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<h2>OEP is Around the Corner - Is Your Agency Ready?</h2>The Open Enrollment Period (OEP) is quickly approaching, and for agencies working in the insurance space, it's the busiest - and often most critical - time of the year. This window is your prime opportunity to help clients make informed decisions and secure the coverage they need for the year ahead.&nbsp; But with so much on the line, the big question is: Is your agency truly ready? <h2>Why OEP Preparation Matters More Than Ever</h2>The insurance landscape is constantly evolving. New plans, shifting regulations, and changing client needs mean that agencies must stay agile and well-prepared to serve their communities effectively. Missing deadlines, lacking updated information, or struggling with overwhelmed staff can lead to missed opportunities - and dissatisfied clients. <h2>Key Areas Your Agency Should Focus On</h2> 1. Staff Training and ReadinessOEP is high pressure, and clients expect knowledgeable, confident agents. Conduct refresher training sessions on the latest plan options, regulatory changes, and customer service best practices. Make sure your team understands the nuances of plan comparisons and enrollment processes. 2. Technology and Systems CheckAre your enrollment systems and CRM platforms up to date and fully functional? Technical glitches during OEP can be costly. Ensure your software integrations work seamlessly and that your team is comfortable navigating any new tools. 3. Marketing and OutreachYour clients need to know you're ready to help. Ramp up your marketing efforts with targeted emails, social media posts, and community outreach. Highlight key dates, plan changes, and how your agency stands out as a trusted resource. 4. Client Data ReviewTake time now to review your existing client data. Are contact details current? Have clients expressed any changes in their health needs? Proactively reaching out to clients with personalized recommendations can increase engagement and retention. 5. Compliance and DocumentationEnsure your agency is compliant with all CMS regulations and has updated documentation ready for audits or reviews. Proper record-keeping isn't just about following rules - it's about protecting your agency and clients.<h2>What Happens If You're Not Ready?</h2>Agencies that are unprepared face a range of risks: lost clients, penalties, and reputational damage. The pressure of last-minute scrambling often leads to mistakes and missed enrollments. OEP is not the time to "wing it."<h2>Final Thoughts</h2>The countdown to OEP is on - are you ready to hit the ground running? Taking proactive steps now can make all the difference in delivering a smooth, successful enrollment season for your agency and your clients. If you want to explore tools, training, or strategies to get your agency fully prepared, reach out! Let's make this OEP your best yet.

<h2>Interested in learning how we can help you scale your agency?</h2>

Pivot Health by Healthcare.com is proud to provide longer durations for short-term medical products in 20 states, including Texas. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

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OEP is almost here—Is your agency prepared? From staff training to tech checks, get ready now to ensure a smooth, successful enrollment season for your clients.

