Key Updates: What’s Changing for Individual and Family Plan
Stay informed to stay ahead
Important changes are on the horizon for Individual and Family Plan coverage that could impact both costs and care. Via Benefits is here to help you stay informed so you can navigate these updates with confidence during Open Enrollment, which is November 1 through December 15, 2025.
Key Changes Ahead
Expiration of Enhanced Premium Tax Credits (PTCs)
Since 2021, enhanced PTCs have helped make Pre-Medicare health plans more affordable for millions. However, unless Congress extends these provisions, eligibility will tighten in 2026—leading to reduced federal support and potentially higher monthly premiums.
Expected Premium Increases
Health insurance premiums often fluctuate annually due to various factors. Contributing factors include:
Possible expiration of enhanced PTCs
Increased use and cost of healthcare services
Inflation and rising labor costs
Higher drug prices, especially for weight loss medications
A less healthy risk pool, as healthier individuals drop coverage due to rising costs
A Bit of Good News
Improved Prior Authorization Process
Starting in January, insurers will be required to provide clearer explanations for coverage denials and share approval statistics. By 2027, they’ll also be required to use electronic systems to streamline the process—making it faster and more transparent.
What You Can Do
Stay alert for updates from your insurance carrier. If your plan is ending or premiums are increasing beyond your comfort level, reach out to Via Benefits.
Compare plans early. Visit the marketplace.viabenefits.com website or schedule an appointment with a licensed benefit advisor when Open Enrollment begins. We’ll help you find coverage that fits your health needs and budget.
Change is constant—but with Via Benefits by your side, you can feel confident in your coverage decisions.
