Open Enrollment 2026–27: How to Pick a Health Plan That Covers Telehealth and GLP-1 Prescriptions
Open enrollment for 2027 ACA marketplace coverage begins November 1, 2026, and for the first time in several years, choosing the wrong plan carries a steeper price — benchmark silver premiums for a 40-year-old are averaging roughly $625 per month before subsidies, up approximately 26% from 2025 after enhanced federal tax credits expired. If you use telehealth regularly, take a GLP-1 medication like semaglutide or tirzepatide, or want to start one, this year’s plan comparison requires more due diligence than usual. Here is a concise guide to the decisions that matter most.
When does open enrollment start and end in 2026?
The federal HealthCare.gov open enrollment window opens November 1, 2026 and closes December 15, 2026 for a January 1, 2027 coverage start date. Several state-based exchanges — including California and Massachusetts — extend their deadlines into late December or early January; check your state’s marketplace for the exact cutoff. Enrolling by December 15 is the safest way to guarantee coverage starting January 1. If you miss the window, you will generally need a qualifying life event (job loss, marriage, birth of a child) to enroll outside the regular period.
If your coverage comes from an employer, employer open enrollment typically runs from October through mid-November for a January 1 plan start. Check with your HR department for your company’s specific window — it is usually separate from the ACA marketplace calendar.
Does my health insurance cover telehealth visits?
As of 2026, telehealth coverage varies considerably by plan type and insurer. There is no federal mandate requiring ACA marketplace plans to cover telehealth at parity with in-person care, but the landscape shifted in one important direction this year.
The One Big Beautiful Bill Act (OBBBA), signed in 2025, permanently reinstated the HDHP telehealth safe harbor under IRC Section 71306. In plain language: high-deductible health plans (HDHPs) are now permanently allowed to cover telehealth visits at $0 before you meet your deductible — without jeopardizing your HSA eligibility. This is the most significant structural win for telehealth users in recent memory. You can video-chat with a provider for free, pay nothing toward your HDHP’s deductible on in-person services, and still make tax-free contributions to your HSA.
Starting in 2026, CMS also requires marketplace insurers to report whether their network providers offer telehealth — a transparency step that makes plan comparison easier on HealthCare.gov. About 18.4% of commercially insured Americans had at least one telehealth claim in Q1 2026, up 10% quarter-over-quarter, reflecting growing use across all plan types (FAIR Health, 2026).
What to do: When comparing plans, look at the Summary of Benefits and Coverage (SBC) for the line item “Telehealth services” or “Virtual visits.” Plans will show the copay or coinsurance you owe per visit and whether it applies before or after your deductible.
Will my health plan cover Ozempic, Wegovy, or other GLP-1 weight loss drugs?
This is the question driving the most frustration during 2026 open enrollment. The honest answer is: it depends on whether your coverage comes from an employer or the ACA marketplace — and even employer coverage is becoming less reliable.
ACA marketplace plans: GLP-1 medications prescribed for obesity are generally not covered by individual and family marketplace plans. Obesity pharmacotherapy is not an Essential Health Benefit (EHB), so insurers are not required to include it. Ozempic (semaglutide) prescribed for Type 2 diabetes is more commonly covered because diabetes management overlaps with EHB requirements, but Wegovy and Zepbound specifically for weight loss are largely excluded at the marketplace level. Check each plan’s drug formulary directly — use HealthCare.gov’s drug coverage comparison tool or search the plan name plus “formulary.”
Employer plans: Coverage is higher but declining. According to the Business Group on Health’s 2026 survey of large employers, 67% of large employers cover GLP-1s for weight management — but only 72% of those expect to maintain that coverage in 2027, and 10% plan to drop it entirely. High per-member costs, which can reach $800–$1,300 per month at retail, are pushing employers to add prior authorization requirements and step-therapy protocols. The KFF 2025 Employer Health Benefits Survey found that 43% of firms with 5,000 or more employees covered GLP-1s for obesity — but only 19% of firms with 200 or more employees did.
| Coverage Source | GLP-1 for Weight Loss? | Notes |
|---|---|---|
| ACA Marketplace (all tiers) | Generally no | Not an EHB; check individual formulary |
| Small employer plan (<200 employees) | Rarely | Very cost-sensitive |
| Large employer plan (200–4,999 employees) | ~19% | KFF 2025 Employer Health Benefits Survey |
| Large employer plan (5,000+ employees) | ~43% | KFF 2025; declining heading into 2027 |
| Medicare Part D | No (weight loss indication excluded) | Diabetes indication only |
| Medicaid | Varies by state | Expanding in some states |
Even if your plan covers a GLP-1 for weight management, expect prior authorization and possibly a step-therapy requirement. A telehealth provider can help document your medical history and navigate prior authorization on your behalf.
Which plan type is best for telehealth — HMO, PPO, or HDHP?
In 2026, your choice of plan structure matters as much as your choice of metal tier.
