Marketplace Updates
Binder Payment Reminder for January 1, 2026 Effective Dates
Open Enrollment runs from November 1, 2025 through January 15, 2026.* As a
reminder, all new members with a January 1, 2026 effective date must submit their first
month’s binder payment by December 31, 2025 for their coverage to activate and
benefits to begin.
Agents can view and download their list of members with outstanding binder payments
directly from the Unpaid Binder Payments tile in the Broker Portal dashboard.
Important Update for Nebraska & Pennsylvania
Members transitioning from a 2025 Premier network plan into a 2026 Ambetter Health
plan must complete their binder payment no later than January 15, 2026 to maintain
continuous coverage.
Tools & Resources
● Make a payment or set up Auto Pay for your clients through the Broker Portal.
● Access the Broker Portal Quick Guide under the Training Materials section for
step-by-step instructions.
Reminder: Brokers must obtain and document member permission before
enrolling them in Auto Pay.
*OEP dates may vary for State-Based Exchanges (SBEs).
Georgia Access has reported a statewide system outage affecting both the website and
consumer portal due to a widespread internet issue. Agents may experience difficulty
completing or accessing applications at this time.
The state is working to restore access and will share updates as soon as the system is
back online.
For questions, agents may contact: PlanManagement@georgiaaccess.ga.gov
CMS Releases 2026 Marketplace Plans & Prices Update
CMS published the Plan Year 2026 Marketplace Plans & Prices Fact Sheet, confirming
that Open Enrollment will run from November 1, 2025, through January 15, 2026 for
most states.
Key highlights include:
● Average lowest-cost Marketplace premium projected to be $50/month after tax
credits — an increase of about $13/month from 2025.
● Premium tax credits will continue covering around 91% of the lowest-cost plan
premium for eligible enrollees.
● Analysts, including KFF, warn that subsidy expirations and eligibility adjustments
will be major issues to watch for the 2026 OEP.
Telehealth Flexibility Extended for Medicare Advantage
CMS announced temporary enforcement discretion allowing MA plans to continue
offering certain telehealth benefits through December 31, 2025, despite other federal
telehealth flexibilities expiring on Oct. 1.
This ensures continuity in remote access for beneficiaries while Congress considers
permanent policy changes.
2026 Medicare Physician Fee Schedule Final Rule
CMS released its CY 2026 Physician Fee Schedule Final Rule, focusing on:
● Payment accuracy
● Support for chronic-disease management
● Quality-of-care incentives
These changes may influence MA provider networks and plan structures for 2026.