Open Enrollment begins on November 1, 2025, and runs through January 15, 2026. Anthem will offer shopping starting November 1. Some exchanges may offer window shopping options earlier. We encourage you to check specific exchanges for their timelines.
We’re here to help you connect your clients to a health plan that delivers the care and savings they need. Benefits include $0 preventive care,1 $0 virtual care visits,2 and prescription drug coverage including convenient home delivery. Plus, our SydneySM Health app gives members their health information, resources, and well-being support in one convenient place.
Important updates for 2026
- Key changes
- The extra help provided by the American Rescue Plan Act may stop on December 31, 2025. This might mean your client will have to pay more for their premium after that date. Anthem also offers other plan options that may be lower cost and work better for your client.
- The per-prescription maximum for Tier 3 and Tier 4 Rx drugs has been removed for on-exchange Bronze plans and all off-exchange plans.
- Preventive Rx coverage has been added to all off-exchange plans. This includes no-cost select generic drugs for asthma, diabetes, high cholesterol and heart health, and blood pressure.
- Off-exchange plans will no longer include embedded pediatric dental coverage. For off-exchange consumers, the ACA requires anyone up to age 19 to have coverage for pediatric dental services. We’re informing members in their renewal packets that by renewing their medical plan, they are agreeing to purchase pediatric dental separately for anyone up to age 19.
- A new lower cost bronze plan is available on and off exchange. The plan features a $7,000 deductible, no coinsurance, $70 PCP office copay, and $50 lab copay.
- Behavioral Healthcare (BH) Therapy Visits: For on-exchange plans (except the $7,000 deductible bronze plan), BH therapy visits are offered at the same cost as a PCP office visit. For off exchange plans, BH therapy visits are offered on the gold plan at the same cost share as PCP and offered on silver and bronze plans at the same cost share as Specialist.
- The new out-of-pocket maximums for plans without a health savings account are $10,600 for individuals and $21,200 for families.
- The time frame to receive a $50 incentive for wellness exams has increased from 90 to 120 days.
- Discontinuation of off-exchange plans
- Our existing off-exchange portfolios will be discontinued as of December 31, 2025. A new off-exchange HMO portfolio of plans will be offered beginning January 1, 2026, using the Pathway X Enhanced network.
- Off-exchange EPO and HMO plans will be discontinued, and notices will be mailed at the end of September. A follow-up renewal notice will be mailed in late October to advise members they will be renewed into a Pathway X Enhanced network HMO plan. This will be an automatic renewal as long as members continue to make monthly premium payments on time.
2026 open enrollment renewal materials
- We’ll mail your clients their personalized open enrollment renewal packets.
- The cover letter explains how they can find out if they qualify for financial help and make sure they receive all the savings available to them.
- To view the renewal letter for a specific client, visit Producer Toolbox, select Book of Business, then select Renewals.
- After enrollment, your clients can virtually access their member ID cards and other plan details through the Sydney Health app.
Helpful tips and tools
- Your clients need to pay the full amount of their January 2026 bill on time to make sure their 2026 coverage begins January 1, 2026.
- If your clients are staying on the plan they have now, they can maintain their coverage by continuing payments.
- If the Health Insurance Marketplace® contacts your client about updating their account information, please advise them to reply quickly. We can’t complete their enrollment until the Marketplace tells us their account information is current.
- Use E-Submit for paper applications and maintenance paperwork.
- Enhanced Direct Enrollment allows you and your client to enroll, renew, or update your information for Affordable Care Act (ACA) plans on the exchange using anthem.com.
- Generate client reports in Producer Toolbox.
We’re here to help you connect your clients to affordable Anthem health plans. If you have questions, please call Broker Services at 833-864-0133 or email IndividualBrokerServices@anthem.com.
Thank you for your partnership and dedication to your Anthem clients. Visit Anthem Broker Hub for additional online support to help your business and your clients.
1 Nationally recommended preventive care services received in-network have no copay and no deductible requirement.
2 Virtual care visits, including video visits using the Sydney Health app are at no cost to members for most plans (however, it may be subject to the deductible depending upon the terms of the plan). Virtual care visits refer to video consultations, as deemed appropriate by a licensed physician. In addition to using a telehealth service, you can receive in-person or virtual care from your own doctor or another healthcare provider in your plan’s network. If you receive care from a doctor or healthcare provider not in your plan’s network, your share of the costs may be higher. You may also receive a bill for any charges not covered by your health plan. Sydney Health is offered through an arrangement with Carelon Digital Platforms, a separate company offering mobile application services on behalf of your health plan.