12 predictions for health insurance agents in 2026

If you thought 2025 kept you on your toes, 2026 is shaping up to be just as eventful. We're looking at regulatory changes, shifting market dynamics, and clients who are going to need more guidance than ever.

Here's what we think is coming, broken down by quarter so you can actually plan for it. Some of these predictions will affect your book immediately. Others will build over time. All of them are worth paying attention to now rather than six months from now when you're buried in enrollment season.

Quarter one: January through March

This will be the busiest Medicare Advantage open enrollment period yet

Tons of Medicare Advantage beneficiaries saw some kind of plan disruption this year. Plans closed, premiums went up, deductibles increased. And even though agents worked hard to reach everyone, some beneficiaries didn't get the message in time.

Starting in January, people are going to realize their coverage changed. Maybe their plan doesn't exist anymore. Maybe their dental benefits disappeared. Maybe that part B giveback they were counting on is gone. When they figure it out, they're going to call you. Just make sure you're up to speed on the marketing rules for this period.

Supplemental benefits got hit particularly hard. Carriers were dealing with higher Part D costs and sicker beneficiaries, so they had to cut somewhere. OTC cards, transportation, healthy food benefits, dental, vision, and hearing—most carriers trimmed these back. Part B givebacks took a hit, too.

A lot of beneficiaries won't know any of this until they try to use those benefits. Then you'll hear from them.

Supplemental policies are going to matter more than they used to

Medicare Advantage carriers didn't just reduce supplemental benefits. They also increased the amount that beneficiaries pay per day for hospital stays. And now, beneficiaries are likely paying those copays for seven days instead of five. It's another way carriers are managing their costs.

Hospital indemnity policies make sense here. For less than the cost of one hospital day, beneficiaries can cover those $440 daily charges plus their ambulance ride. When clients push back on paying another premium, ask them this: Would you rather pay $50 a month or $440 per day when you need it?

The under-65 market is even tougher. ACA deductibles and out-of-pocket maximums have gone through the roof. Families are looking at $19,000 or $21,000 deductibles before their insurance pays anything. That's where accident and critical illness policies start making a lot of sense.

Sure, clients might not love adding more premium. But $50 to $80 a month is a lot easier to swallow than a five-figure bill after their kid gets hurt playing sports. Present the option. You might be surprised how many people say yes.

A lot of people are going to regret dropping their ACA coverage

Enhanced tax credits don't look like they're getting renewed, which means ACA premiums are climbing. According to the Kaiser Family Foundation, about 25% of marketplace enrollees are planning to just go without insurance in 2026.

That sounds fine until they actually need to see a doctor. Then they're going to scramble for options, and they'll be looking at ACA alternatives, short-term plans, health shares, or mini-med plans.

Each of these has tradeoffs. Major medical alternatives can work, but they require underwriting, and the premiums aren't necessarily cheaper. Mini-med plans have lower premiums but strict coverage limits. Health shares aren't actually insurance; as such,  there's no guarantee they'll pay claims when needed.

Your job isn't to tell people what to do. It's to help them understand what each option really means. Get ready for those conversations now, because they're coming.

Negotiated drug prices take effect, but there's a catch

Ten drugs are getting cheaper on January 1st thanks to the Inflation Reduction Act. Every part D plan has to cover them. If your clients take these medications, that's good news.

But here's what happens when drug prices drop: more people fill their prescriptions. Better adherence means higher volume. Even though each prescription costs less, total spending goes up. And carriers are absorbing a lot of that cost under current Part D rules.

Don't be shocked when you see part D premiums increase for 2027. The drug negotiations worked for individual prices. They might not work for controlling overall spending.

Quarter two: April through June

Trump RX is going to change the conversation around drug coverage

President Trump's prescription drug marketplace is coming in early 2026. It promises most-favored-nation pricing, which means Americans pay the same low prices that Europeans do. Big manufacturers are already on board—Pfizer, AstraZeneca, Eli Lilly, Novo Nordisk. The platform is focusing on expensive drugs, including those weight-loss medications everyone seems to be getting prescribed now.

Once Trump RX launches, some of your clients won't care if their insurance covers certain drugs. If they can save hundreds of dollars buying directly, they're not going to worry about whether it counts toward their deductible.

This is especially true for people with high deductibles they don't expect to hit anyway. If you're staring down a $21,000 out-of-pocket max that feels impossible to reach, why not save money on prescriptions where you can?

What you need to know is which drugs are available through Trump RX and which aren't. Clients making plan decisions need to understand where they'll actually be filling prescriptions. Some clients won't go formulary shopping if they can order their drugs directly. Others will need solid drug coverage because their medications won't be on the platform. Either way, be prepared to talk them through whether and how their choice will impact progress toward deductibles and out-of-pocket maximums.

Everyone's going to be talking about HSAs

You've probably noticed more products being advertised as FSA or HSA eligible. There's a reason for that. Starting in 2026, all bronze and catastrophic marketplace plans are HSA-eligible. That means a lot more of your clients will have access to these accounts.

