Open Enrollment on the Health Insurance Marketplace for the Farm Population

Fall is not just harvest season. It is also open enrollment season to purchase or update health insurance plans on the marketplace. Based on a survey of over 1,100 farm families in ten states across the country, 40% had purchased a plan on the health insurance marketplace, and 50% had received a tax credit or subsidy to help offset the cost (Becot & Inwood 2019). With agriculture being a dangerous and physical occupation, three-quarters of farm families said that health insurance is an important or very important risk management strategy for their farm (Inwood et al., 2018). In this article, we provide information on the health insurance marketplace and how to navigate the open enrollment season. We also touch on recent changes that will impact people for 2026. Open enrollment takes place every year between November 1 and January 15. Besides qualifying events such as the birth of a new child or the loss of insurance coverage from off-farm employment, open enrollment is the only time when people can purchase or change a plan through the health insurance marketplace.

Health Insurance Marketplace™

Health insurance marketplaces are an aggregate of health insurance plans that people can compare and purchase. There are two types of marketplaces: the ones run by the federal government and those run by states. Pennsylvania runs its own health insurance marketplace called Pennie. If you live outside of Pennsylvania, the easiest way to find out about the marketplace relevant to you is by visiting healthcare.gov.

There are two key things to know about the plans offered on the Federal or state marketplace: 

1. All plans include coverage for pre-existing conditions and cover the essential benefits listed in the Affordable Care Act (ACA) of 2010. These ten essential benefits include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, and mental health services. Plans must offer dental coverage for children, while providing dental coverage for adults is optional.
2. Financial savings may be available by way of lower premiums and out-of-pocket expenses.
   • There are two types of financial savings: advanced premium tax credit to lower monthly premium payments and cost-sharing reduction to lower out-of-pocket expenses (i.e., from medical bills). Financial savings are calculated using your expected household income for the coming year and are available for income ranging between 100% and 400% of the federal poverty guidelines (FPL). In 2025, 100% of the FPL for a household of four was $31,200 and 400% of the FPL was $124,800 (except for Alaska and Hawaii, where guidelines are higher) (KFF, 2024). In other words, financial savings were available to households of four earning between $31,200 and $124,800 in 2025. To see income thresholds for families of different sizes, see Explaining Health Care Reform: Questions About Health Insurance Subsidies. One important thing for farmers to know is that business assets are not included in the calculation to determine eligibility for financial savings. Another important thing to know is that COVID-era premium tax credits are set to expire at the end of 2025. Unless they are extended, monthly premium costs will increase. 
   • While the income threshold varies from state to state, people with lower income may be eligible for public coverage through Medicaid (also known as Medical Assistance in Pennsylvania) and the Children's Health insurance program (CHIP). Pennsylvania has adopted a "no wrong door policy," which means that if the information you provide when applying for a plan on the insurance marketplace meets the criteria for public coverage, your application will be transferred to the Pennsylvania Department of Human Services, which is the department in charge of Medical Assistance and CHIP.

How to Enroll, Renew, or Change a Health Insurance Plan

Besides qualifying events such as the birth of a new child or the loss of insurance coverage from off-farm employment, open enrollment is the only time of the year when people can purchase or change a plan through the health insurance marketplace. Open enrollment takes place every year between November 1 and January 15.  For more information about qualifying events or to buy a plan outside of open enrollment, see Special Enrollment Periods.

Eligibility Criteria to Use the Insurance Marketplace

To use the insurance marketplace, you must:

• Live in the U.S.
• Be a U.S. citizen or national or be lawfully present non-citizen in the U.S.
• Not be incarcerated
• Not having Medicare coverage
• While having the option to get insurance coverage through an off-farm job does not preclude you from buying a plan on the insurance marketplace, you might not be eligible for financial savings. For more information about financial savings eligibility for marketplace health insurance plans for people who have access to coverage through an off-farm job, see People with Coverage Through a Job.

Of note, there are recent changes impacting eligibility based on immigration status. Since August 2025, DACA recipients are no longer eligible for Marketplace coverage or premium tax credit. Starting January 1, 2026, permanent residents in the U.S. for less than 5 years are no longer eligible for the premium tax credit, but they can still buy a plan on the Marketplace.

Accessing the Health Insurance Marketplace

The simplest approach to accessing the insurance marketplace is by visiting the Health Insurance Marketplace. You will be asked about your state of residence and redirected accordingly. In Pennsylvania, that means being redirected to Pennie.com. You can also choose to work with an insurance agent or a broker certified to sell marketplace plans. Use the Search tool to find certified agents and brokers in Pennsylvania. For additional help in navigating Pennie, call 1-844-844-8040.

Application Process

You will first be asked to provide information about your household and expected income for the coming year. You can use this checklist (PDF) to help you assemble the documents you need to fill out the application form. You can use the Count Income and Household Size worksheet to estimate your income for the coming year. In addition, because farm families’ income is often complex, some farmers consult with their bookkeeper or tax preparer to get ready to fill out their application.

