Major ACA changes in 2026 are coming that could significantly affect health insurance premiums for millions of Arizona residents. Enhanced subsidies that dramatically reduced marketplace costs may expire, and Congress is debating what comes next. Here’s what to expect and how to prepare before the changes take effect.
Major shifts are on the horizon for the Affordable Care Act (ACA) in 2026 — The Trump administration’s newly proposed rule introduces changes that could leave millions of Americans without viable coverage options or struggling to afford marketplace plans.
Here’s what’s ahead—and why Short-Term Medical (STM) insurance remains a smart, strategic choice, even as we await the potential reinstatement of the previous 3-year coverage option.
Open Enrollment is Shrinking
- Change: Open enrollment will be shortened by 4 weeks, ending December 15 instead of January 15 or later.
- Challenge: Consumers who miss the new deadline will be locked out of ACA coverage.
- STM Solution: STM plans can be purchased year-round, providing immediate gap coverage for those who miss enrollment or need temporary insurance between major life changes.
Year-Round Enrollment for Low-Income Americans May Disappear
- Change: The special enrollment window for low-income individuals could be eliminated.
- Challenge: Vulnerable consumers will have fewer opportunities to secure ACA coverage when they need it.
- STM Solution: STM plans ensure access to coverage for these individuals, bridging them until ACA re-opens or other coverage becomes available.
Subsidy Rollbacks = Steep Premium Increases
- Change: Enhanced federal subsidies are set to expire at the end of 2025, leading to higher out-of-pocket costs across the board.
- Challenge: The Congressional Budget Office estimates 2.2 million could become uninsured due to affordability issues.
- STM Solution: STM offers budget-friendly premiumsand customizable plan options, providing a viable alternative for those priced out of the marketplace.
Reduced Access to Enrollment Assistance
- Change: Funding for navigators is being slashed by 90%, making it harder for consumers to get the help they need.
- Challenge: Confusion and missed opportunities are inevitable, especially for underserved populations.
- STM Solution: Offering STM plans gives consumers a clear, supported path to protection when ACA guidance is lacking.
Reach out today to learn about options available to you:
American Insurance Benefits – Andy Orlikoff
www.AZhealth.us
623-742-3878
Located locally in Surprise Arizona, and serving the entire state.
Navigating ACA changes in 2026 is easier with a local broker who knows all your options. I’m Andy Orlikoff, an independent health insurance broker in Surprise, AZ. Call (623) 742-3878 or fill out the contact form — my help is always free.
If you’re tempted to ditch Medicare Advantage, you’re not alone. Millions of Americans switch away from Medicare Advantage plans every year — and the numbers are growing. Here’s when it makes sense to leave, how to do it, and the critical timing issue most people miss.
Why More People Are Choosing to Ditch Medicare Advantage
The most common reasons people decide to ditch Medicare Advantage:
- Their doctor left the plan’s network
- Prior authorization denied necessary care
- Out-of-pocket costs were higher than expected after a serious illness
- Benefits were cut at the annual renewal
- Moving to a different part of Arizona or another state
- Wanting access to Mayo Clinic, which doesn’t accept most Advantage plans
According to CMS data, Medicare Advantage enrollment has seen increasing churn as plan benefits change annually and major insurers pull back from markets.
The Critical Warning Before You Ditch Medicare Advantage
Here’s what stops many people from leaving: the one-way door problem. If you ditch Medicare Advantage and want to switch to a Medicare Supplement (Medigap) plan, you may need to pass medical underwriting — especially if you’ve been on Advantage for more than a year.
That means insurance companies can review your health history and potentially deny you Medigap coverage or charge more based on pre-existing conditions. The longer you stay on Medicare Advantage, the more health conditions you may accumulate — and the harder it becomes to qualify for Medigap.
This is why timing matters: if you’re thinking about leaving, do it sooner rather than later.
When You Can Ditch Medicare Advantage Without Penalty
There are two main windows to leave Medicare Advantage:
- Medicare Advantage Open Enrollment Period (MA OEP): January 1 – March 31. You can switch to Original Medicare, with coverage starting the first of the following month.
- Annual Enrollment Period (AEP): October 15 – December 7. Changes take effect January 1.
What to Do After You Ditch Medicare Advantage
Once you return to Original Medicare, you’ll want a Medicare Supplement Plan G to cover your out-of-pocket costs. With Plan G, after the Part B deductible ($283 in 2026), you pay nothing for covered services for the rest of the year — no networks, no prior authorization, no surprises.
Ready to Make the Switch?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I help Arizona seniors who want to ditch Medicare Advantage navigate the process and enroll in the right Medigap plan — even when medical underwriting is required.
