Newsletter

NEW MED PERFORMANCE PLAN MAJOR MEDICAL PLANS AVAILABLE

We are now able to offer four different PPO major medical plans that utilize Cigna’s largest national PPO network. These plans are designed for non- or lowly-subsidized individuals who find that Affordable Care Act plans are too costly.

Enrollment is permitted through age 64 and the plans can be kept after age 65 for those not eligible for Medicare. These plans can be offered to citizens as well as legal residents. 

Premiums are age-banded (18-29, 30-39, 40-49, 50-59, and 60-64) based on the age of the primary policy holder. The younger spouse can be named as the primary policy holder. 

Four different plans are offered (3500 Classic, 5000 Classic, 5000 HSA, and 7350 Value). Click on the following link to learn more about each plan: 

https://www.1enrollment.com/index.cfm?id=622051&cat=Med Performance

Each of the four plans is described separately. Click on the Info tab for each plan to learn more about the plan. The Info tab contains the brochure for the plan, the schedule of benefits for the plan, the formulary, and instructions for determining if a provider is in the network.

Applicants must successfully answer these questions to be eligible to enroll.

Applicants are eligible for enrollment if they can answer NO to all the health questions.

There are no pre-existing condition limitations for enrollees, and enrollees will find that the premiums for these plans are significantly lower than for equivalent Affordable Care Act plans. These plans qualify as Affordable Care Act plans for purposes of meeting requirements of having ACA plans in those states that impose penalties for not enrolling in an ACA plan.

Enrollment can occur on a year-round basis. Enrollment must occur as of the 20^th of the month for enrollment to be effective as of the first of the following month.

Please contact us at 786-970-0740 if you’d like to learn more about these plans or if you need help in enrolling.

Current members of the AFI-CIGNA association plans are eligible to switch to these plans if they can satisfactorily answer the health questions.

AFFORDABLE CARE ACT ENROLLMENT DROP IS DEEPER THAN EXPECTED

The April 15, 2026 Individual Market Early Effectuation and Morbidity Update, a national actuarial analysis prepared by the Wakeley Consulting Group covering roughly 80 % of the individual market, shows that 2026 ACA enrollment declines are far larger than early January numbers suggested. Only 86% of enrollees paid their first premium, and updated projections now show 17%–26% lower effectuated enrollment for 2026.

What’s driving the drop

• Higher premiums pushed many consumers toward Bronze or Catastrophic plans.
• Silver enrollment continues to fall; in some markets Gold is now cheaper than Silver.
• Morbidity is projected to rise 2.9%–6.5% — meaning the average enrollee is expected to be sicker and more expensive to insure because healthier people are disproportionately leaving the market.
• State-based exchanges remain more stable than the federal exchange.

Important for consumers

• Losing coverage due to nonpayment does not qualify for a Special Enrollment Period (SEP).
• Auto‑reenrolled members should confirm invoices immediately to avoid unintended lapses.
• Consumers should compare all metal tiers — pricing relationships have shifted in many states.

Important for consumers

• Losing coverage due to nonpayment does not qualify for a Special Enrollment Period (SEP).
• Auto‑reenrolled members should confirm invoices immediately to avoid unintended lapses.
• Consumers should compare all metal tiers — pricing relationships have shifted in many states.

Bottom line

Affordability pressures and nonpayment are reshaping the 2026 ACA market. Consumers who stay engaged, shop carefully, and monitor billing are in the best position to maintain coverage.

STATES ADD NEW SUBSIDIES AS ARPA ENHANCEMENTS EXPIRE

With the federal subsidy enhancements created under the American Rescue Plan Act (ARPA) now expired, several states (not including Florida) are stepping in with their own affordability programs for 2026.

ARPA was a 2021 law that temporarily increased ACA premium tax credits, removed the 400% FPL subsidy cliff, and capped premiums at 8.5% of income. These enhancements expired on December 31, 2025, and have not been extended, contributing to higher premiums this year.

With ARPA gone, subsidy rules reverted to pre‑2021 levels — including the return of the 400% FPL subsidy cliff — prompting several states to step in with their own affordability programs.

States offering or expanding subsidies in 2026

• California: Premium subsidies up to 600% FPL; added cost-sharing help.
• Colorado: State-funded subsidies through the Colorado Option; enhanced support up to 300% FPL.
• Connecticut: “Covered Connecticut” expanded; no premiums and minimal cost sharing up to 175% FPL.
• Maryland: Expanded Young Adult Subsidy Program (ages 18–34) and added support up to 400% FPL.
• Massachusetts: "ConnectorCare" expanded to households up to 500% FPL.
• New Jersey: Increased NJ Health Plan Savings subsidies up to 600% FPL.
• Vermont: Premium subsidies up to 300% FPL with enhanced cost-sharing reductions.

What this means for consumers

• Middle-income households — especially those just above 400% FPL — may see meaningful relief depending on their state.
• Some states now offer premiums that resemble ARPA-era affordability levels.
• Consumers should re-run Marketplace quotes to see whether state subsidies reduce premiums or out-of-pocket costs.

Bottom line

With federal enhancements gone, state programs are becoming a key driver of affordability. Consumers in participating states may see significantly lower premiums than expected.

About Paul Cholak

Paul has over forty years of benefits experience and has been Director of Employee Benefits for large companies, as well as a benefits consultant with major consulting firms. He understands the health and life insurance needs of individuals and families of all ages. He also has considerable experience in selling health and life insurance to employer groups.

He guides you through the steps of getting health and/or life insurance and is available to help you both BEFORE and AFTER you've made your purchase decision.