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ACA Open Enrollment 2027: What's Changing and How to Compare Plans

Published October 29, 2026 路 8 min read 路 Figures last verified October 29, 2026

Reviewed by D.P., PharmD.

Key takeaways
  • ACA Marketplace open enrollment runs November 1, 2026 to January 15, 2027 in most states. Pick a plan by December 15 for coverage that starts January 1.
  • The most you can be charged out of pocket for in-network covered care rises to $12,000 for one person and $24,000 for a family in 2027, up from $10,600 and $21,200.
  • Insurers are leaving the Marketplace in more than 20 states. If your plan is ending, the Marketplace may auto-assign you a plan you never chose. Pick your own.
  • The enhanced subsidies expired at the end of 2025, so the income cap on subsidies is back (400% of the poverty level). Full-price premiums are up about 15% at the median.
  • Compare plans on total yearly cost: premium times 12, plus the deductible, plus what your prescriptions and visits will cost. Never the monthly premium alone.

In this guide: what's changing for 2027 路 the subsidy cliff 路 if your insurer is leaving 路 the four inputs 路 compare in one sitting 路 free help

Key dates
  • November 1, 2026: Open enrollment opens. First day to enroll, renew, or switch plans.
  • December 15, 2026: Last day to pick a plan for coverage starting January 1. If you log in on or after December 16, HealthCare.gov may show that you were automatically re-enrolled. You can still switch until January 15.
  • January 15, 2027: Open enrollment closes. Plans picked between December 16 and January 15 start February 1. After that, you need a Special Enrollment Period (a move, a lost job, a new baby, and similar life events).
  • State-run exchanges can differ: Massachusetts runs October 23 to January 23, DC to January 31, and Idaho closes December 15. Check your state's Marketplace.
A common moment at the kitchen table

It's early November. A renewal notice says your premium is going up, and a second letter says your insurer won't be offering plans in your area next year. The easy move is to do nothing and let the Marketplace sort it out. Here's the catch: if your plan is ending, the Marketplace's algorithm picks a replacement for you, and it doesn't know your prescriptions, your pharmacy, or your doctors. This guide shows how to choose for yourself in one sitting.

What's changing for 2027

Marketplace shopping happens against national numbers that reset every year. Here's what moved:

Figure20262027
Out-of-pocket maximum, one person$10,600$12,000
Out-of-pocket maximum, family$21,200$24,000
HSA contribution limit, self-only$4,400$4,500
HSA contribution limit, family$8,750$9,000
Median proposed full-price premium increasen/aabout 15%

A few things worth knowing about these numbers:

  • The out-of-pocket maximum is a ceiling, not a price. Many plans set theirs well below $12,000. A rule that would have let some Bronze plans go as high as $15,600 was stayed by a court in July 2026, so $12,000 is the highest single limit you'll see. Premiums never count toward it, and neither do out-of-network bills or drugs the plan doesn't cover.
  • Premium increases vary widely. The weighted average proposed increase ranges from under 7% in Vermont, Iowa, and Utah to 29% in Arizona. Most Marketplace enrollees get a subsidy, and subsidies grow when the benchmark Silver plan's price grows, so your after-subsidy premium may move far less than the sticker price.
  • All Bronze and Catastrophic Marketplace plans are HSA-eligible again in 2027. HSA contributions also lower the income the Marketplace uses for your subsidy.
  • Catastrophic plans are harder to get. If you're 30 or older, you'll need a hardship or affordability exemption certificate, and that paperwork takes time, so start early.
  • Fewer immigrants qualify for subsidies. Starting in 2027, only lawful permanent residents, Cuban-Haitian entrants, and COFA migrants qualify. Refugees, asylees, people with TPS, and people on work or student visas no longer do.
  • Oregon moves off HealthCare.gov to its own platform, Explore Health. Virginia adds a state-funded subsidy for incomes between 138% and 250% of the poverty level.