Call or text: (623) 742-3878
Email: andy@azhealth.us
Fill out the contact form →
Serving Surprise, Phoenix, Peoria, Glendale, Goodyear, Buckeye, Scottsdale, Mesa, Chandler, Gilbert, and all of Arizona.
American Insurance Benefits | 14955 W Bell Rd #8031, Surprise, AZ 85374 | Licensed Arizona Insurance Broker since 2004
UnitedHealth Group’s collapse in 2025 has become the most visible example of a structural problem with Medicare Advantage flaws that independent brokers have warned about for years. The nation’s largest Medicare Advantage insurer is facing federal investigations, allegations of fraud, and a dramatic stock collapse — all while its Medicare Advantage business model is under scrutiny. Here’s what happened and what it means for Arizona seniors.
UnitedHealth’s Collapse: What Happened
In early April 2025, market analysts were calling UnitedHealth Group a tariff safe haven. Two months later, the company is in free fall. UnitedHealth faces three federal investigations covering:
- Civil and criminal fraud allegations related to Medicare Advantage billing practices
- DOJ antitrust investigation into its healthcare operations
- Allegations that clinicians were pressured to record questionable diagnoses to trigger additional Medicare payments — a practice known as “upcoding”
The Wall Street Journal reported the DOJ is investigating whether UnitedHealth made its clinician employees record questionable diagnoses to make Medicare Advantage patients appear sicker than they are, generating extra federal payments.
The Medicare Advantage Flaws at the Core of the Problem
UnitedHealth’s troubles aren’t just a corporate scandal — they reflect fundamental Medicare Advantage flaws built into the program’s payment model.
Medicare Advantage pays private insurers a set amount per enrollee based partly on their health status. Sicker patients generate higher payments. This creates a financial incentive to make patients appear sicker on paper — regardless of whether they actually receive more care. The Guardian alleged UnitedHealth secretly paid nursing homes to prevent or delay transfers of Medicare Advantage patients to hospitals, saving the company money while patients who desperately needed hospital care were delayed.
Prior Authorization and Denial Rates
Medicare Advantage plans — including UnitedHealth’s — have significantly higher prior authorization denial rates than Original Medicare. A Senate investigation found that UnitedHealth denied coverage for medically necessary care at rates that alarmed federal investigators.
Original Medicare does not require prior authorization for most services. Medicare Supplement Plan G works alongside Original Medicare — meaning your doctor decides your care, not an insurance company’s algorithm.
What This Means for Arizona Medicare Advantage Enrollees
If you’re currently enrolled in a UnitedHealth Medicare Advantage plan in Arizona, here’s what to consider:
- UnitedHealth has been reducing its Medicare Advantage footprint — your plan may not renew in 2026
- Federal investigations could lead to plan disruptions
- This is an opportunity to review whether Medicare Advantage is still the right choice for your situation
The Annual Enrollment Period runs October 15 – December 7. That’s your window to switch to Original Medicare with a Medigap supplement plan if you qualify.
Questions About Your Medicare Options?
I’m Andy Orlikoff, an independent Medicare broker in Surprise, AZ. I don’t sell Medicare Advantage. The Medicare Advantage flaws exposed by UnitedHealth’s collapse are exactly why I’ve recommended Medicare Supplement Plan G to Arizona seniors for 20+ years.
Call or text: (623) 742-3878
Email: andy@azhealth.us
Fill out the contact form →
Serving Surprise, Phoenix, Peoria, Glendale, Goodyear, Buckeye, Scottsdale, Mesa, Chandler, Gilbert, and all of Arizona.
American Insurance Benefits | 14955 W Bell Rd #8031, Surprise, AZ 85374 | Licensed Arizona Insurance Broker since 2004
Open enrollment season — the window healthcare.gov defines as your annual opportunity to change health coverage — is a critical time of year. It’s a window during which you can make significant decisions about your healthcare coverage, often with long-lasting financial and medical implications. Yet many employees and individuals approach it casually or wait until the last minute, which can lead to costly open enrollment mistakes. Selecting the wrong health plan isn’t just a minor misstep; it can result in paying too much for inadequate coverage, or worse—discovering that you’re stuck with healthcare services that don’t meet your needs for an entire year.
If you’ve ever felt overwhelmed by the array of options or confused by the fine print, you’re certainly not alone. Each year, countless individuals make common health insurance errors when choosing or updating their policies. To help you steer clear of these pitfalls, we’ll walk through the top mistakes people make and provide open enrollment tips to ensure you’re making informed decisions.