Countdown to OEP: 5 Ways to Prepare Your Agency Now

In today's ever-evolving healthcare landscape, more consumers are seeking alternatives to traditional insurance. With the rising cost of health plans under the Affordable Care Act (ACA), many are turning to Short-Term Medical (STM) plans -especially longer-duration options - as a viable solution. But what's driving this shift, and why are these longer-duration plans appealing to today's buyers? Let's explore the key factors influencing consumer behavior and demand. <h2>Key Consumer Segments Driving Demand</h2>Understanding the demographics behind the demand for longer-duration STM plans is essential. Three primary consumer segments are leading the charge:<ol><li>Healthy Unsubsidized Individuals: A significant portion of the population is ineligible for ACA subsidies, leaving them with expensive premiums that often don't align with their healthcare needs. These individuals, typically younger and healthier, may find themselves paying for coverage they don't fully use. For these consumers, short-term medical (STM) plans offer a cost-effective and flexible option that covers 8 out of 10 essential benefits.</li><li>People in Transitions: Transitioning between jobs, relocating, or facing a gap in coverage (e.g., after aging out of a parent's plan) leaves many in need of temporary yet reliable coverage. Longer-duration STM plans are ideal for those who prefer the peace of mind of extended health insurance coverage, available for up to 3 years in select states.</li><li>Network-Choice Seekers: Some consumers are looking for flexibility outside the structured networks of ACA-compliant plans. STM plans, particularly the longer-duration options, can provide more flexibility in choosing healthcare providers. In addition, they can support consumers opting for a narrower network, which may appeal to those who prioritize access to specific doctors or healthcare systems.</li></ol> <h2>Affordability: The Clear Advantage of STM</h2>One of the most significant driving forces behind the demand for longer-duration STM plans is affordability. With unsubsidized ACA premiums continuing to rise, many consumers are looking for cost-effective alternatives. According to recent studies, STM plans can often cost less than half the price of traditional ACA plans, making them an attractive option for consumers on a budget. For healthier individuals and those with limited healthcare needs, the affordability of STM plans can be a major selling point. While ACA-compliant plans often come with higher premiums to cover a broad range of services (including those for individuals with pre-existing conditions), STM plans provide more affordable options without compromising essential benefits.<h2>Emotional Drivers: Why Simplicity, Control, and Stability Matter</h2>Beyond financial considerations, several emotional drivers play a crucial role in the growing preference for STM plans. These include:<ul><li>Simplicity: STM plans are often simpler to navigate compared to the complexity of ACA-compliant plans. With fewer moving parts, less paperwork, and straightforward options, consumers find peace of mind in the ease of understanding their coverage and knowing exactly what is included. For many, simplicity is a key part of reducing stress during an already stressful healthcare decision-making process.</li><li>Control: The flexibility to choose how long a consumer wants to be covered - whether for a few months or up to a year - appeals to those who want to remain in control of their healthcare choices. The ability to select their plan duration according to their needs offers a sense of autonomy that many traditional insurance plans simply don't provide.</li><li>Stability: With longer-duration STM plans, consumers can rely on the stability of their coverage for a set period, alleviating the anxiety of constantly needing to re-apply for coverage or worrying about gaps in care. This sense of stability is particularly comforting to individuals in transitional phases of life.</li></ul> <h2>Addressing Misconceptions: Transparency and Education are Key</h2>Despite the growing demand for STM plans, misconceptions about their limitations remain. It's important for agencies and brokers to educate consumers about the benefits and constraints of STM plans.<ul><li>Misconception 1: STM plans don't cover essential health benefits. While STM plans are not ACA-compliant, they do cover a wide range of essential health services, though not all ACA-required benefits are included. Clear communication about what STM plans cover - and what they don't - can help manage expectations and build trust.</li><li>Misconception 2: STM plans are just a temporary stopgap with no long-term value. Many consumers view STM plans as only for short-term use, but the longer-duration options are designed to provide consistent, stable coverage for up to 12 months or even 3 years. Education around these extended options can help shift the perception that STM is only for the "brief" and "transitional" periods.</li><li>Misconception 3: STM plans are only for young, healthy individuals. While STM plans may be most attractive to those who are generally healthy, they can also benefit individuals with minor or manageable health conditions who don't need the level of care provided by ACA-compliant plans. While preexisting conditions still affect eligibility, conditions approved during the coverage period may enable consumers to access the coverage they need. Transparent marketing can help dispel this myth and widen the appeal to a broader audience.</li></ul> <h2>Conclusion: The Need for Listening and Adaptation</h2>To successfully serve today's consumers, agencies must listen to the market and respond to evolving needs. Longer-duration STM plans are an increasingly popular choice for those seeking affordability, flexibility, and stability in their healthcare coverage. By understanding the key consumer segments driving this demand and educating buyers on the benefits and limitations of STM plans, agencies can ensure they're providing the most effective solutions for today's insurance market. The appeal of STM plans will likely continue to grow as healthcare costs rise and consumer preferences shift towards more tailored, transparent, and cost-effective coverage options. By adapting to these changing demands and overcoming misconceptions, agencies can stay ahead of the curve and build lasting relationships with consumers.

<h2>Interested in learning how we can help you scale your agency?</h2>

Pivot Health by Healthcare.com offers solutions to your clients whether they are a good fit for STM or ACA. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

Discover why longer-duration STM plans are gaining popularity as affordable, flexible alternatives to ACA coverage—driven by evolving consumer needs.

