Open Enrollment for Medicare & ACA Marketplace - This Year Reviewing Your Plan Is Not Optional. It’s Essential.

I’m Carol Foley, a Licensed Insurance Agent & Medicare Specialist, and I’ve already had several clients come to me in disbelief at the numbers they’re seeing. One of my first ACA meetings this season was about a gentleman recently diagnosed with Cancer — his premium went up 150% overnight. The very next appointment was a family of six whose new monthly premium was quoted at $3,700 — an amount that’s simply unaffordable for most middle-class families.

Unfortunately, these aren’t isolated cases. This year, the combination of shrinking federal subsidies and rising insurance company costs is hitting many ACA policyholders hard. While the Affordable Care Act marketplace has been a lifeline for millions since 2014, the reality for 2026 is that many Americans are now priced out of their own “affordable” coverage.

The New Reality of ACA Premiums

Just recently, Politico reported on Florida residents facing staggering rate increases. One Miami woman, Francoise Cham, said her premiums are set to rise 250 percent, leaving her unsure how she’ll keep coverage while caring for her parents, brother and daughter.

Another story came from Boynton Beach’s Kara Farley, who previously struggled with medical debt before enhanced federal subsidies began in 2021. Her husband has Type 1 Diabetes, and she’s now undergoing treatment for Malignant Melanoma. “Our premiums are expected to double,” she said. “I honestly don’t know where we’ll find that extra money in our budget.” And Seth Grossman, a Clinical Psychologist from Parkland, shared that he’s already paying $3,000 a month to cover his family, including a son with Autism. In 2026, his premiums will jump to $4,500 a month.

These stories are heartbreaking — but they also highlight a growing truth: without a fix to the ACA Marketplaces, more working families will be forced to forgo coverage altogether.

Why Reviewing Your Plan This Year Is Essential

If you’re under 65 and enrolled in an ACA Marketplace plan, you simply cannot afford to “auto-renew” this year. Even if your plan worked for you last year, changes in subsidies, networks, or drug formularies could cost you thousands in 2026.

Here’s what I tell every client:

• Premiums have changed dramatically.** Even small income adjustments can cause big swings in your federal tax credit.

• Networks shift every year.** Your preferred doctors or hospitals might no longer be covered under your old plan.

• Drug coverage isn’t static.** Many ACA plans have modified their formularies, changing which medications are covered and at what tier.

• The federal subsidy structure may not help everyone.** Many middle-income earners—especially those not eligible for tax credits—are now being priced out of ACA plans altogether.

Private Alternatives:

Same Quality, Lower Cost

At Main Line Benefits Co., our team anticipated this pricing surge and prepared by identifying several non-ACA private plan options. These plans are built like traditional employer group health plans, but available to individuals and families outside the federal Marketplace — year-round.

Our private plans use nationwide PPO Networks such as Cigna, PHCS, Blue Cross Blue Shield and for many of our clients, the cost is half—or even one-third—of what an ACA plan would be.

These private options are ideal for individuals and families who don’t qualify for ACA tax credits, business owners and anyone who finds ACA coverage unaffordable. They meet the needs of clients who want freedom of choice in providers, access to major hospitals nationwide and predictable out-of-pocket costs.

Why Work With a Licensed Agent?

Health insurance today is more complex than ever. Choosing the wrong plan—or failing to review your options—can lead to major financial consequences.

That’s where a licensed insurance agent can make all the difference. At Main Line Benefits Co., our guidance is completely free. We represent multiple carriers, not just one and our goal is to help you find the **most cost-effective coverage that fits your unique health and financial situation.

We assist clients with:

• ACA Marketplace Plans

• Private Non-ACA PPO Plans

• Small Group & Self-Employed Plans

• Dental & Vision Coverage

• Supplemental (Cancer, Heart Attack, Stroke) Plans

• Life, Disability & Long-Term Care

Our consultations are no-cost, no-obligation and available 7 days a week from 8:00 a.m. to 8:00 p.m. during the Open Enrollment period.

Peace of Mind Starts With a Review

Even if you feel confident in your current plan, this is the year to schedule a quick review. During our consultation, we’ll look at:

• Whether your doctors and medications remain covered at an affordable rate

• How your premium and subsidy will change for 2026

• If a private PPO plan might better fit your needs or budget

• What additional savings or coverage options might apply to you

Healthcare is not one-size-fits-all. With significant changes ahead in 2026, doing nothing is no longer a safe choice. Whether you’re enrolled in an ACA Marketplace plan or exploring private coverage, this year’s Open Enrollment requires action.

At Main Line Benefits Co., our mission is to guide you through those choices—at no cost to you. Let us help you navigate these changes, protect your coverage, and ensure you’re getting the best value for your healthcare dollar.

Carol Foley

Licensed Insurance Agent & Medicare Specialist

Main Line Benefits Co.

1980 South Ocean Drive, Hallandale Beach, Florida 33009

Phone: (610) 639-5616

Email: cfoley@mlbenefitsco.com

www.mlbenefitsco.com

Bottom Line: Open Enrollment is here — and the landscape has changed. This year, reviewing your plan is not optional. It’s essential.

Credit: https://www.politico.com/news/2025/11/03/senate-democrats-trump-florida-obamacare-00634078?nid=0000014f-1646-d88f-a1cf-5f46b4500000&nname=florida-playbook&nrid=09ed32a5-594e-49a8-87c9-a4d174619cae