Open Enrollment Mistakes: Underestimating Plan Complexity
Many people assume that health insurance selection is straightforward, but that’s rarely the case. Today’s marketplace offers multiple tiers, plan types (like HMOs, PPOs, and High-Deductible Health Plans), and a wide range of supplemental benefits. Amidst this complexity, it’s easy to commit health plan selection errors if you don’t take the time to compare your choices thoroughly. Rather than just reselecting your existing plan, invest a few hours in researching alternatives. This effort can pay off by securing better coverage, lowering your costs, and helping you avoid common oversights.
Failing to Review Changes in Current Plans
One frequent error is assuming the coverage you had last year remains unchanged. Insurers frequently adjust premium rates, alter their provider networks, or modify deductibles and copayments. By not checking these details, you might end up locked into a plan that suddenly excludes your preferred physician or costs significantly more than expected. Approach each enrollment period as if it’s your first, and go through the details with a fresh perspective.
Overlooking Your Healthcare Needs
Your health needs evolve over time. Maybe you’ve developed a chronic condition or you’re anticipating the birth of a child. Even if your health situation hasn’t changed, your financial priorities or available plans might have. Ignoring these shifts can lead to selecting a plan poorly suited to your needs—a classic example of insurance enrollment guidance not followed. To avoid this, think critically about what you’ll need in the upcoming year. Are you expecting a major procedure? Do you need access to specific specialists or prescription drugs? Tailor your choices accordingly.
Focusing Solely on Premiums
It’s tempting to sort plans by price and pick the one with the lowest monthly premium. While this might feel budget-friendly in the moment, it can cause substantial trouble down the line. Lower premium plans often have higher deductibles, meaning you’ll pay more out-of-pocket before coverage kicks in. If you require frequent doctor’s visits, labs, or prescriptions, that “cheap” plan could lead to hefty medical bills over time. Conversely, a higher premium plan might cover more services upfront, saving you money later.
Not Considering Total Cost of Care
When you look at a plan, calculate your estimated total healthcare costs for the year. Combine premiums, deductibles, copays, and coinsurance. By taking a comprehensive view, you can avoid health plan selection errors and get a realistic picture of what you’ll pay. This approach ensures that you’re not lured in by a low premium only to be hit with unexpected expenses after you’ve committed.
Ignoring the Provider Network
Another frequent open enrollment mistake is failing to check which doctors, hospitals, and specialists fall within your plan’s network. In-network providers have pre-negotiated rates, resulting in lower costs for you. If you skip this step, you might learn too late that your trusted physician or preferred hospital is out-of-network—forcing you to either find a new provider or pay significantly higher fees for out-of-network care.
Confirming Your Provider’s Status
Even if you stayed with the same insurer, networks can shift. A previously in-network doctor might no longer be included. Call your provider’s office or check the insurer’s online directory to confirm that the healthcare professionals you rely on remain covered. This simple step can save you from scrambling after the enrollment window closes.
Missing Out on Additional Benefits
Open enrollment is not just about choosing a health plan; it’s often the time to sign up for related benefits like vision, dental, disability, life insurance, and health savings accounts (HSAs). Overlooking these supplementary options is one of the most common health insurance errors—particularly if you later discover you need those additional coverages but can’t access them until the following year.
Flexible Spending Accounts and HSAs
If your employer offers a Flexible Spending Account (FSA) or a Health Savings Account (HSA), consider how these tax-advantaged accounts can help you manage out-of-pocket costs. They reduce your taxable income and offer a pool of funds dedicated specifically to healthcare expenses. Remember, however, that FSAs typically don’t roll over entirely, so don’t allocate more than you reasonably expect to spend. Missing this opportunity can be one of the more subtle open enrollment mistakes, as it might mean you’re leaving savings on the table.
Waiting Until the Last Minute
Procrastination is the enemy of informed decision-making. When you wait until the final days of the open enrollment period to review your options, you’re more likely to rush through the details and make hasty decisions. This increases your risk of avoiding enrollment pitfalls incorrectly—essentially stumbling into them instead.
Carving Out Time Early
Treat open enrollment like a project. Mark the enrollment start date on your calendar, and set aside an hour or two each week to research, compare plans, and compile open enrollment FAQs. By giving yourself ample time, you’ll have a better chance of verifying all your information, speaking with HR representatives if needed, and making confident choices. This proactive approach is one of the best open enrollment tips you can follow.
Not Asking Questions or Seeking Help
One of the biggest insurance enrollment guidance errors is assuming you have to navigate the process on your own. Your HR department, insurance brokers, or customer service representatives can help clarify confusing terms, coverage limits, and network specifics. If something about the plan doesn’t make sense, ask. It’s better to seek help now than to struggle with unexpected coverage issues later.
Utilizing Online Resources and Tools
Many insurance providers offer online tools like plan comparison charts, cost calculators, and educational videos. Take advantage of these resources. They can help break down complex details into understandable terms, guiding you away from open enrollment mistakes. If your employer offers webinars or Q&A sessions, don’t hesitate to join in. Being informed is the most powerful strategy to ensure you pick the right coverage.