What the Market is Saying: The Shift Toward Longer STM Plans

The individual health insurance market is in flux once again - especially with the return of longer-duration Short-Term Medical (STM) plans. As brokers and agents, it's time to take a fresh look: are STM and ACA really in competition, or can they co-exist - and even complement one another? <h2>The Return of Longer STM Plans: What's the Impact?</h2>As regulations shift and longer STM plans make a comeback, one of the biggest questions on the table is whether they'll siphon off healthy, unsubsidized consumers from the ACA market. The logic is clear: younger, healthier individuals who don't qualify for subsidies may find STM's lower premiums appealing. But let's not oversimplify. ACA performance isn't solely tied to STM's presence. Take Centene's recent performance as an example. Even with duration caps on STM plans in place, they reported underperforming loss ratios in July 2025. That suggests broader ACA dynamics - such as pricing strategy, provider network issues, or changes in enrollee risk profile - are also at play. In short, STM might influence the ACA market, but it's not the only driver under the hood.<h2>ACA and STM: Not Rivals - But Resources</h2>There's a growing recognition in the broker community that STM and ACA serve different needs:<ul><li>ACA is the go-to option for subsidized enrollees and those with ongoing or complex health conditions.</li><li>STM, on the other hand, fits well for healthy, unsubsidized individuals or those in temporary coverage gaps - like between jobs or outside open enrollment.</li></ul>These aren't necessarily competing products - they're tools for different scenarios. By understanding where each one fits, agents can better serve diverse client needs and provide ethical, compliant solutions.<h2>The Agent Opportunity: Start with a Subsidy Check</h2>The real opportunity for agents lies in positioning ACA and STM side-by-side, not as either/or choices. The key? Always start with a subsidy check. If the consumer qualifies for an ACA subsidy, that's often the clear path forward. If not, STM may be a cost-effective alternative - especially if the consumer is in good health and needs short-term protection. By leading with value, transparency, and a full view of the available options, agents can:<ul><li>Grow their client base</li><li>Build long-term trust</li><li>Stay relevant in a shifting market</li></ul><h2>Conclusion: Two Products, One Goal</h2>ACA and STM may take different paths, but they're both headed toward the same destination: helping consumers get the coverage they need, when they need it. For agents, the winning strategy is to embrace both, educate clients, and guide them toward the best-fit solution.

Pivot Health by Healthcare.com offers solutions to your clients whether they are a good fit for STM or ACA. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

Explore how Short-Term Medical (STM) and ACA plans serve different needs and how agents can leverage both to grow their business and better serve clients.

STM and ACA: Friends, Foes, or Just Different Paths?

Short-term medical (STM) plans are making a strong return - but with renewed interest comes renewed scrutiny. As a broker, it's essential to understand not just the opportunities, but the real risks that come with selling STM. Missteps can impact your clients, your compliance standing, and your reputation. Let's break down what you need to watch for - and how to navigate smartly. <h2>1. Compliance Is Non-Negotiable</h2>STM plans are under the microscope. Regulatory expectations are shifting fast, and staying compliant isn't just about avoiding fines - it's about protecting your business. One small slip in disclosures or plan explanations can trigger client complaints or even regulator action.Tip: Ensure your sales process includes clear documentation, updated training, and built-in compliance checks.<h2>2. Consumer Confusion = Broker Risk</h2>Many clients don't fully understand what STM covers - and more importantly, what it doesn't. Exclusions for pre-existing conditions, annual/lifetime caps, and limited benefit coverage often fly under the radar until a claim is denied. Guess who they'll call first? You.Tip: Be brutally transparent. Help clients understand the gaps in STM so they can make an informed choice-and so you're protected from misrepresentation claims.<h2>3. Reputational Fallout Can Happen Fast</h2>In today's social and digital world, one unhappy client can turn into a reputational headache. And with STM's controversial history, it won't take much for critics - or regulators - to spotlight poor sales practices.Tip: Position yourself as an ethical expert. Transparency builds long-term trust, and it differentiates you from bad actors in the space.<h2>4. STM Isn't One-Size-Fits-All</h2>Not every client is a fit for STM. Trying to force a plan that doesn't meet someone's medical or financial needs will eventually backfire.Tip: Treat STM like a tool. Use it where appropriate, explain the trade-offs, and be ready with alternative options for those who need more comprehensive coverage.<h2>5. The Market Is Watching</h2>Agencies and brokers should expect increased attention - from regulators, consumer advocates, and even the media. Missteps in STM sales won't stay behind closed doors.Tip: Stay ahead by embracing transparency. Proactive communication, honest marketing, and documentation are your best defense.<h2>Bottom Line: Lead with Integrity</h2>STM can be a valuable solution - but only when it's sold responsibly. As a broker, your role is to guide clients with honesty, stay compliant, and protect your professional reputation. The risks are real---but so is the opportunity to stand out as a trusted advisor in a sensitive space.

