Update – New Data Shows ACA Coverage Gaps That Need Ancillary and Supplemental Policies

ACA coverage gaps and increasing client cost shares are real! A survey of returning ACA clients in late 2025 shows that 51% report “a lot higher” healthcare costs than in 2024.
 
A large majority of this same group, 80%, indicate their healthcare premiums, deductibles, copays, and coinsurance are “higher” than in 2024. Almost 75% of returning enrollees “are very or somewhat concerned” about affording ER and hospital visits, with nearly half of all returning enrollees concerned about paying for routine healthcare visits and needed prescription drugs.
 
Almost 1 in 10 2025 ACA enrollees are now without health insurance due to these higher costs. This new data confirms why our Friday article is a must-read if you haven’t already.
 
ACA agents need ancillary and supplemental products to protect these ACA clients experiencing these rising costs. If you’re an agent for an ancillary or supplemental policy, an opportunity is knocking at your door from the ACA Marketplace, seeking your product expertise and experience.
 
This opportunity is in the federal Marketplace and your state’s ACA exchange if your state(s) you currently work in have their own state exchange or Marketplace.

The Agility Difference

Agility empowers ACA and ancillary and supplemental agents to fully access this emerging opportunity through extensive national and regional carrier contracting and virtual and in-person training on ACA, ancillary, and supplemental policies. Our compliance team has extensive experience with ACA CMS compliance and is available to assist agents as needed.
 
ACA-specific administrative tools are available, as are marketing experts in both ACA and ancillary or supplemental policies, with many years of experience in ACA and ancillary or supplemental policy marketing activity. With the ongoing evolution of the insurance market we discussed above, Agility empowers you to identify your defining characteristic through our team’s expertise, positioning you for growth.
 
With Agility, you also get Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer any insurance questions and direct you to our Medicare, ACA, and ancillary experts. They can also add you to our weekly email list for tips and updates.
 
Let Agility empower you to evolve your capabilities and capture the opportunities in 2026.

If you’ve noticed clients becoming more cautious and asking questions like “what will this actually cost me?” and “what happens if something big happens?”, you’re not imagining things. 2026 looks like a great year for ancillary and supplemental policies because coverage gaps are more obvious, budgets are tighter, and consumers are more open to practical, affordable protection than they have been in a while.

Here’s what makes this year different and how you can bring that up in real conversations.

Medical costs are still rising, and people feel it in their wallets

Even with “good insurance,” the financial shock is often what hurts the most.

Accident, hospital indemnity, and critical illness coverage aren’t just “extras” when clients worry about unexpected costs. They help cover deductibles, copays, time off work, travel, childcare, and other disruptions.

So, try saying this, “Your major medical covers the care itself. This helps with the cash flow hit that comes with it.”

Deductibles and out-of-pocket expenses are still a thing for working people

Many clients aren’t uninsured; they’re just under-prepared.

2026 is prime time since many people are used to paying more out of pocket these days. That makes gap coverage easier to accept when you present it as predictable protection.

So, try saying, “We’re not trying to cover everything. We’re focusing on the part that could ruin your month.”

Medicare and ACA gaps are still wide for everyday stuff people use

If you sell to Medicare or ACA clients, 2026 is a great year to talk about practical add-ons.

This is a hot spot for ancillary and supplemental policy sales because dental, vision, hearing, and hospital indemnity solutions naturally fit when clients consider what ACA and Medicare may not cover. So, use, “Medicare is solid, but it just isn’t designed to cover routine extras fully.”

“ACA plans are leaving some coverage gaps now, so let’s take a look at these other solutions to close these gaps.”

In 2026, increasing HSAs and FSAs provide a ‘built-in funding story’

This is powerful because it changes the conversation from “another bill” to “using money you’ve already set aside.”

  • The IRS announced 2026 inflation adjustments, including an increase in the health FSA salary reduction limit to $3,400 and carryover changes, depending on plan design.
  • For 2026, the annual HSA contribution limit is $4,400 (self-only) and $8,750 (family).

This matters for ancillary and supplemental policies because clients who use HSAs or FSAs are already thinking about their health budgets. That makes accident, hospital indemnity, and critical illness coverage easier to fit in, especially when you present it as risk budgeting.

So, try using, “You’re already saving for medical costs. This protects you if those costs come all at once.”

Employers are leaning into voluntary ancillary or supplemental policy offerings

Even if you mostly sell to individuals, the workplace trend helps because it makes these products feel normal.

This angle matters because clients see these products at work and hear friends talk about them, helping them start to feel like a normal coverage option.

Success in 2026 is keeping it practical, not dramatic

Here are three easy ways to position ancillary and supplemental policies that feel natural:

1) The “gap math” is closed fast and clean

“If you faced a $2,500 to $5,000 expense tomorrow, would you rather pay from savings or have a benefit designed to cover it?” Then show one simple example, not five.

2) The “choose your layer” approach to reduce pressure

Offer three options:

  • Basic approach of Accident or Hospital Indemnity
  • Better approach to Accident and Hospital
  • The most effective approach is to add Critical Illness or Disability, where appropriate
3) The protect-the-paycheck angle

Clients understand right away, so say “Medical bills are one problem, but missing work is another. Let’s protect your income and your savings.”

2026 is the best year in a while for ancillary and supplemental because people are:

  • More exposed to out-of-pocket ACA and Medicare costs
  • More anxious about surprise bills
  • More aware of coverage gaps, especially Medicare and ACA dental, vision, and hearing realities
  • More able to “fund” protection through rising HSA and FSA limits

If you keep it simple by saying “major medical covers care; this covers the financial hit,” you’ll find 2026 conversations are easier, shorter, and convert better.

The Agility Difference

With the ongoing evolution of the insurance market, Agility enables you to deliver the best possible client experience through our team’s decades of expertise, positioning you for growth. With Agility, you get Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer any insurance questions and direct you to our Medicare, ACA, and ancillary experts.

They can also add you to our weekly email list for tips and updates. Let Agility empower you to evolve your capabilities and win the client experience opportunities in 2026.

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