to verify your information so that your plan auto-renews during the open enrollment period. We will keep you updated as the state and federal governments share more information about this verification opportunity.

2. We have the expertise to fix any data matching problems that come up. We will work with you to get your documentation uploaded and running before your first payment is due on December 31st.

3. Since Aetna has announced that it is exiting the Georgia Access marketplace, we will review all options with our Aetna clients and find the best fit for you and your family.

Initial filings by insurance carriers are indicating that Georgia will be seeing the fourth-highest rate increases in the nation.

There will still be negotiations between Georgia Insurance Commissioner John F King and the carriers. A lot can change before the final prices come out closer to November. Some are likely to be hurt by the pricing. Others may not see that much of a difference because when rates go up, so do the subsidies.

What you can do now to protect yourself and keep your coverage:

• Make sure your contact information, income, and other eligibility information is current with us and in GeorgiaAccess.gov. Continue to keep your information as up-to-date as possible

• Set-up auto-pay for your monthly premium payment so you don’t accidentally fall behind on payments and lose your coverage

• If you experience a major life event (marriage, divorce, death of a family member, moving, having/adopting a child, etc.), contact us as soon as possible so we can help you with any insurance changes that may result from your life event

• Call your members of Congress and urge them to renew the “enhanced premium tax credits” that almost certainly help to lower your monthly premiums. (More than 9 in 10 Georgians get this financial help.) Congress still has time to prevent our 2026 premiums from spiking unnecessarily. (Use this calculator to see how your premiums could change if Congress doesn’t act.)

• Check your plan and your premium during open enrollment (Nov. 1-Jan. 15, 2026). Plans and premiums may shift significantly ahead of 2026, so check to see if they still fit your needs and budget. If not, we’ll help you find a plan that works better.

Finally, in life we can only control the things we can control. But our partnership with you and with our community is strong. Working together we can and will beat the dire predictions. The pendulum of political power swings back and forth. But what remains a constant is our goal: to get and keep you covered so you can get the health care you need, and to make sure our local health care providers can get paid for the care they provide.

Thank you for your continuing partnership and we promise to keep you informed with updates as we learn them.

Sincerely,

Kirk Lyman-Barner, President

Client First Insurance Solutions, LLC