Updated on 10/15/2026
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 as well as Medicaid changes which will be implemented on January 1, 2027. 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.
Below we’ve highlighted the major changes to know about for this open enrollment season.
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 Marketplace on healthcare.gov, open enrollment for 2027 coverage runs from November 1, 2026 through January 15, 2027. This means if you need to purchase health insurance via healthcare.gov, you must do so before January 15, 2027. These dates may be slightly different in some states, so go directly to healthcare.gov for more information.
If you have Marketplace coverage, you will be re-enrolled in the same plan as the previous year unless you enroll in a different plan before open enrollment closes. Before you re-enroll in a plan, it is worth checking your plan’s cost for the year and your tax credit eligibility again rather than letting your plan auto-renew. Extra tax credits that lowered monthly costs during the pandemic ended in 2026 and have not been renewed by Congress.
Some people who face significantly higher costs may be eligible for a type of Marketplace plan known as “catastrophic coverage.” When you apply through healthcare.gov, you will be notified if you qualify based on your age or income. These plans are designed to prevent very high medical bills and offer low premiums but very high deductibles—$12,000 for an individual in 2027. Most health care costs, including many diabetes costs, are out of pocket until you reach that deductible amount. Catastrophic plans do cover at least 3 primary care visits and preventive care before the deductible is met, and some plans cover insulin and CGMs pre-deductible, but not all do. These plans are also not available in every state. Be sure to understand how your insulin, devices, and other medical needs would be covered before enrolling 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 2027. Medicare’s Annual Enrollment Period runs October 15 through December 7, 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 or your state’s Medicaid agency, if you qualify. For changes in 2027, your state will reach out with instructions, so it is essential to open and respond to any mail, texts, or other communications from your state’s Medicaid program right away. Many states use a state-specific name for their Medicaid program, so know your state’s program name so you recognize official notices. Click here to find your state’s Medicaid program name.
Starting January 1, 2027, many adults ages 19–64 with Medicaid coverage will need to document at least 80 hours per month of a qualifying activity in order to keep their Medicaid coverage. Qualifying activities include:
- Paid employment
- Job training or job search activities
- Community service or volunteering
- At least half-time enrollment in higher or technical education
- Caregiving for a dependent
Exemptions exist for pregnant women, caregivers, veterans with disabilities, people in active substance use disorder treatment, and those who qualify as “medically frail”. Each state will individually decide the definition of “medically frail,” so it will be important to pay attention to information from your state’s Medicaid office to understand if T1D is included. People who are not working due to their health will need to work with their doctor to verify this to their state Medicaid program.
Redeterminations for Medicaid eligibility are also getting more frequent. States must now check some enrollees’ eligibility every 6 months instead of annually. There’s a bit of a grace period built in for some states but not all. Through 2027, some states will accept self-attestation when they do not already have information verifying work or an exemption on file.
To read more about the changes coming to Medicaid, please click here to get more information.
Immigration Status
Many legally present immigrants with income below 100% of the federal poverty level who do not qualify for Medicaid remain unable to get tax credits to help buy health insurance through healthcare.gov. If this affects you, you will be charged full price for healthcare.gov plans and will not be eligible for catastrophic coverage plans discussed above. If your employer offers health insurance, that will likely be your best option. If not, community health centers provide care at 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 has resources to help. For more information and tools for understanding insurance while living with T1D, visit our Health Insurance Guide.
