Buying Health Insurance for 2026
Health insurance will see a lot of changes in 2026 with some health benefits being expanded and some reduced.
Looking to buy health insurance for 2026? Get up to speed on rules and policy changes and how they affect your options—plus, how to get or keep coverage.
Medi-Cal Asset Limits to Return
Medi-Cal savings and asset checks will begin again for many programs that were previously exempt. The asset limit is set at $130,000 for a single person, plus an additional $65,000 for each extra household member (up to 10). This change mainly affects older adults, people with disabilities, and non-MAGI Medi-Cal programs. MAGI-based Medi-Cal programs remain income-only and are not affected.
Medi-Cal Eligibility Freeze for Immigrants
Some undocumented adults and certain lawfully present adults will no longer be able to newly enroll in full-scope Medi-Cal. If you already have full-scope coverage, you can stay covered, but you must continue to renew on time and meet all eligibility rules to continue coverage. If you lose coverage, you have a 90-day window to fix the issue or your benefits will shift to restricted Medi-Cal.
Medi-Cal’s Dental Benefits Reduced for Some Immigrants
Some adult immigrants may lose full-scope dental coverage. Urgent and emergency dental services will remain covered, but routine and comprehensive dental benefits may no longer be available.
Medicare Advantage Payment Rate Increases
Medicare is giving Medicare Advantage health plans more money. This likely means premiums will not increase. Be sure to check your Annual Notice of Change letter when it arrives and that your doctors, meds, and pharmacy are still covered and meet your needs. If you do also have Medi-Cal, you’ll probably see more plan options that coordinate both benefits.
Vaccines Covered at No Cost
A new state law has empowered the California Department of Public Health to issue official immunization recommendations. Any state-regulated health plan is required to cover those vaccines with zero cost for the patient. That means no copay, coinsurance, or deductible to receive these life-saving routine and seasonal vaccines. California is now coordinating vaccine guidance along with Oregon, Washington, and Hawaii to keep access and messaging around consistent.
No Copay on Preventive Services
The same law that requires covering vaccines is also keeping copays and coinsurance at $0 for screenings, contraception, and other services in state-regulated plans. Those other services include cancer screenings, HIV screenings, and PrEP for those at risk, behavioral health screenings, pregnancy-related checks, and more.
This is meant to shield Californians from potential federal rollbacks.
Year-Round Low Income Special Enrollment Period Ends
The federal government under the Trump administration has ended the year-round special enrollment period for people with incomes at or below 150% of the Federal Poverty Level. That’s about $22,590 for an individual and $46,800 for a family of four using 2024 FPL figures for 2025 coverage. This means consumers now need to enroll during open enrollment or have a major life change (move, loss of coverage, birth, etc.).
60-Day Automatic Extension for Income Inconsistencies Ends
The automatic 60-day extension to fix any income inconsistencies will no longer be available. Now, when you receive a notice from Covered California requesting income documents, you have 95 days from the date of the letter to send them. If you miss the 95-day window, it can put your financial help (and even your health coverage) at risk. If you need more time or aren’t sure on what to submit, contact Covered California right away.
You Must Pay Back Extra Financial Help in Full
Starting with 2026 coverage, if you received more financial help than you qualified for, you’ll have to pay back that extra amount when you file your 2026 taxes in 2027. The old payback limits are gone. To avoid a surprise bill, notify Covered California any time your income or household size changes.
Some Covered California Plans Now HSA-Eligible
Most Bronze plans and all minimum coverage (catastrophic) plans through Covered California will be HSA-eligible. A Health Savings Account (HSA) lets you set aside pre-tax money and spend it tax-free on qualifying medical expenses. You cannot use HSA funds to pay for your health insurance premium, but you can use it on your plan’s out-of-pocket costs (deductibles, copays, coinsurance) and prescriptions.
VA Cuts Gender-Affirming Care
The Department of Veterans Affairs has stopped offering gender-affirming care, impacting California veterans who rely on health systems that follow federal policy, such as the VHA (Veterans Health Administration), TRICARE or FEHB (Federal Employees Health Benefits)/PSHB (Postal Service Health Benefits) plans. This change follows other federal-level rollbacks in LGBTQ+ healthcare protections.
California Protects Gender-Affirming Care
Despite federal rule changes made under the Trump administration that end gender-affirming care, California law requires all state-regulated plans to cover medically necessary care. These protections fall under the state’s Insurance Gender Nondiscrimination Act. If a service is denied, you have appeal rights, and you can get help from the DMHC Help Center (call 1-888-466-2219).
We’ve Got You Covered!
Just like purchasing health insurance, your needs and those of your family may change from year to year. We are here to help. Find out quickly and easily how much financial help you could get to pay for health insurance. Explore your options now to get the health coverage you need—or contact us.
What’s New from Previous Years
These articles reflect updates and policy changes specific to their year and are for reference only.
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