Shopping for Plans

Once you have provided your personal information, you will then be able to shop for plans. Determining your healthcare needs and which plan(s) best fit your needs can be difficult. Plans with lower monthly premiums might be attractive, but the coverage may not adequately cover your healthcare needs. This situation is called under insurance. In the survey mentioned above, over half (56%) of farm families were not confident in their ability to pay for the cost of a major illness or injury without going into debt. The quality and type of health insurance coverage were associated with being concerned about going into debt (Becot & Inwood, 2022). See the Resources section below for resources to help you shop for the plan that best suits your needs.

How often should you shop for a new plan?

Even if your current plan will be available again in the coming year, it is recommended that you visit the health insurance marketplace during every open enrollment season because: 

• New plans may have been added. These plans might be cheaper or may include coverage that fits your needs better.
• Monthly premiums for your current plan might have drastically increased: With the ending of the COVID-era premium tax credits set to expire at the end of 2025, premium increases are expected across all plans. You might have been informed of this increase by your Health Insurance Marketplace. If you have not heard anything and if you auto-renew, make sure to log in your account to see how your premiums are changing for the coming year. 
• Your families' healthcare needs might have changed and there might be better plans on the marketplace to meet these needs.
• Your expected income might be changing. Financial savings are based on your expected estimated income for the coming year. As such, it is important to keep this information up to date. For example, if you expect your income to be lower, you could qualify for more savings. On the other hand, if you expect your income to be higher, you may qualify for less savings, and if you do not update your income information, you may owe money on your tax return. One strategy to limit the repayment is to inform the Health Insurance Marketplace mid-year if your income is significantly higher than planned. They can adjust your tax credit for the rest of the year to limit how much you have to repay at the end of the year. This is particularly important because the repayment cap is going away, meaning that people will now be responsible for all overpaid premium tax credit.

Resources to Navigate the Health Insurance Marketplace 

Because it can be difficult to shop for a plan that meets your needs, several resources are available to help you determine your healthcare needs, the plan(s) that best fit your needs, and financial savings eligibility. 

• Smart Choice Smart Use Workbook (PDF). This workbook was designed to help people determine the healthcare needs of their families and the type of plan that might best fit their needs. You can print the workbook and work your way through the sections that are most relevant to you.
• Health insurance navigators, or Exchange Assisters, are individuals trained to help you navigate the options available on the insurance marketplace and your eligibility for financial savings. One caveat that farmers have shared is that sometimes these navigators need to become more familiar with the specifics of self-employed individuals like them. Some farmers have said that it can also be helpful to talk to a tax accountant or bookkeeper (see below). Working with a health insurance navigator is free. In Pennsylvania, you can find an Exchange Assister using the Pennie search tool. In addition, you can call Pennie to help you get connected: 1-844-844-8040.
• Tax accountants and bookkeepers with expertise in agriculture. Even if you don’t regularly work with one, tax accountants and bookkeepers can help by providing guidance on determining your future income and how your farm investment plans may impact your health insurance choices and savings.
• Health insurance agents and brokers have a comprehensive understanding of health insurance options and tend to offer more plan options than what is available on the insurance marketplace. However, if you want access to the marketplace insurance plans and savings, make sure that they are certified to offer these plans. If possible, work with a health insurance agent or broker with a track record of working with farmers to ensure that they know how to navigate farmers' health insurance needs and their complex income situation. Use the Pennie search tool to find certified agents and brokers in Pennsylvania. Agents and brokers in rural areas are more likely to have experience working with farmers.

More Information, including about recent policy changes:

• Health Care Insurance Options for Farm Business Operations (PDF) from the University of Maryland and the University of Delaware
• What's new - Changes for Pennie enrollees from Pennie
• Health Insurance Literacy Course from the University of Delaware
• What to Expect for Open Enrollment for 2026 from Georgetown University
• 8 Things to Watch for the 2026 ACA Open Enrollment Period from KFF

Disclaimer:

Please note that this article is for educational purposes only; it is not intended to be a substitute for professional health insurance navigators, tax professionals, and immigration lawyers. Always seek the advice of the relevant professional if you have specific questions about your situation.

References

Becot, F., & Inwood, S. (2019). Farm households' health insurance coverage and costs (PDF). 2017 National Farmer and Rancher Survey Findings. Health Insurance, Rural Economic Development and Agriculture (HIREDnAg). The Ohio State University.

Becot, F., & Inwood, S. (2022). Medical economic vulnerability: a next step in expanding the farm resilience scholarship. Agriculture and Human Values, 39, 1097-1116. doi.org/10.1007/s10460-022-10307-4

Inwood, S., Knudson, A., Becot, F., Brown, B., Goetz, S., Kolodinsky, J., Loveridge, S., Morris, K., Parker, J., Parsons, R., Welborn, R., & Albrecht, D. (2018). Health Insurance and National Farm Policy. Choices, 33(1), 1-7. 

KFF. (2023). Explaining Health Care Reform: Questions About Health Insurance Subsidies.