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Kathy Healy:
Hi, I’m Kathy Healy with Healy Wealth Management. Today I’m joined by Bill Neglia of Neglia Insurance Group to talk about the latest and greatest in health insurance. I’ve known Bill for over ten years, and he’s navigated all the changes in our health care system and continues to help clients sort through what’s new and how to make the best decisions for themselves and their families.
Bill, would you tell us a little about yourself and your business?
Bill Neglia:
Yeah, sure. Thanks, Kathy. I appreciate the invitation to be on this platform. So I started my agency back in 1983. It was mostly a life insurance–based organization. I worked with companies like MassMutual, Northwestern Mutual, John Hancock. That’s how I got my interest and indoctrination into the insurance world. And then in 1991, I moved my family from New York to Georgia.
And soon thereafter, I decided to change my emphasis into more of a benefits — a general benefits business — with health insurance being my lead product. I found it was a lot easier to talk to people, especially self-employed individuals, which was my target market, about health insurance than it was life insurance. So for the last 30-plus years I’ve been running a primarily health-insurance-oriented book of business.
I do all the other things as well, but health insurance has been my bread and butter. I’ve got my son and son-in-law working with me on a part-time basis. We have one assistant, thank God, who does a lot of the grunt work — the quoting, the tedious stuff that takes me out of the field and allows me to be more fluid and conversational with my clients, because they really need to talk to me about their options. And then my assistant can just run the numbers.
Kathy Healy:
So when I’m doing financial planning for clients, a big thing that often comes up — a scenario they want to run — is early retirement. But when people are younger than 65, can’t go on Medicare yet, and they’re going to have a period of years when they’re not covered under their employer’s plan, what can they do?
Bill Neglia:
Yeah. So they’re outside of an employer group plan, which historically is the best option for people if it’s available to them. For the last 15 years, the marketplace has been where a majority of people have gone, especially those that have preexisting conditions or incomes that allow them to qualify for tax credits.
The thing is, going forward, in 2026, people are going to be in for a real rude awakening, because not only are the gross premiums going up across the board with all of the carriers, the tax credits — which were enhanced under the American Rescue Act in 2022 — are going to expire December 31st. And as of right now, they’re not going to be renewed.
And that’s the main reason why the government is still shut down and they haven’t agreed on a budget. The Democrats want that reinstated, and the Republicans are saying no, they were set to expire and we’re going to let them expire. So that’s the problem. And of course in the crosshairs are the consumers. And people, especially the last four years since the enhanced credits went out, have been leaning on those credits to pay for their health insurance.
Open enrollment started on Saturday, and the rates and plans just came out. In the small sample size I’ve looked at — and the people who have emailed, texted, or called me — we’re seeing increases of 100%, 200%, even 300%. A lot of people have now fallen out of the threshold that the extension put them in, so they no longer qualify for the credit.
So their credit last year might have been $2,000 a month, and now that’s gone. Plus the premium that was maybe $2,500 is now $3,500. So it’s not unusual for somebody who paid a net thousand dollars a month last year to now be looking at $3,500 a month for the same plan with a higher out-of-pocket maximum.
So that’s the sticker shock people are now being exposed to. I think about 75% of the marketplace population from 2025 won’t be able to stay in the marketplace in 2026. Even the cheapest option without a tax credit is probably going to be more than they’re willing or able to spend.
I’m afraid that market may just totally crash in 2026. If 75% leave and all that’s left are the very unhealthy or the very economically challenged, you have a poor risk pool, which means it’s only going to get worse. We could be seeing the end of Obamacare in the next year or two if things continue this way.
Kathy Healy:
So even before November 1st, I think you told me that a few carriers had pulled out — Aetna?
Bill Neglia:
Yeah. In 2025, Aetna announced they were pulling out of the marketplace in all states. They’re focusing on group insurance. So anyone with an Aetna marketplace plan has to change carriers regardless of their circumstances.
I just had a client call me — his wife is due in January, they’ve been with Aetna, and now they have to change carriers. There’s no guarantee the OB she’s been seeing for eight months will be in any other network.
And provider networks have eroded over time. A lot of doctors and hospitals that were in the marketplace years ago have slowly pulled out. They’ve gone concierge, joined larger practices, merged, or gotten out of medicine altogether.
We’re seeing a perfect storm of bad events. I think 2026 is going to be the worst year since its inception.
Kathy Healy:
So tell me how you help people and the value of using somebody like you.
Bill Neglia:
Well, the first thing is I’ve got 40+ years’ experience, and I don’t charge a dime for my service. If you go direct to a website or call center, you’re going to pay the same price — only you’re not going to get advice.
And if you call Blue Cross, they’re not going to tell you United has a better plan. If you go on healthcare.gov or GeorgiaAccess.gov, you’ll see plans, but it’s overwhelming. There are about 150 plans for any given person or family.
My process is the same with everyone. I have an intake form questionnaire. It asks the right questions — not just birthdays and addresses. You can have what looks like the best plan on paper, but if your doctor doesn’t take it, it’s no good. If your prescriptions aren’t covered, it’s no good.
We take the questionnaire, evaluate everything, run quotes, send the quotes, and then go over specifics: doctors in the network, prescriptions, coverage details.
Doctors sign contracts that expire. Your doctor might be in today and out in January. Marketplace plans are all HMOs and only cover in-network unless it’s a life-threatening emergency — which the carrier decides, not you.
There are so many variables that you need someone walking you through it. We take clients from A to Z and even help enroll if they want. You won’t get that from a website.