Pivot Health by Healthcare.com provides a simplified underwriting process to determine if your client is eligible for short-term medical coverage. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

Explore key risks brokers face when selling STM plans—compliance, client misunderstandings, and reputational pitfalls—and how to navigate them.

What Could Go Wrong? Navigating the Risks of STM’s Comeback

As the short-term medical (STM) insurance market continues to evolve, carriers are preparing for a new generation of products that reflect changing consumer expectations, regulatory updates, and tech-driven possibilities. What's ahead for STM---and what you should be ready for. <h2>Likely Changes on the Horizon</h2>Several product changes are expected to define the future of STM. Among the most anticipated updates:<ul><li>Return of 364-Day Terms: Regulatory flexibility may open the door for plans with longer durations, bringing back nearly year-long coverage options that offer more stability for consumers between major medical plans.</li>
<li>Clearer Plan Naming: Simplifying and standardizing plan names will help consumers make more informed decisions, cutting through confusion and aligning expectations.</li>
<li>Enhanced Benefit Summaries: Expect more detailed, yet easier-to-read plan summaries designed to make benefit details transparent at a glance.</li>
<li>Tech-Enabled Enrollment: Enrollment platforms will become smarter and more intuitive, reducing friction and guiding users with tools like chatbots, auto-fill, and recommendation engines.</li>
<li>Modular Add-Ons: Plans will likely offer mix-and-match add-ons, allowing consumers to customize coverage based on their needs---whether that's mental health, telemedicine, or prescription benefits.</li></ul><h2>Carriers Will Compete on More Than Price</h2>Price remains a key driver, but the next wave of STM plans will see carriers differentiate in new ways:<ul><li>Underwriting Speed: Fast, seamless underwriting powered by automation and real-time data will be a competitive edge.</li>
<li>Digital Tools: From mobile apps to user portals, carriers will invest heavily in user-friendly tools that put more control in the hands of the insured.</li>
<li>Transparent Benefits: Clear, upfront explanations of what's covered (and what's not) will be essential for trust and retention.</li></ul><h2>Affordability vs. Compliance: The Delicate Balance</h2>Looking ahead, the biggest challenge - and opportunity - will be finding the sweet spot between affordability and compliance. As regulators continue to examine the STM market, carriers must design plans that meet legal standards without losing the price appeal that defines STM. Consumers want low-cost options, but they also want clarity, convenience, and confidence. Striking this balance will shape the next era of short-term medical offerings and determine which players lead the market forward.

Pivot Health by Healthcare.com partners with three A-rated carriers to provide budget-friendly, longer term duration short-term medical plans for your clients. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

Next-gen STM plans are coming: longer terms, clearer benefits, faster tech, and more flexibility—all while balancing cost and compliance.

The Next Generation of STM Plans: What’s Coming and When

<span style="border-color: rgb(from var(--color-gray-200) r g b/1); --tw-border-spacing-x: 0; --tw-border-spacing-y: 0; --tw-translate-x: 0; --tw-translate-y: 0; --tw-rotate: 0; --tw-skew-x: 0; --tw-skew-y: 0; --tw-scale-x: 1; --tw-scale-y: 1; --tw-pan-x: ; --tw-pan-y: ; --tw-pinch-zoom: ; --tw-scroll-snap-strictness: proximity; --tw-gradient-from-position: ; --tw-gradient-via-position: ; --tw-gradient-to-position: ; --tw-ordinal: ; --tw-slashed-zero: ; --tw-numeric-figure: ; --tw-numeric-spacing: ; --tw-numeric-fraction: ; --tw-ring-inset: ; --tw-ring-offset-width: 0px; --tw-ring-offset-color: #fff; --tw-ring-color: rgb(59 130 246/0.5); --tw-ring-offset-shadow: 0 0 #0000; --tw-ring-shadow: 0 0 #0000; --tw-shadow: 0 0 #0000; --tw-shadow-colored: 0 0 #0000; --tw-blur: ; --tw-brightness: ; --tw-contrast: ; --tw-grayscale: ; --tw-hue-rotate: ; --tw-invert: ; --tw-saturate: ; --tw-sepia: ; --tw-drop-shadow: ; --tw-backdrop-blur: ; --tw-backdrop-brightness: ; --tw-backdrop-contrast: ; --tw-backdrop-grayscale: ; --tw-backdrop-hue-rotate: ; --tw-backdrop-invert: ; --tw-backdrop-opacity: ; --tw-backdrop-saturate: ; --tw-backdrop-sepia: ; font-weight: bolder; font-size: 18px;">Last Updated: September 22, 2025

