The “Big, Beautiful Bill” has been approved by the U.S. House of Representatives and is now in the second step of its three-step process to become law. As agents, we care what it says about healthcare in the U.S.
This article begins a series on how the bill affects the healthcare market. These changes are also discussed in depth in an article by KFF.
We begin our analysis by examining the changes this bill has made to the ACA market and the impact of those changes on insurance agents.
Open Enrollment Period
The bill ends the ACA Open Enrollment Period a month earlier. It could now end on December 15, 2025. Open Enrollment still begins November 1, 2025.
Opportunity For Agents
- ACA prospects have a greater sense of urgency to make choices more quickly.
- Agents need sharper focus, better organization, and proactive communication to achieve higher conversion rates. This urgency generates more ACA sales activity and revenue.
- On December 16, 2025, ACA agents should reach out to their ACA clients with supplemental products to address coverage gaps (vision, dental), high-cost shares (hospital indemnity), and any other issues your clients need to address.
Special Enrollment Periods (SEPs) (effective January 1, 2026)
- The bill eliminates the year-round Low-Income Special Election Period (SEP) enrollment opportunity for people with incomes up to 150% of poverty.
- It limits all ACA Marketplaces to providing SEPs based on individuals’ incomes relative to the poverty line.
- All enrollees must prove eligibility for ACA plans before enrolling.
Opportunity For Agents
- Higher quality clients and better retention of ACA clients with regular, proactive communication.
- Develop a robust supplement product portfolio to assist ACA clients with higher cost-sharing and premiums.
- Medicare and ICHRA are markets to add to your portfolio to broaden your product reach and client base.
SEPs and Tax Credit Eligibility (effective in the third calendar month following the date the bill is enacted)
- Low-income SEPs end.
- Prospects enrolling in an ACA plan with a non-qualified Life Experience (QLE) SEP can’t receive premium tax credits or Cost-Sharing Reductions (CSRs).
Opportunity For Agents
- This probably means lower churn of your current clients.
- Other insurance product opportunities, such as ICHRA, Medicare, and supplemental products, are worth exploring and adding to your portfolio to diversify your income profile.
Actuarial Value (effective January 1, 2026)
- Returns to the 2022 plan year allowable variation in actuarial value, which ranges between -4 percentage points and +2 percentage points.
- The de minimis variation in actuarial value for silver plans is now +/- 1 percentage point.
Opportunity For Agents
- Agents may see more plan design diversity within each metal tier and coverage level, affecting deductibles, copays, and out-of-pocket limits.
- Tighter AV ranges for Silver Plans should result in less benefit fluctuation and more predictable coverage.
- Agents should be able to tailor coverage more easily to meet clients’ needs.
Premium Adjustment Percentage (PAP) Methodology (effective January 1, 2026)
It reverts to the 2019 PAP methodology, which causes the PAP to grow more slowly and pass more cost-sharing onto ACA consumers over time.
Opportunity For Agents
Agents need a robust supplemental product portfolio that includes high-cost shares, such as hospital indemnity, to help your ACA clients manage future cost increases.
ACA Marketplace Coverage Eligibility for Lawfully Present Immigrants (effective January 1, 2027)
- Only lawful permanent residents (LPRs or “green card” holders), Compact of Free Association (COFA) migrants residing in the U.S., or certain immigrants from Cuba are eligible for subsidized ACA Marketplace coverage. Refugees, asylees, and people with Temporary Protected Status are no longer eligible.
- Effective January 1, 2026, Marketplace eligibility will be eliminated for all lawfully present immigrants with incomes at or below 100% of the FPL.
Opportunity For Agents
- Inform any immigrant clients meeting these criteria about their loss of eligibility.
- Confirm with your state’s Medicaid agency if there are any options for these clients to obtain coverage through these programs.
ACA Marketplace Coverage Eligibility for Deferred Action for Childhood Arrivals (DACA) Recipients (effective January 1, 2026)
DACA recipients in all states are ineligible to purchase ACA Marketplace coverage as they don’t meet the definition of “lawfully present.”
Opportunity For Agents
- Work with DACA clients to identify group coverage options and cooperative health coverage available in their area.
- Determine if short-term health coverage is an option for your DACA clients.
Cost-sharing Reductions (CSRs) (effective January 1, 2026)
- Fund CSRs through payments from the federal government with explicit congressional appropriation of funds.
- This provision may end “silver-loading,” which reduces premiums for silver plans and, in turn, reduces the size of premium tax credits.
Opportunity For Agents
A strong supplementary product portfolio with policies that address rising cost shares and premiums is a great way to help clients facing these rising costs and to build your diversified revenue base.
At this time, Agility cannot confirm whether these provisions will remain in the bill approved by the U.S. Senate or in the final bill passed by both the U.S. House and the U.S. Senate. We will keep you informed about the latest developments on this bill on our blogs.
In an article coming soon, we will cover more ACA changes, including verifying personal information; filing and reconciling; recapturing excess premium tax credits; premium underpayments; effectuation of coverage; automatic re-enrollment; and changes in abortion and gender-affirming care coverage.
Mike Berglund, our ACA product specialist, is here to help you with any questions about these changes and the opportunities they present to agents. Mike can also refer you to our Medicare and Supplement product specialists for any questions you have in these areas.
Contact Agility Producer Support at (866) 590-9771 or email support@enrollinsurance.com for answers to your ICHRA questions. Agility can also add you to our free weekly email list for tips and vital information!
