Yesterday, August 3, 2026, KFF updated its analysis of 2027 Marketplace rate filings. With 276 insurers across all 50 states and the District of Columbia now included, the median proposed premium increase is 15 percent, following last year's 20 percent median final increase. At the same time, Medicaid expansion adults move to six-month renewals starting with renewals due December 31 and face work requirements by January 1, 2027, earlier in some states. And every commercial deductible resets on January 1. Your patients are going to ask the person at the front desk what they should do. That person needs an answer that is accurate, brief and not insurance advice.
This is the communication plan we help practices build. It is organized by when, then by who, then by what to say. It assumes you have already done the billing-side work: day-before eligibility checks with benefit detail, a current network participation list, and a financial policy that collects at time of service. If you have not, start there; a good script cannot rescue a bad process.
Key takeaways
- Staff can explain your network participation, your financial policy and where to get help. They cannot recommend a plan, estimate a subsidy or judge an exemption. Teach the line in one sentence.
- Messages go out by audience and month from August to January, through more than one channel, because half your patients do not read the portal.
- Four documents need to exist before October: a network letter, a financial policy, a coverage-lapse letter and a clinical documentation template for exemption requests.
- Measure it in February with three numbers, because this is now an annual event.
What your staff can and cannot say
Front desk and billing staff can explain your practice's network participation, your financial policy, and where patients can get help. They should not recommend a specific plan, estimate a patient's subsidy, or tell a patient whether they qualify for a Medicaid exemption. The line is simple to teach: we can tell you about us, and we can tell you where to go; we cannot tell you what to pick. Put that sentence in the training and on a card at the desk. Then give staff the names and numbers to hand over: the Marketplace call center, your state's Medicaid agency, and a local navigator or enrollment assister if one exists. Handing someone a number is help; picking their plan is liability.
The timeline
| When | Audience | Message | Channel |
|---|---|---|---|
| August | All staff | Training: what is changing, the script, the escalation path to the practice manager | Staff meeting, one page |
| September | Medicaid patients | Confirm your address with the state; watch for renewal and work requirement mail; here is the state's number | Check-in script, portal message, waiting room sign with a phone number |
| Early October | Marketplace patients | Open enrollment starts November 1; check that we are in network for any plan you consider; ask about the deductible, not just the premium | Letter or portal message, handout at check-out |
| November | All commercially insured patients | Your deductible resets January 1; here is how we estimate and collect patient responsibility | Statement insert, portal message |
| December | Medicaid expansion adults | Renewals are now every six months; if you lose coverage, here is what to do and who to call | Check-in script, handout |
| January | Everyone | Bring your new card; we verify coverage the day before every visit | Appointment reminder text |
The scripts
When a Marketplace patient asks "should I switch plans?" "I can't tell you which plan to choose, but I can tell you two things. We are in network for these 2027 plans [hand them the list]. And when you compare plans, look at the deductible and the copay for a specialist visit, not only the monthly premium, because that is what you'll pay when you see us. The Marketplace has free navigators; here is the number."
When a Medicaid patient asks "am I going to lose my coverage?" "That is the state's decision, and it depends on your situation. What I can do is make sure the state has your current address so you get their letters, and give you this sheet with the state's number and the list of exemptions. If your doctor needs to document a medical condition for you, let us know and we'll get that started."
When a patient with a new high-deductible plan is surprised by a January balance. "Your plan's deductible reset on January 1, so the plan applied today's visit to it. Our estimate before the visit was $X, which is what we collected. If that is a hardship, we have payment plans; let me get you the form." The important part is that the estimate came before the visit. If you are having this conversation after the fact, the process failed upstream.
When a patient's coverage shows inactive the day before the visit. Call them. "We checked your coverage for tomorrow and it shows inactive with [plan]. Sometimes that is a state or plan error, so you may want to call them today. If it is not resolved by tomorrow, we can still see you; the visit would be $X at our self-pay rate, and we have a payment plan. Would you like to keep the appointment?" This call turns an after-the-fact denial into a decision the patient makes with information.
The letters to have ready
- Network participation letter, dated, listing the 2027 Marketplace and Medicaid managed care plans you participate in. Update it when the plan lists are final, usually in October, and again if a payer changes its product names in December, which happens.
- Financial policy, one page, plain language: we verify coverage before your visit, we estimate what you owe, we collect at the visit, here is the payment plan, here is who to call. Put it on the website and in the portal, not only on paper.
- Coverage-lapse letter for patients whose eligibility shows inactive: what we found, what today's visit costs at our self-pay rate, how to reapply or enroll, and the Marketplace special enrollment period for people who lose Medicaid. Have counsel review it once.
- Medical documentation template for patients who need a condition documented for a state exemption. This is a clinical letter and goes out under the provider's name, with a defined turnaround, ideally 48 hours.
A worked example of the volume
A six-provider family practice with 25,000 visits a year has, say, 12 percent Marketplace visits and 20 percent Medicaid visits, of which half are expansion adults. That is roughly 3,000 Marketplace visits and 2,500 expansion adult visits, or about 1,200 and 1,000 unique patients respectively. The October Marketplace letter goes to 1,200 people; at a dollar each for print and postage plus a portal message, it is a small spend. The September and December Medicaid scripts touch about 85 check-ins a week. The exemption documentation requests, if even one in ten expansion adults asks, are about 100 letters over the winter, which is why the template and the turnaround matter. None of this is large. All of it fails if nobody owns it.
The mistakes we see
Waiting until January. Sending one letter and assuming it was read. Letting a well-meaning front desk person say "you should get the Blue plan," which is both a liability and, often, wrong. Not telling the billing office what the front desk is promising, so the estimate at check-in and the statement three weeks later disagree. Forgetting that many patients do not use the portal, so a portal-only message reaches half of them. Putting a sign in the waiting room with a QR code and no phone number. And treating the exemption letter as a favor rather than a workflow, so it takes three weeks and the patient loses coverage in the meantime.
Measuring whether it worked
Three numbers in February: the percentage of January visits with a day-before eligibility check completed, the count of CO-27 and CO-31 (coverage-related) denials compared with last January, and the percentage of estimated patient responsibility collected at time of service. If all three moved the right way, the plan worked. If not, you know which piece to fix before next year, because this is now an annual event. Add a fourth if you can: the number of Medicaid patients who told you the state had a wrong address and fixed it. That is the number that represents coverage kept.
Questions we hear
Is any of this the practice's job?
Nobody requires it. But an uninsured patient is an unpaid visit, and a patient who kept coverage because your front desk told them to update their address is a paid one. It is also simply the right way to treat people who are confused by a system none of us designed.
We are a PCMH. Does this count as care coordination?
Helping patients maintain coverage fits naturally in the care management and access work that recognition already asks for, and it belongs in your documented workflows. Our PCMH annual review team can show you where. For the billing side, the eligibility and estimation workflow is built into our medical billing service.
Can we send one combined letter to everyone in October?
You can, and it will be ignored, because a Medicare patient does not care about open enrollment on the Marketplace and a Medicaid patient does not care about deductibles. Segment by payer type. Your practice management system can produce the lists in an afternoon.
What to do this month
- Run the staff training and hand out the one-sentence rule and the phone numbers.
- Pull the patient lists by payer type: Marketplace, Medicaid expansion adults, other commercial.
- Draft the four documents and send the coverage-lapse letter to counsel.
- Add the address-confirmation question to the Medicaid check-in script for September.
- Book the October letter run and the November statement insert with whoever prints them.
