What do independent practices already need to have in motion for a successful 2026 selling season in ACA and Medicare? How can insurance carriers help them be successful?
If you want 2026 to be smooth, financially strong, and free from enrollment-season chaos, here’s what you should already be setting in motion right now.
Take a Hard Look at Your Payer Contracts
Our last article discusses why this contract review is critical for providers and payers alike. Enrollment season is where the rubber meets the road, as contract issues come to light.
If you haven’t started reviewing your payer agreements, you’re already behind. Set aside time as soon as possible to compare contracts. Even minor adjustments can protect your margins in 2026.
Know Your Numbers and Use Them
Do you know which health plans the majority of your patients currently use? Do you know which carriers generate most of your revenue?
You should already have this data; if not, find it ASAP. Without this data, you’re flying blind and can’t do the following for your staff:
- Prioritize the insurance payers’ information that your staff may need to answer patient questions specific to their 2026 Medicare or ACA health plan.
- Locate the best enrollment facilitator or broker to answer your patients’ questions about their 2026 Medicare or ACA health plan.
- Inform the staff of the ACA or Medicare health plans patients are most likely to ask about during enrollment season.
Strengthening Patient Communication Channels
Physicians are the second most used source for health insurance information, behind only the internet. Patients look to you when they’re confused about insurance options.
This “trusted advisor status” means they depend on you and your team to provide them with basic, accurate facts about the Medicare and ACA health plan selling seasons. You and your team already should know how you’ll communicate this information to your patients, and these systems should be ready to go when you need them:
- Send broadcast messages through your EHR or patient portal.
- Share timely updates via email or text about beginning or ending dates for the ACA and Medicare selling seasons.
- Offer simple FAQs about which plan and coverage options you have available at your office(s) on your website.
Train Your Team to Handle Coverage Questions
Your front desk staff, billing team, and even medical assistants will get hit with questions like:
- “Will you still be in my plan next year?”
- “What insurance should I choose so I can keep seeing my doctor?”
You should already have staff training in motion to prepare them for how you want them to answer these questions, including:
- Building scripts for the most common questions.
- Teaching staff where to direct patients for enrollment help (navigators, brokers, etc.) since you and your staff aren’t supposed to promote specific plans (stay compliant with CMS!).
- Streamline your health insurance verification process so coverage checks don’t slow down the schedule.
A confident staff makes patients feel confident, too.
Build Relationships That Protect Access
Patients need help navigating the system, so you should already be building partnerships that can make open enrollment smoother:
- Enrollment navigators or brokers who can guide patients toward the primary plans you found, as discussed earlier in this article.
- Care coordinators who help patients manage transitions when coverage changes.
- Community partners (pharmacies, clinics, advocacy groups) that strengthen patient trust and retention.
When your patients feel supported, they’re more likely to stay with your practice, even if the insurance landscape gets messy.
Double-Check Compliance and Documentation
You should be confirming enrollment season compliance by preparing to:
- Make sure coding and documentation practices fully align with 2026 payer requirements.
- Update your compliance manuals and policies to reflect the changes.
- Do a mini-internal audit to catch errors before they become bigger problems.
Think of it as “spring cleaning” for your practice before the enrollment rush.
Go Time is NOW
Enrollment season success starts now by tightening contracts, preparing your team, keeping patients informed, and leveraging resources to grow your practice instead of just surviving. Time is short to do the things needed for a successful 2026 enrollment season.
How Patient Care Health (PCH) Can Help
At PCH, we collaborate with independent physicians and practice managers to provide everything you need for a successful 2026 enrollment season. Our team has decades of experience successfully facilitating the activities above for a practice’s revenue and operational success.
Partner with PCH today to ramp up your 2026 enrollment season success so you can focus on what matters most – your patients’ excellent care. Let’s talk now so PCH can empower your 2026 enrollment season success.
Phone: (866) 985-2010, Monday-Friday 9 A.M. – 5 P.M. CT
Email: info@patientcarehealth.com
