Every year around this time, open enrollment begins for individuals and families to select their healthcare coverage options for the following year. This year, there are changes coming for people with Healthcare.gov/Marketplace plans and in 2027, changes for people with Medicaid. Staying informed about your plan and coverage options will empower you to take charge of your health and feel more confident about your decisions.
For the type 1 diabetes (T1D) community, understanding your deductible responsibility, out-of-pocket costs for drugs, devices, and supplies and if your preferred doctors are in-network are all factors to consider before making a selection. As always it is essential to pay special attention to the type of plan you’re enrolling in and the key elements that determine how much you will pay. You can learn more about this at Breakthrough T1D’s Health Insurance Guide.
Given recent government action, there are a number of pending changes that could impact your health care insurance decisions over the coming months. Below we’ve highlighted those major changes.
Employer insurance
If you receive insurance through an employer, your human resources department will communicate when your open enrollment period is (typically in November or early December). They should also note what action, if any, needs to be taken on your part. By staying informed, you will allow yourself ample time to understand any plan changes or differences in costs that your employer may announce.
If your employer offers a flexible spending account or health savings account, you must reenroll every year. These can be used to pay for your copays, deductibles and even for some non-prescription supplies like alcohol wipes and test strips. See our Health Insurance Guide for more information about these types of accounts.
Healthcare.gov/ Marketplace insurance
If you get your health insurance through healthcare.gov, open enrollment for these health plans is set for November 1, 2025 – January 15, 2026. This means if you need to purchase health insurance via healthcare.gov, you must do so before January 15, 2026. These dates may be slightly different in some states. Please go directly to healthcare.gov for more information.
Your monthly payments and/or cost sharing may be significantly higher in 2026 than in previous years. There was an increase in tax credits made available during the Covid emergency, but now that that has ended, these extra tax credits are no longer available. Many people will lose access to all tax credits and will have to pay the full premium every month. Deductibles and copays may also increase. This will raise the monthly cost for marketplace plans significantly for many people who buy plans from healthcare.gov.
Some people who experience significantly higher costs in 2026 may be eligible for a health plan type known as “catastrophic coverage”. When you apply for a plan through Healthcare.gov, you will be notified if you are eligible for one of these plans based on income. These plans are designed to prevent very high medical bills, so most health care costs, including many diabetes costs, will be out of pocket. They have high deductibles ($10,600 for an individual in 2026) but lower premiums. Catastrophic plans cover three primary care visits and some medications before the deductible is met but most costs will be paid out of pocket. Some of these plans may cover insulin and CGMs as preventive medications, so they can be covered before the deductible is met, but not all plans will do so. These plans are also not available in every state. Be sure to understand how your insulin, devices and other medical needs may be covered before you enroll in one of these plans.
Medicare
If you have Medicare or Medicare Advantage, click here to learn more about this coverage and any changes for 2026.
Medicaid
If you have Medicaid or think you might qualify there is no special open enrollment time; you can sign up at any time via healthcare.gov if you qualify.
Medicaid eligibility rules remain mostly the same for most of 2026, but will be changing in late 2026 and 2027. If you are currently enrolled in Medicaid, it is essential that you respond to any mail, texts or other communications from your state’s Medicaid program. Many states have a state specific name for their Medicaid program, so be aware of your state’s program name so you can watch for notifications from the program. Click here to find the name of the Medicaid program in your state.
Starting in late 2026, you may have to provide proof of employment or student status to remain eligible. To read more about the important changes coming to Medicaid in 2026, please click here to get more information.
If you have Medicaid coverage and have any questions or need to update your information, click here to see how to connect to your state’s Medicaid program.
Immigration Status
In 2026, many legally present immigrants who have income less than 100% of federal poverty level but do not qualify for Medicaid will no longer be able to get tax credits to help buy health insurance through Healthcare.gov. If you are someone who is losing these tax credits, you will be charged full price for healthcare.gov health plans, and will not be eligible for catastrophic coverage plans that are discussed above. If your employer offers health insurance, that will likely be the best option for you and/or your family. If not, community health centers provide health care for a low out of pocket cost and insulin manufacturers offer discounts for people who are uninsured. Visit our Help with Costs page for more information.
Breakthrough T1D also has resources to help. For more information and tools for understanding insurance while living with T1D, visit our Health Insurance Guide.
