Updates to Individual and Family Plans for 2026
1. When can I purchase Individual and Family (ACA) plan for coverage in 2026?
Open Enrollment in Pennsylvania runs from Nov. 1, 2025 through Jan. 15, 2026.
2. What if I miss that deadline?
You will have opportunities to purchase a plan outside of Open Enrollment if you experience certain life changes, such as marriage, childbirth, loss of coverage due to job loss, or loss of coverage due to divorce. Please contact us at 877-563-0292 (TTY: 711) or visit our page on Special Enrollment Periods to learn if you qualify.
3. I have been hearing about changes in subsidies and tax credits. How can I find out if they will affect me?
Enhanced subsidies that were offered through the Inflation Reduction Act are set to expire at the end of 2025. Advance premium tax credits (APTC) may change for the 2026 plan year. We will provide specific information to current members affected by any changes. If you are considering a health plan for 2026.
4. Is financial assistance still available?
Advance premium tax credits (APTCs) are still available for individuals who qualify, and you may be able to receive financial assistance. Call us at 877-563-0292 or visit our marketplace shop.
5. Will I automatically be re-enrolled in my current plan?
Most members will be automatically reenrolled however we always suggest our members confirm their benefits and enrollment by logging onto the member site, or by checking our reenroll marketplace during open enrollment. Members will receive their member kit before open enrollment begins.
6. Are there citizenship requirements for purchasing an Individual or Family health plan? Can I purchase a plan if I have a student visa?
For eligibility regulations related to purchasing an Individual and Family health insurance plans, please call us at 877-563-0292 (TTY: 711) to discuss your situation or visit Pennie.com.
7. Will eligibility requirements be changing for special enrollment periods?
New federal government policy changes have tightened the requirements for special enrollment periods. Additional documentation may now be required to qualify when applying outside of open enrollment. For more information call us at 877-563-0292 (TTY: 711) or read more about Special Enrollment Periods.
8. Are preventive care services still covered without copays?
Yes. UPMC Health Plan covers preventive care without copays. Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive1. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
9. Will behavioral health still be covered?
Yes, most plans do cover behavioral health services. Having coverage through UPMC Health Plan means you will still have the same access to quality care for your mental health, including six free counseling sessions through LifeSolutions®.
1Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.
*All information is current as of 9/10/2025