Overlooking Family Needs
If you’re not the only one affected by your choice, you must consider the needs of your spouse, children, or other dependents. Ignoring their health requirements can lead to inadequate coverage and unexpected costs. For example, if one family member relies on a particular specialist or a high volume of prescriptions, ensure your chosen plan caters to these specific demands. This evaluation helps you avoid health plan selection errors that affect everyone covered under your plan.
Life Changes and Family Adjustments
Think about any life changes you anticipate in the coming year. A new child, a dependent headed off to college, or a partner switching jobs might all influence your coverage needs. Incorporate these factors into your decision-making process. Adjusting early can prevent you from being caught off guard by these shifts.
Over-Relying on Past Choices
It’s comfortable to stick with what you know. Many people roll over the same plan year after year, assuming it will continue to serve their needs. While this might be convenient, it’s often one of the common health insurance errors that leads to overlooked savings or subpar coverage. Plans evolve, and so do your healthcare demands. If you’re unwilling to revisit your decision, you may pay more than necessary or end up with inadequate coverage.
Regular Plan Evaluations
Commit to reassessing your insurance plan every open enrollment period. Read the plan descriptions, compare costs, review coverage details, and confirm network providers. Look closely at how you used your healthcare during the past year. Did you overpay for services you rarely used? Could a different plan offer better coverage for a medical condition that emerged? An annual evaluation keeps you agile and aligned with the best option available.
Not Understanding Key Terms
Insurance jargon can be intimidating. Terms like deductible, coinsurance, copayment, out-of-pocket maximum, and formulary might appear straightforward, but misunderstandings can lead to poor plan choices—another prevalent insurance enrollment guidance misstep. Before selecting a plan, make sure you understand how these terms affect your costs and coverage. For instance, a low premium might come with a high deductible, meaning you’ll pay more before your plan contributes.
Resources for Demystifying Insurance Language
If you’re struggling to interpret the terms, seek out glossaries or ask for explanations from your benefits administrator. Many insurers provide easy-to-read guides that break down each concept. Don’t select a plan until you’re confident you understand the financial implications and coverage details.
Open Enrollment Mistakes: Forgetting Prescription Drug Coverage
If you rely on prescription medications, you must carefully examine how each plan covers your prescriptions. Check if your medications are in the plan’s formulary and how much you’ll pay in copays or coinsurance. Failing to verify this can lead to shockingly high pharmacy bills. This is a prime open enrollment mistake—one that’s easily avoided by spending a few extra minutes reviewing the details.
Planning for Medication Needs
Even if you don’t currently take prescription drugs, consider the possibility that you may need them in the future. A balanced plan will offer a reasonable drug benefit structure. Think proactively to prevent unpleasant surprises at the pharmacy counter later in the year.
Ignoring Preventive Care Benefits
Many plans cover preventive services at no cost or reduced cost. These services—like annual check-ups, screenings, and vaccinations—can help detect health issues early and maintain your well-being. Overlooking these benefits can mean missing out on valuable healthcare that keeps you healthy and reduces long-term expenses.
Investing in Prevention
When evaluating your plans, pay attention to the preventive services included. Make sure you’re choosing a plan that encourages routine check-ups and screenings. Good preventive coverage is a hallmark of a high-value plan that saves you money and supports your overall health.
Reviewing the Open Enrollment FAQs
Before finalizing your decision, consider creating a personal list of open enrollment FAQs. Compile the questions you wish you had answers to last year and seek clarification on them. For instance: “Are there any new plan options this year?” “How do out-of-network providers affect my costs?” “Which preventive services are fully covered?” Having these answers at your fingertips is a powerful way of avoiding enrollment pitfalls and ensuring you don’t overlook important details.
Avoid Open Enrollment Mistakes and Make the Right Decision
The key to avoiding enrollment pitfalls lies in active engagement, informed decision-making, and careful review. By dodging these open enrollment mistakes, you put yourself in a position to secure a health plan that aligns with your medical needs and financial constraints. Take advantage of every resource available, from HR guidance to online tools, and don’t hesitate to ask questions. Armed with the right information, you can confidently choose a plan that supports your well-being and your wallet—this year and beyond.
Need Affordable Health Plans in Surprise, AZ?
At American Insurance Benefits, we’re passionate about helping individuals and families in Arizona secure the health insurance coverage they need at a price they can afford. Since 2004, Andy Orlikoff and our team have been dedicated to making the process of finding the right plan as simple and stress-free as possible. If you’re looking for expert guidance tailored to your unique needs and budget, don’t hesitate to reach out to us today. Let’s find the perfect health insurance solution together.