On August 7, 2025, the Centers for Medicare &amp; Medicaid Services (CMS), in collaboration with other federal agencies, issued a joint statement announcing that they will not prioritize enforcing the 2024 federal rule that restricts Short-Term Medical (STM) plans to a three-month duration. As federal regulations around Short-Term Medical (STM) plans begin to ease, insurers and agents are eyeing new opportunities - but navigating this shifting landscape requires more than just a national outlook. Since STM remains regulated primarily at the state level, understanding and adapting to jurisdiction-specific rules is essential.<h2>A Patchwork of Regulations</h2>Despite the federal loosening of STM rules, states still call the shots when it comes to the legality and structure of these plans. The regulatory map is varied:<ul><li>Some states outright ban STM plans altogether (i.e., California, Illinois, New York)</li><li>Others restrict the duration-capping them at just a few months regardless of federal guidelines (i.e., Delaware, North Carolina, Oregon)</li><li>Still, a number of states align more closely with federal standards, offering broader flexibility (i.e., Florida, Texas)</li></ul><h2>Who's Likely to Expand-and Who's Not</h2>Looking ahead, it's clear that permissive states like Texas, Florida, and Arizona are poised to embrace any additional flexibility the federal government offers. These markets may present growth opportunities for carriers and brokers willing to adapt quickly. On the flip side, restrictive states such as California, Illinois, New York, and New Jersey are unlikely to loosen their stances. In these jurisdictions, regulatory resistance is strong, and STM expansion remains improbable.<h2>Practical Compliance Steps</h2>In this evolving regulatory environment, staying compliant isn't optional-it's critical. Here are three key steps every stakeholder should take:<ol><li>Build or Maintain a State Compliance Matrix - A centralized matrix that outlines each state's STM rules can help ensure you're operating within legal boundaries.</li><li>Update Marketing Materials with State-Specific Disclosures - Customizing collateral for each state reduces compliance risk and builds consumer trust.</li><li>Train Agents on Jurisdictional Rules - Agents must understand which products can be sold where---and under what conditions. Ongoing training helps prevent accidental violations.</li></ol><h2>Final Thoughts</h2>As federal STM guidelines shift, it's tempting to focus solely on the national narrative. But the real story is unfolding at the state level, where regulations continue to vary dramatically. Success in this space will depend not just on recognizing opportunities-but on navigating the regulatory nuances with precision.

Pivot Health by Healthcare.com is proud to provide longer durations in 20 states, including Texas. Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

Federal STM rules are easing, but state laws still rule the game. Stay informed on where short-term medical plans can grow—or hit a wall.

STM Rules Are Loosening—But What About Your State?

