2026 Benefits Open Enrollment: Q&A
From broader health coverage to greater financial flexibility for your family, reviewing your insurance options early helps you maximize your benefits before 2026 open enrollment closes.
Open enrollment isn’t just paperwork. It’s your opportunity to choose coverage that supports your health goals, protects your finances, and aligns with your family’s needs for the year ahead. Taking time now to review your options helps ensure you’re fully prepared for 2026.
Whether you’re comparing plans through the Health Insurance Marketplace or reviewing commercial coverage options, take time to understand what each plan offers. Many plans provide tiered coverage levels, cost-sharing support, and added benefits to help you manage specialty medications and ongoing care more affordably.
Even small changes in your benefits can affect access to infusion care, specialty medications, respiratory, nutrition supplies, and equipment. Reviewing the details now helps you make confident, informed choices and avoid surprises in coverage next year. Below are answers to common questions that can help you plan ahead for your health in 2026.
What is health insurance and why do I need it?
Health insurance helps cover the cost of medical care, from doctor visits and prescriptions to infusion treatments and hospital stays. Coverage can come through a public program, such as Medicaid, Medicare, or TRICARE, or through a private plan offered by your employer, your spouse’s employer, a parent, or the Health Insurance Marketplace.
What if I can’t afford insurance?
If cost is a concern, you may qualify for a reduced premium or lower out-of-pocket costs through the Health Insurance Marketplace. Depending on your income or age, you could also be eligible for Medicaid or Medicare. In addition, many nonprofit organizations offer premium assistance or help with covering copays, and our Community Resources team can connect you to these resources to make care more affordable.
When do I need to sign up for insurance coverage?
The open enrollment period for Health Insurance Marketplace plans runs from Nov. 1, 2025 – Jan. 15, 2026, in most states. If you enroll by Dec. 15, 2025, your coverage will begin Jan. 1, 2026. Enrollments completed between Dec. 16, 2025 – Jan. 1, 2026, typically begin coverage Feb. 1, 2026. Marking these dates is important to ensure you don’t miss your window to enroll in a Marketplace plan. Enroll at healthcare.gov or call 800-318-2596.
When is the Medicare enrollment period?
The Medicare open enrollment period runs Oct. 15 – Dec. 7, 2025. During this time, beneficiaries can enroll in a new plan, switch plans, or drop their current coverage. Any changes made during this period take effect Jan. 1, 2026.
What should I consider if I qualify for public insurance?
Public health insurance programs such as Medicaid, Medicare, and TRICARE offer valuable coverage for eligible individuals and families. Each program has its own requirements based on income, age, disability, or military service. It’s important to review which services are covered, including infusion therapy, specialty medications, and medical equipment, and to understand any copays or prior authorization steps. If you’re unsure which program best fits your needs, our team can help you compare options and maintain consistent access to care.
What if I get insurance through my employer?
If you’re covered through an employer-sponsored plan, your open enrollment dates may differ from the federal Marketplace or Medicare timelines. Check with your company’s Human Resources or Benefits Department to confirm your specific enrollment window and plan options. This is also a good time to review how your coverage supports specialty pharmacy needs, infusion therapy, or other ongoing treatments so there are no gaps in your care.
What should I look for when comparing or choosing a plan?
When reviewing your options, take time to look beyond the monthly premium. Compare deductibles, copays, coinsurance, and out-of-pocket maximums to understand your total yearly costs. Check that your infusion pharmacy, specialty medications, and preferred providers are in-network, and confirm coverage for medical equipment or nutrition supplies you rely on. A plan that seems less expensive at first may cost more later if your regular care or prescriptions aren’t included.
What happens if my needs change during the year?
If your health needs or treatment plans change, your coverage may shift too. Certain life events, such as moving, getting married, losing other coverage, or adopting a child, may qualify you for a special enrollment period that allows you to update your plan outside of open enrollment. Even if you don’t qualify, keeping your care team and specialty pharmacy informed can help ensure your medications, infusion therapy, and equipment remain covered without interruption.
What happens if I miss open enrollment?
If you miss the open enrollment period, you may still qualify for special enrollment if you’ve experienced a qualifying life event, such as losing other coverage, moving, getting married, or having a baby. Outside of these situations, you will generally be required to wait until the next open enrollment period to make changes. If you’re unsure whether you qualify, our team can help you review your options and connect you to available resources.
How can I get help reviewing my options?
Choosing the right insurance coverage can feel overwhelming, but you’re not alone. Our Community Resources team can help you understand your benefits, compare plan options, and find financial and nonprofit resources to help make specialty medications and infusion therapy more affordable. We work closely with providers, case managers, nonprofits, and payers to help ensure every patient has continuous access to the care and support you require throughout the year.
We’ll take it on. All of it.
PromptCare’s Community Resources team is here to answer your questions about marketplace exchange plans, commercial insurance, Medicare and Medicaid replacement, state Medicaid plans, and supplemental coverage.
866-451-8804