Kathy Healy:
So someone is leaving their job right now and they’re looking at COBRA versus ACA marketplace or private insurance. How do they make the decision?
Bill Neglia:
Talk to a professional first. Years ago COBRA rates were so outrageous people didn’t consider it. But now COBRA is much more competitive. It’s probably 50/50 whether COBRA or private insurance is the better option.
One huge factor: if you cancel COBRA mid-year and go private, your deductible does NOT carry over. You could have met your deductible in June and then start from zero in July on a private plan.
Cost matters too. If COBRA is $1,800 and private is $1,500 — is $300 a month worth downgrading from a group PPO to an HMO with a new deductible?
In the last five or six years, I’ve talked more people out of leaving COBRA early than into leaving it.
Kathy Healy:
Let’s talk about dates. November 1st was open enrollment day one. What does that mean? How long does it last?
Bill Neglia:
For policy year 2026, you have one open enrollment from November 1st to December 15th for coverage starting January 1st. A second open enrollment is December 16th to January 15th for coverage starting February 1st.
If they miss both and don’t have a plan they can renew, they need a qualifying event: moving counties, marriage, divorce, having a child, losing employer coverage — things like that.
Kathy Healy:
How long does COBRA last?
Bill Neglia:
18 months for a regular job loss.
36 months for death or divorce.
Kathy Healy:
If people want something other than the ACA, what’s out there?
Bill Neglia:
There are alternatives.
Short-term major medical is number one. It used to be three-month policies meant as a bridge. Then Trump expanded it to 12–36 months. Biden cut it back to four months. Trump is back, so it’s reinstated to 12–36 months again.
Short-term has preexisting exclusions and doesn’t cover mental health or maternity, but it’s cost-effective major medical.
Then you have indemnity plans — reimbursement plans like Aflac. You pay cash at the doctor, then file the claim and get a fixed benefit check. They have no deductibles and pay immediate benefits.
With indemnity plans, you want to shop for the lowest medical pricing because your benefit is fixed regardless of cost. Doctors will give you cash prices.
You have to be in relatively good health for these. You can have controlled blood pressure, cholesterol, thyroid meds, ADD meds — those are usually okay — but major conditions are not.
Kathy Healy:
To summarize some of this, if somebody is looking for coverage for 2026, now’s the time, because the time runs out December 15th.
Bill Neglia:
For January 1st, yes. Then there’s a small window December 16th to January 15th for February 1st coverage. After that, unless they have a qualifying event, they can’t get marketplace insurance.
If nothing else, at least get a basic marketplace plan. Then if something happens you may be able to upgrade depending on circumstances.
But this year you cannot just auto-renew like many did in 2025. The evaluation time is going to be significant. People who wait until December 10th may not give themselves enough time.
We started sending questionnaires in early October. Half haven’t responded — Halloween, Thanksgiving, Christmas, there’s always an excuse.
We can only help if they send their information. We cannot assume their profile is the same as last year.
Kathy Healy:
And for almost everybody in the ACA, costs are going up.
Bill Neglia:
For the most part. Gross premiums are up across the board, and tax credits are going down.
There will be maybe 25% who see little or no increase, but they’re the minority. This is a federal issue — every state is impacted the same.
Three out of four people are already telling me they can’t afford what they’re being renewed at.
When that happens, I look at their questionnaire. If they’re healthy, I offer alternatives like short-term plans.
Yesterday I wrote someone making a lot of money who didn’t want marketplace rates. I wrote him a three-year short-term policy for him and two kids. He said that’s exactly what he needed: catastrophic coverage.
I’ll lose a lot of marketplace business, but hope to replace it with alternatives.
One more alternative: there is now an option for self-employed individuals to get group insurance. If they can show 1099 or K-1 income, they can join a group and get PPO plans. There’s underwriting, but if they pass it, it’s solid group coverage.
Kathy Healy:
That’s really good news for self-employed people and small business owners. I think you have a word of caution about sharing policies.
Bill Neglia:
Yes. About eight years ago I got involved with a sharing plan company. This is not an indictment, just my experience.
They are extremely restrictive — Christians only, no smokers, no one who admits to drinking.
The biggest problem is claims take months. Six months was typical for my clients. Most people can’t wait six months — by then they’re in collections.
With insurance, claims must be paid or acknowledged within 30 days. Sharing programs are NOT insurance.
They use different terminology intentionally: “annual responsibility” instead of deductible, “contribution” instead of premium.
If you have a problem, you cannot go to the Department of Insurance for help because they’re not insurance. My analogy: it’s like passing a plate around at church and whoever needs the money raises their hand.
There is no guarantee a claim will be paid. And if it’s denied, it’s denied. No recourse.
I don’t like them, and E&O won’t cover agents for them. I only consider them as an absolute last resort.
Kathy Healy:
So if somebody has a problem with the sharing plans, they’re not covered under the Department of Insurance?
Bill Neglia:
No. They’re not filed as insurance. They’re filed as sharing programs. The Department of Insurance will not intervene. Agents aren’t protected either.
Kathy Healy:
That’s a great word of caution. I really appreciate you being here and sharing all this great information with us. It’s an important time for people to get covered, watch the deadlines, and trust a professional.
Bill Neglia:
And again, the biggest takeaway is: talk to a professional. Even if you don’t like what they say, you want to know the truth.
Kathy Healy:
Okay, well thanks again, Bill.
Bill Neglia:
Great. Thank you.
For more from Bill Neglia, you can visit: HEALTH INSURANCE – Neglia Insurance Group