Last Updated: August 25, 2025

<h2 role="heading" aria-level="1" data-uw-rm-heading="level">CMS Signaled Major Shift in STM Enforcement</h2>On August 7, 2025, the Centers for Medicare &amp; Medicaid Services (CMS), along with other federal agencies, issued a joint statement confirming they will not prioritize enforcement of the 2024 federal rule that limits Short-Term Medical (STM) plans to just three months. While the official rule remains on the books, this non-enforcement stance - paired with encouragement for states to follow suit - effectively opens the door for STM plans to operate with greater flexibility, particularly in states that already permit longer durations. <h2>What "Non-Enforcement" Really Means</h2>For now, this doesn't amount to a formal repeal. But in practice, it allows:<ul><li>Carriers to file and launch STM products with durations of up to 12 or even 36 months, depending on the state.</li><li>Agencies and brokers to prepare for a meaningful expansion of STM offerings ahead of Open Enrollment.</li><li>Consumers to access more affordable, customizable options - especially those in transition or facing ACA premium hikes.</li></ul><h2>The Big Picture</h2>This policy shift comes at a pivotal moment. With ACA premiums projected to rise significantly in 2026 - and enhanced federal subsidies potentially sunsetting -millions of Americans may find themselves priced out of the Marketplace. In this context, STM plans could re-emerge not as a niche or stopgap solution, but as a viable alternative for middle-income Americans, gig workers, and others who don't qualify for subsidies but still need coverage.<h2>What to Watch For</h2><ul><li>Increased Carrier Activity - Expect more STM filings and new product launches in STM available states.</li><li>Expanded Sales Opportunities - Agents should revisit their STM strategies now to get ahead of the market shift.</li><li>Regulatory Nuance - While federal enforcement is easing, some states still ban or tightly regulate STM. Understanding local rules is critical.</li><li>Strategic Pairings - STM can be combined with supplemental products like accident, critical illness, or fixed indemnity to help with cost gaps.</li></ul><h2>Bottom Line</h2>This quiet - but powerful - policy update gives STM a renewed role in the market. It's not a cure-all, but in today's climate of rising costs and limited options, STM is worth a fresh look - for carriers, agents, and the consumers they serve.Pivot Health currently offers up to 3 years of STM coverage through three different carriers in select states - giving agents a head start in this evolving market.

Unlock your growth potential—share a few details, and see how Pivot Health by Healthcare.com can turn your goals into results.

CMS won’t enforce 2024 STM duration limits, allowing longer plans in some states—opening new sales, product, and coverage opportunities across the market.

Short-Term Medical Insurance in 2025: A New Era of Opportunity for Agents & Agencies

<h2 role="heading" aria-level="1" data-uw-rm-heading="level">In a competitive and ever-changing health insurance landscape, agents need more than just a range of plan options—they need a partner they can trust to deliver reliable support, clear communication, and flexible solutions. </h2> For Jason VanderBeek of IHC Specialty Benefits, Pivot Health has become that trusted partner.
Licensed and appointed with multiple ACA and short-term providers, Jason’s priority is helping clients find the right coverage for their needs and budget. Time and again, Pivot Health has stood out as the provider he confidently recommends.
 Here’s what Jason had to say about his experience with the Pivot Health team:
 “I always recommend Pivot Health to all my clients! I am licensed and appointed with multiple ACA and short-term providers. My goal is to provide my clients with the best coverage within their budget with plan options that are easy to understand.
 Pivot Health support representatives have always provided accurate information when dealing with complex situations. The response time is excellent, they work together as a team to make sure the client receives prompt resolution, and communication is clear, concise, and executed professionally.
 I have relied on their team to support me as an agent in corrections on applications, verifying coverage parameters, clarifying policy benefits, and making sure the enrollment process is easy and provides a customized coverage solution!
 I am always impressed with every individual who handles my client’s policies from start to finish. Pivot Health compliance and regulatory solutions are amazing. They provide solutions to the enrollment time frames that vary on the Federal and individual state level making it easy on consumers to understand what to expect, and agents like myself, to provide options for difficult enrollment situations.
 The flexibility of the policies and world-class support far exceeds any other provider that I am appointed with and I will continue to recommend every eligible person to a Pivot Health plan, when appropriate. I know that my clients are with the best in the industry and hope that legislation changes will allow them to provide benefits on longer terms for those who looking for a more affordable solution to healthcare in our country.”

Trusted agent shares why Pivot Health’s flexible plans and exceptional support make them a top recommendation for clients seeking affordable coverage.