HDHP (High-Deductible Health Plan) — Best for $0 telehealth. Thanks to the permanent OBBBA safe harbor, HDHP plans can cover telehealth visits at no cost before the deductible. Pairing an HDHP with an HSA lets you use pre-tax dollars for any remaining out-of-pocket costs. The trade-off is a high individual deductible — $1,650 minimum in 2026 — so unexpected in-person care can be expensive. Works best for generally healthy enrollees who primarily use telehealth for routine or acute visits.
PPO (Preferred Provider Organization) — Best for flexibility. PPOs allow you to see any provider, in-network or out-of-network, without a referral. Telehealth is typically covered at the same copay structure as in-person visits. Higher premiums than HDHP or HMO, but useful if you manage chronic conditions across multiple specialists or want maximum telehealth provider choice.
HMO (Health Maintenance Organization) — Lowest cost, more restrictions. HMO plans generally require a primary care physician referral for specialist telehealth and cover only in-network providers. Premiums and cost-sharing are lowest, and telehealth copays are often competitive — but you cannot access out-of-network telehealth services at an HMO rate.
Summary: If $0 telehealth is your top priority and you are otherwise healthy, an HDHP with an HSA is the strongest 2026 option. If you have complex or chronic conditions and need provider flexibility, a PPO offers the broadest access. If cost is the primary concern, an HMO typically delivers the lowest premiums.
How do I read a Summary of Benefits to evaluate telehealth and drug coverage?
Every plan sold on HealthCare.gov must provide a Summary of Benefits and Coverage (SBC) — a standardized, plain-language document that breaks down covered services and your share of costs. Look for these specific items:
- Telehealth / virtual care: Copay or coinsurance per visit, and whether it applies before or after the deductible
- Specialty drugs (Tier 4 or Tier 5): GLP-1 injectables that are covered usually appear here — note per-fill cost-sharing and whether quantities are limited
- Prior authorization requirements: Listed under each category; GLP-1s almost always require prior auth if they are covered at all
- Drug formulary (separate document): Download the formulary to verify the specific brand is included — Wegovy and Ozempic have different formulary status even though both contain semaglutide
HealthCare.gov’s plan comparison tool also lets you enter your current medications and see estimated annual drug costs across all available plans before you choose.
What Omnia TeleHealth can do when your plan doesn’t cover GLP-1 medications
If your plan does not cover GLP-1 therapy, telehealth is still an affordable path to a physician evaluation and all available options — including manufacturer savings programs, documented medical necessity letters for employer prior authorization appeals, and guidance on compounded semaglutide alternatives still legally available under state pharmacy regulations. Our telehealth weight loss program includes provider consultations, ongoing monitoring, and support navigating coverage in your specific plan.
Scheduling a consultation before open enrollment ends can help you choose the right plan and prepare prior authorization paperwork before your new coverage starts on January 1. A 20-minute visit now may save you weeks of delays in January.
Frequently Asked Questions
When does ACA open enrollment start in 2026? Open enrollment for 2027 ACA marketplace coverage starts November 1, 2026. The federal HealthCare.gov deadline to start coverage January 1, 2027 is December 15, 2026. Several state exchanges — including California and Massachusetts — run longer; check your state marketplace for its specific cutoff.
Does Medicaid cover Ozempic or Wegovy for weight loss? Medicaid coverage of GLP-1 drugs for obesity varies by state. An increasing number of states are expanding their formularies to include semaglutide and tirzepatide for obesity treatment, but coverage is not universal. Contact your state Medicaid office or managed care plan to verify eligibility criteria and whether prior authorization is required.
If I’m on an HDHP, can I use telehealth for free? Yes, as of 2026. The One Big Beautiful Bill Act permanently restored the HDHP telehealth safe harbor (IRC Section 71306), allowing HDHP plans to cover telehealth visits at $0 before you meet your deductible — without disqualifying you from HSA contributions. Verify that your specific plan’s benefit design includes $0 virtual visit coverage; not all HDHPs have implemented it yet.
What if I miss ACA open enrollment? If you miss the December 15, 2026 deadline (or your state exchange deadline), you can only enroll mid-year if you have a qualifying life event: losing job-based coverage, getting married, having a baby, or moving to a new coverage area. Without a qualifying event, you must wait for the next open enrollment period.
Can a telehealth provider help me get a GLP-1 covered by insurance? Yes. A licensed telehealth provider can document your medical history, BMI, and relevant comorbidities — such as hypertension, prediabetes, or obstructive sleep apnea — in a format designed to support a prior authorization request. They can also write a letter of medical necessity, help you navigate step-therapy requirements, and advise on manufacturer assistance programs like Novo Nordisk’s NovoCare or Eli Lilly’s Lilly Cares if your plan does not cover the medication. Scheduling a consultation before open enrollment ends gives you the best chance of coverage approval from day one of your new plan.