Starting October 15, the federal Medicare Annual Enrollment Period officially begins. Covered California has also released next year’s individual health insurance plan prices, and current members can now renew, adjust, or switch their plans for the coming year.
KCAL Insurance would like to remind everyone that 2026 will be a critical year for health insurance in California: the individual health insurance market will face steep premium increases, reduced benefits, and stricter income verification — a “triple shift.” At the same time, the Medicare market will also see rising premiums and adjustments to eligibility rules.
If you do not review and update your policies in time, you may risk losing benefits or face significantly higher medical expenses.
Three Major Changes Ahead — Individual Coverage Under Strain
Covered California recently announced that statewide premiums will rise by an average of 10.3% in 2026, marking the largest increase in eight years. Major insurers such as Anthem Blue Cross and Health Net are raising rates by as much as 15%, while IEHP plans in the San Bernardino region will see an even steeper overall increase of 17.9%.
What’s even more concerning is that the Enhanced Premium Tax Credit (EPTC)—a major financial relief measure introduced during the pandemic—expired at the end of September. Without this substantial subsidy, Covered California members will face premium increases of up to 97%.
Middle‑income families earning around 400% of the Federal Poverty Level (FPL) will be hit the hardest, as they confront the double burden of losing subsidies + rising premiums. These households are strongly encouraged to contact a Covered California–certified insurance agent as soon as possible to evaluate whether switching plans may help reduce their financial strain.
At the same time, eligibility for the Silver 73 plan will be narrowed: instead of covering households above 200% of the Federal Poverty Level (FPL), it will now only apply to those between 200% and 250% FPL. In addition, the plan’s deductible will jump dramatically from $0 to $5,200, resulting in a significant reduction in benefits.
Households earning above 250% FPL will be moved back to the Silver 70 plan, where the out‑of‑pocket maximum will increase to $9,800.
Furthermore, premium subsidy verification will become more stringent. Going forward, all reported income will be cross‑checked with IRS data, and applicants will be required to provide documentation—such as pay stubs, W‑2 forms, or bank statements—in order to pass the verification process.
Rising Medicare Costs: Part B May Exceed $200, Medi-Cal Eligibility Tightening
The Medicare market in 2026 is also shaping up to be turbulent. Multiple major media outlets report that the Medicare Part B monthly premium may rise from $185 to approximately $206.50, an increase of 11.6%. For seniors in Southern California who may find this increase burdensome, it may be worth considering a “Part B Giveback Plan,” which allows certain Medicare Advantage plans to reduce part or even all of the Part B premium.
Meanwhile, the Medicare Advantage market is undergoing a reshuffling. Some insurance carriers may withdraw from certain regions, and many plans are expected to reduce supplemental benefits such as dental coverage, transportation services, and OTC allowances. This means your current plan may no longer meet your healthcare needs next year.
It is crucial to take advantage of the Annual Enrollment Period (AEP) from October 15 to December 7, and work with a licensed Medicare agent to review your options and select a plan that fits your needs for the coming year.
An even more important development is the potential adjustment to Medi‑Cal (California’s Medicaid) eligibility rules. Over the past two years, California suspended asset testing, allowing applicants to qualify for low‑income assistance based solely on income. However, policy previews indicate that asset limits may return in 2026, signaling the end of the current “no‑asset‑check” era.
For seniors, losing Medi‑Cal eligibility would have significant consequences. Many of the enhanced Medicare benefits they currently receive because of Medi‑Cal assistance would be reduced or eliminated. They would once again be responsible for paying the Part B premium, and copays for prescriptions and medical visits would increase—potentially leading to a sharp rise in overall healthcare expenses.
Review Your Coverage Now — Work With a Professional
The 2026 California health insurance market is undergoing major upheaval, and consumers must plan ahead to minimize premium increases and prevent benefit losses. With growing awareness around insurance, more people now understand the importance of taking advantage of the Open Enrollment Period and proactively consulting licensed insurance agents to review their coverage.
Relying on automatic renewal—or following advice from unqualified individuals—can easily lead to choosing the wrong plan. The result may be reduced benefits, higher copays, and the loss of an entire year’s worth of protections, potentially costing families thousands of dollars in unnecessary expenses.
As soon as Open Enrollment began, large numbers of consumers have already visited KCAL Insurance for guidance, seeking help in planning next year’s health insurance and Medicare coverage for themselves and their families. KCAL Insurance offers free one‑on‑one professional consultations to help you reassess your 2026 health and Medicare benefits and ensure your coverage stays protected.
For coverage effective January 1, 2026:
-
Individual health insurance must be completed before the end of the year.
-
Medicare plan changes must be finalized by December 7.
For any further questions, please call 626‑333‑1111.