Pivot Health Sets the Gold Standard for Agent Support and Coverage Options

Last Updated: August 25, 2025

With significant changes coming to ACA rules and regulations in 2026, agents must be ready to support their customers with diverse and customizable plan options tailored to each individual’s needs. Here’s what you need to know about the upcoming changes and preparing for the season ahead.<h2>Open Enrollment Period Will Shrink</h2>Change: Beginning with the 2027 plan year (Open Enrollment Fall 2026), the ACA open enrollment window for the federal Marketplace and most state-based marketplaces will be shortened by four weeks, running from <a href="https://insurancenewsnet.com/innarticle/health-plans-must-prepare-for-changes-after-new-rules" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://insurancenewsnet.com/innarticle/health-plans-must-prepare-for-changes-after-new-rules" aria-label="November 1 to December 15 - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://insurancenewsnet.com/innarticle/health-plans-must-prepare-for-changes-after-new-rules$november1todecember15">November 1 to December 15</a>. State-based exchanges may extend slightly, but only within set parameters. Challenge: Consumers missing the tighter deadline will be locked out of ACA coverage for the year unless they qualify for a Special Enrollment Period (SEP). Solution: Pivot Health STM plans, available year-round, can offer immediate gap coverage for those who miss the open enrollment window or need temporary insurance between jobs or major life events.<h2>Expiration of Enhanced Subsidies = Higher Premiums</h2>Change: The enhanced federal premium subsidies (introduced by the American Rescue Plan (ARP) and extended by the Inflation Reduction Act) are set to expire at the end of 2025. Unless Congress acts, 2026 will see a return to <a href="https://www.kff.org/policy-watch/who-might-lose-eligibility-for-affordable-care-act-marketplace-subsidies-if-enhanced-tax-credits-are-not-extended/" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.kff.org/policy-watch/who-might-lose-eligibility-for-affordable-care-act-marketplace-subsidies-if-enhanced-tax-credits-are-not-extended/" aria-label="pre-ARP subsidy levels - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.kff.org/policy-watch/who-might-lose-eligibility-for-affordable-care-act-marketplace-subsidies-if-enhanced-tax-credits-are-not-extended/$pre-arpsubsidylevels">pre-ARP subsidy levels</a>, reinstating the income cap and reducing subsidy amounts for lower-income enrollees. Challenge: Millions may face sharply higher premiums, with some estimates projecting <a href="https://www.npr.org/sections/shots-health-news/2025/07/02/nx-s1-5453870/senate-republicans-tax-bill-medicaid-health-care" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.npr.org/sections/shots-health-news/2025/07/02/nx-s1-5453870/senate-republicans-tax-bill-medicaid-health-care" aria-label="increases of up to 75% - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.npr.org/sections/shots-health-news/2025/07/02/nx-s1-5453870/senate-republicans-tax-bill-medicaid-health-care$increasesofupto75%">increases of up to 75%</a> for certain groups. The Congressional Budget Office projects millions could become uninsured due to affordability issues. Solution: Pivot Health STM plans offer budget-friendly premiums and customizable coverage, providing a viable alternative for those priced out of the ACA marketplace.<h2>Year-Round Enrollment for Low-Income Americans Ends</h2>Change: The monthly SEP for individuals with <a href="https://www.cms.gov/newsroom/press-releases/cms-takes-aim-reduce-improper-enrollments-and-promote-more-affordable-health-insurance-marketplaces" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.cms.gov/newsroom/press-releases/cms-takes-aim-reduce-improper-enrollments-and-promote-more-affordable-health-insurance-marketplaces" aria-label="incomes up to 150% - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.cms.gov/newsroom/press-releases/cms-takes-aim-reduce-improper-enrollments-and-promote-more-affordable-health-insurance-marketplaces$incomesupto150%">incomes up to 150% </a>of the federal poverty level is being eliminated nationwide for 2026. Low-income Americans will only be able to enroll during the Annual Open Enrollment Period or after a qualifying life event. Challenge: Vulnerable populations will have fewer opportunities to secure ACA coverage when they need it. Solution: Pivot Health STM plans can bridge coverage gaps for these individuals until they regain eligibility during the open enrollment period or after a qualifying event.