In our 2025 Year in Review, we saw clear signs that the economics of health plan growth were changing. This post looks at what those shifts mean heading into 2026 and where plans should expect conditions to tighten.
Most of what will define 2026 is already in motion. Preparation will matter more than prediction.
Premium Pressure Is Becoming Structural
Marketplace premiums for 2026 are rising meaningfully, with many showing increases well above historical norms. Premium increases certainly aren’t new, but it’s the timing that is different in 2026.
As enhanced ACA subsidies expire, many members are faced with significantly higher premiums at the same time base rates are increasing.
For health plans, this combination results in:
- Greater enrollment volatility
- Increased sensitivity among healthier members
- More pressure on brokers, agents and service teams to explain changes they didn’t control
What stands out is that many health insurers have already priced in disruption for 2026. That reflects how the market is approaching next year: not expecting stability, but preparing for continued change.
Policy Changes Increase Friction
Several policy changes scheduled for 2026 affect how and when people enroll, maintain coverage, or reconcile subsidies.
Shorter enrollment windows, the removal of automatic re-enrollment, and changes to subsidy repayment rules all add friction for members. This is especially true for populations that already struggle to navigate the system.
While these changes don’t fundamentally alter the structure of coverage, they do increase the likelihood of:
- Gaps in coverage
- Delayed enrollment
- Member confusion that plans, providers, brokers and agents have to deal with
From an operational standpoint, friction rarely stays contained. It tends to show up downstream as higher service volume, more exceptions, and greater administrative load.
Technology Expectations Are Maturing
Technology will continue to play a role in 2026, but expectations are changing.
Health plans are becoming more selective about what they invest in and why. There’s less appetite for tools that require extensive customization, parallel processes, or ongoing workarounds to function.
What tends to stick are systems that:
- Reduce manual effort
- Improve data accuracy
- Support core workflows without creating new ones
- Keep compliance front and center without adding extra steps for the team
- Fit how organizations actually operate
Durability is overtaking experimentation. 2026 is the time to rely on systems that are tried and proven, not to test unproven ideas. The health plans and carriers that don’t invest in technology now will be left behind as their peers gain a valuable competitive advantage.
Sales Distribution Is Where These Pressures Intersect
Brokers and agents experience change before it shows up in reporting. Misalignment between sales, operations, finance, and compliance becomes visible quickly when volume shifts or rules change.
In 2026, challenges are less likely to come from a single disruption and more from accumulated strain:
- Limited visibility into agent activity and member interactions
- Inconsistent compliance oversight
- Manual or fragmented commissions processes
- Difficulty explaining performance with confidence
What This Means for 2026
Heading into 2026, there’s less tolerance for inefficiency and less margin for error. Members expect clarity. Regulators expect consistency. Internal teams expect systems that support the work instead of complicating it.
Plans that are best positioned are focusing on:
- Predictability over short-term expansion
- Alignment across teams rather than isolated optimization
- Embracing technology with platforms designed for sales distribution, not adapted to it
This is the thread that carries from 2025 into 2026. The plans that have already been investing in clarity and structure are much better equipped to deal with change. Those that didn’t are being forced to react now and are struggling to keep up.
If you want a deeper look at how health plans are adapting their distribution models, we explore these topics regularly on the Insuring Growth podcast. If you’re evaluating how your organization manages brokers, commissions, and compliance at scale, that’s the operational gap Abacus was built to address.