Retailers already know this is coming. Amazon, Sephora, and other companies are pushing HSA eligibility hard. When your clients see that label next to their regular purchases, they're going to start asking questions about how these accounts work.

Right now, only about 30% of people with HSAs actually use them. That number is going to climb. Get ahead of it by explaining the benefits now. If someone steps down from a silver plan to a bronze to save money, encourage them to put that premium difference into their HSA.

For FSA holders, remind them about deadlines. For HSA holders, explain the long-term savings potential. The more they understand these accounts, the more likely they'll actually fund them.

Quarter three: July through September

Plan information is going to come late again

Carriers are dealing with a lot of uncertainty right now. Direct-to-consumer drug pricing, negotiated rates, increased drug utilization, expanded Part D liability—all of it adds up to risk that's hard to calculate. And calculating that risk takes time.

Plans get submitted to CMS. Sometimes CMS sends them back. Carriers adjust and resubmit. The whole process drags on longer than it used to, which means you're getting plan details later than you'd prefer.

Don't expect to spend most of August leisurely studying your options. Expect compressed timelines and details landing at the last minute. The marketplace is dealing with similar issues, especially around whether premium tax credits will be extended. It didn't happen in time for 2026, and it probably won't happen in time for 2027 either.

Late plan releases are becoming the new normal. Plan accordingly.

Commissions aren't getting better

Some states have tried to push back on commission cuts, arguing that carriers can't just eliminate agent compensation whenever they want. On December 4th, CMS essentially told those states to back off. This is federal territory, and CMS doesn't see a problem that needs fixing.

The trend is clear. Commissions are shrinking or disappearing on certain plans. Major carriers have already stopped letting agents market their prescription drug plans. Other plans are being pulled from enrollment platforms altogether. Every change is carriers trying to manage costs by cutting distribution expenses.

You can still submit comments on proposed rules through the end of January, and you should. But you also need to prepare for a future where commission structures change more often and less predictably. Diversification isn't optional anymore.

We'll be in touch

You'll hear from us regularly throughout quarter three as plan information becomes available. Our annual AEP kickoff usually happens the first Thursday in August, but we'll probably push it to mid-month this year to line up with delayed plan releases.

We'll run webinars and sessions covering every carrier we work with. Product rollouts, carrier updates, training—all of it designed to get you ready before selling season hits.

If you need custom marketing help—social media, website updates, client communications—just ask. Quarter three is when you build your marketing foundation. Quarter four is too late.

Quarter four: October through December

It's going to be a sprint, not a marathon

Medicare's annual election period runs from October 15th through December 7th. That's not changing. What is changing is that marketplace open enrollment now ends December 15th instead of running into mid-January.

You're managing two enrollment periods at the same time with almost no gap between them. There's no "I'll handle my Medicare clients first, then focus on my under-65 book." Everyone needs attention right now.

It gets more complicated. If pending legislation goes through as written, passive renewals in the under-65 market are going away. You'll need to actively renew clients every year. They'll have to opt in to coverage instead of being automatically renewed.

Start thinking now about how you're going to handle this timeline. It's not getting easier.

Some regulations are actually getting better

Not everything is moving in the wrong direction. CMS just announced they're adding an NPN field to medicare.gov, matching what's already on healthcare.gov. It means CMS recognizes that agents deserve credit for helping beneficiaries. That's progress.

More good news might be coming from proposed marketing rule changes scheduled for October 1st. The 48-hour rule for scopes of appointment could disappear. Education and marketing events might be allowed back-to-back. You might be able to collect scopes at educational events. Call recording requirements might shrink significantly.

Nothing's final yet. But the direction looks promising. Watch for final rules sometime around mid-spring.

Catastrophic plans won't solve the problem

There's a temporary hardship exemption letting people who lost subsidies enroll in catastrophic coverage for 2026. Some will choose it because the premiums look better than bronze. But catastrophic coverage doesn't include pre-deductible benefits, and the premiums are already getting close to bronze levels anyway.

Most people in catastrophic plans will want out for 2027. They'll want expanded bronze coverage with at least some pre-deductible benefits. Since you'll need to actively renew them anyway, be ready for that conversation.

You'll also need to understand HSA portability. When clients switch from one HSA-eligible plan to another, they're going to ask what happens to their health savings account. Make sure you have the answer ready.

This isn't ending anytime soon

Recent studies show drug spending is going to keep climbing until 2029 or 2030 before it levels off. That means several more years of benefit changes, premium increases, and carriers pushing more costs onto beneficiaries.

Things aren't going back to how they used to be. At least not soon. Plan for ongoing volatility. Diversify your carrier relationships. Build out your supplemental product offerings. Stay on top of regulatory changes. Get your marketing squared away before a hectic enrollment season creeps up on you.

It's going to be a challenging year. But you already knew that. Now you know what to watch for.