<h2>ACA Navigator Funding Slashed</h2>Change: Federal funding for ACA navigators is being cut by 90%, dropping from $98 million to just <a href="https://www.cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding" aria-label="$10 million for the 2026 plan year. - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.cms.gov/newsroom/press-releases/cms-announcement-federal-navigator-program-funding$$10millionforthe2026planyear.">$10 million for the 2026 plan year.</a> Challenge: With less enrollment assistance, consumers—especially those new to the marketplace—may struggle to understand their options and enroll in the right plan. Solution: Licensed insurance agents and health care distributors can fill this gap, guiding clients through Pivot Health STM options and providing critical support as ACA navigation resources dwindle.<h2>DACA Recipients and Lawfully Present Immigrants Excluded</h2>Change: Starting January 1, 2026, DACA recipients (commonly referred to as “Dreamers”) and many other lawfully present immigrants <a href="https://www.msn.com/en-us/politics/government/senate-s-budget-deal-restricting-immigrant-access-to-federal-health-benefits/ar-AA1HHgjq" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.msn.com/en-us/politics/government/senate-s-budget-deal-restricting-immigrant-access-to-federal-health-benefits/ar-AA1HHgjq" aria-label="will lose eligibility for ACA marketplace coverage and subsidies. - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.msn.com/en-us/politics/government/senate-s-budget-deal-restricting-immigrant-access-to-federal-health-benefits/ar-aa1hhgjq$willloseeligibilityforacamarketplacecoverageandsubsidies.">will lose eligibility for ACA marketplace coverage and subsidies.</a> Only lawful permanent residents and a few other categories will remain eligible. Challenge: Tens of thousands of individuals will be left without access to affordable coverage. Solution: Pivot Health STM plans may serve as a stopgap for populations excluded from ACA enrollment. To be eligible, the minimum requirement for non-citizens is 12 months of residency in the United States on an STM application.<h2>Higher Out-of-Pocket Maximums</h2>Change: The maximum out-of-pocket limit for <a href="https://www.wtwco.com/en-us/insights/2025/07/cms-releases-revised-2026-out-of-pocket-expense-limits" rel="noopener noreferrer" target="_blank" data-uw-rm-brl="PR" data-uw-original-href="https://www.wtwco.com/en-us/insights/2025/07/cms-releases-revised-2026-out-of-pocket-expense-limits" aria-label="ACA plans will increase to $10,600 - open in a new tab" data-uw-rm-ext-link="" uw-rm-external-link-id="https://www.wtwco.com/en-us/insights/2025/07/cms-releases-revised-2026-out-of-pocket-expense-limits$acaplanswillincreaseto$10,600">ACA plans will increase to $10,600 </a>for individuals in 2026, up from $10,150 under previous rules. This change also reduces the generosity of premium subsidies. Challenge: Consumers will face higher potential costs even if they maintain ACA coverage. Solution: Pivot Health STM plans often feature lower premiums and can be structured to provide catastrophic coverage for future major medical events.<h2>Implications for the Short-Term Medical Insurance Market</h2>Pivot Health STM plans are not subject to ACA regulations, allowing for:<ul><li>Year-round enrollment.</li><li>Flexible or longer durations up to 3 years for select plans in select states.</li><li>Lower premiums.</li><li>Immediate coverage for unexpected gaps.</li></ul>With ACA access narrowing and costs rising, STM is expected to see increased demand among individuals and families who do not qualify for subsidies or miss open enrollment. For technology companies and marketers, this shift creates opportunities to innovate enrollment platforms, digital marketing strategies, and agent support tools tailored to STM products.<h2>Key Takeaways for Agents and Distributors</h2><ul><li>Tech companies: Prepare to update enrollment systems and user interfaces to reflect new deadlines, eligibility rules, and subsidy structures.</li><li>Marketing organizations: Educate clients and consumers about the new landscape and the expanded role of STM.</li><li>Independent insurance agents: Position STM as a strategic alternative and ensure compliance with evolving federal and state regulations.</li></ul><h2>Government &amp; Private Resources To Monitor</h2><ul><li>Centers for Medicare &amp; Medicaid Services (CMS) official announcements on navigator funding, open enrollment, and eligibility rules.</li><li>Congressional Budget Office (CBO) projections on uninsured rates and premium impacts.</li><li>KFF analyses on subsidy changes and immigrant eligibility.</li></ul>By staying ahead of these sweeping changes, you can help clients and consumers navigate a more complex—and potentially riskier—insurance marketplace.

ACA changes in 2026 will limit access and raise costs. Pivot Health STM plans offer flexible, year-round coverage to bridge gaps and support agents.

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