The subsidy cliff is back

From 2021 through 2025, enhanced premium tax credits meant nobody paid more than a set share of income for a benchmark plan, no matter how much they earned. Those expired at the end of 2025 and weren't renewed. For 2027, the old rule is back: no subsidy above 400% of the federal poverty level.

For 2027 coverage, 100% of the poverty level is $15,960 for one person and $33,000 for a family of four. So the cliff sits at roughly $63,840 for one person and $132,000 for a family of four. Earn a dollar over it and the subsidy drops to zero. If you're close to the line, your estimated income is the most important number on your application, and pre-tax contributions (like an HSA or a traditional 401(k)) can pull it down.

If your insurer is leaving

As of October 28, 2026, KFF counts 11 insurers exiting the Marketplace in some or all of their states for 2027, and seven entering new ones. Hundreds of thousands of people have plans ending December 31.

If you get a notice that your plan is ending:

  • Don't rely on auto-renewal. The Marketplace may move you into a different plan automatically. That plan may not include your doctors, your pharmacy, or your drugs on the same tier.
  • Check the new insurers too. Some areas are gaining plans, and a newcomer may be the better value.
  • Pick by December 15 so there's no gap on January 1.

The four inputs that decide your total

The premium is the price tag, not the price. Your real yearly cost is:

Premium 脳 12 + deductible + prescription copays or coinsurance + doctor-visit copays, up to the plan's out-of-pocket maximum.

A cheap Bronze plan with a $7,500 deductible can cost someone with steady prescriptions far more than a Silver plan with a higher premium and low copays. (That's an illustration, not a real quote.) Four inputs decide which side wins:

1. Your actual drug list

Every Marketplace plan has its own formulary, and each drug sits on a tier. A drug that's tier 1 in one plan can be tier 3 or "not covered" in another. That's why our guide to why copays go up starts with tier changes. Ask your pharmacy to print your medication list and check each drug in each plan.

2. Your pharmacy

Plans can have preferred pharmacies with lower copays. If the pharmacy you actually use is out of network or non-preferred, that's your real price.

3. Your doctors

Most Marketplace plans are HMOs or EPOs, which means out-of-network care often isn't covered at all except in emergencies. Networks change every year, so confirm your doctors for 2027, not 2026.

4. The plan's rules on each drug

Covered isn't the same as easy to get. Check whether your drugs need prior authorization or step therapy in the new plan. A slow prior authorization in January can mean a gap in refills.

One Silver-plan rule to know: if your income is up to 250% of the poverty level, Silver plans come with cost-sharing reductions, which lower the deductible and copays. That extra help only comes with Silver, so a Bronze plan can look cheaper and cost you more.

How to compare in one sitting

HealthCare.gov (or your state's Marketplace) is the official place to compare, with the current plans and your actual subsidy. RxPlainly never builds its own estimator, because the official tool has the live numbers.

  1. Gather your medication list from your pharmacy, your doctors' names, and your best estimate of 2027 household income.
  2. Go to HealthCare.gov or your state's Marketplace and update your application for 2027. Report income carefully, especially if you're near the 400% line.
  3. Enter your prescriptions and doctors in the plan filters.
  4. Sort by estimated total yearly cost, not monthly premium.
  5. For the top plans, open the formulary and check each drug's tier and any prior authorization or step therapy.
  6. Confirm your doctors and pharmacy are in network, then enroll by December 15.

Free help that is actually free

Every state has Navigators: trained, federally funded helpers who walk you through the Marketplace at no cost and don't earn commission. Find one at LocalHelp.HealthCare.gov, or call the Marketplace Call Center at 1-800-318-2596, open 24 hours a day. Licensed agents and brokers can also help for free, but they're paid by insurers, so ask which plans they can show you.

Not medical advice.

This guide explains how ACA Marketplace costs and enrollment windows work. It doesn't recommend any plan, doesn't advise which coverage to choose, and doesn't advise starting, stopping, or switching any medication. Those decisions belong to you, your doctor, and your pharmacist. For personal guidance, use HealthCare.gov or a local Navigator. Full disclaimer.

Sources

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