Shopping for health insurance on the Affordable Care Act marketplace now means facing higher prices, fewer carriers in some places and tighter eligibility rules than a few years ago. Open enrollment for 2027 coverage began on 1 November, and for many households the cost of staying insured has moved more than the plan itself.
In this article, we will discuss what the latest figures show, who is hit hardest, and a practical order of checks to make before you pick a plan.
Open Enrollment Is Under Way, and the Deadlines Need Checking
Open enrollment for 2027 coverage started on 1 November in most states, according to KFF, the health policy research organization. The KFF analysis, published on 30 October and updated on 2 November, does not state an end date, so this article will not guess at one. Deadlines can differ between the federal platform, HealthCare.gov, and the state-run exchanges that operate their own sites, and the date by which you must act to have coverage begin on 1 January can fall earlier than the final day of the window. Check the deadline on HealthCare.gov or your own state exchange before you plan around anything.
This article concerns the United States. Other countries run health coverage on different principles, and the terms used here, such as premium tax credits and metal tiers, are specific to the American marketplace.
The Shortened Window That Was Thrown Out
One piece of good news for people who like a long runway is that a rule that would have shortened open enrollment to nine weeks was vacated, according to KFF’s summary of litigation. Courts decide the fate of many marketplace rules, and several have been in flux, so the rules on paper this month may differ from those in force by the time you read this. The safest habit is to treat the official exchange website as the final word on dates and requirements.
Because dates and rules can change late in the season, it helps to bookmark the official page for your state and look at it again a week before you intend to enroll. If you plan to apply with help from a navigator, book the appointment early, since local slots fill up as the deadline approaches.
Which Site to Use
Nearly everyone should begin at the official federal site or, if your state runs its own exchange, the site that your state operates. Many look-alike websites and call centers exist that use the words health insurance, ACA or Obamacare in their names and collect personal information. Some are legitimate brokers, but many are not, and a few are scams. If you search online, check that the address is a government one, and be wary of any ad that promises a special deal, demands payment to enroll or asks for your full Social Security number early in the conversation.
Premiums Rise Again for 2027
KFF reports that insurers proposed a median increase of 15 percent for 2027. After regulators reviewed the filings, the average increase in finalized benchmark silver premiums came in at 13 percent, which KFF describes as a second straight year of double-digit increases. The benchmark is the second-lowest-cost silver plan in an area, and it matters because the premium tax credit is pegged to it. When the benchmark rises, the dollar value of a subsidy rises too, which cushions many lower-income buyers, while people who receive no subsidy absorb the whole increase.
The Numbers by Platform
The average conceals a split. According to KFF, the finalized increase is 11 percent on HealthCare.gov, which serves the states without their own exchange, and 16 percent on state-run platforms. Benchmark premiums had already risen 26 percent from 2025 to 2026, so a household that has stayed with the same plan type for two years faces a much higher price than it did before. The table below collects the reported figures.
| Measure | Reported figure |
| Median increase proposed by insurers for 2027 | 15 percent |
| Average increase in finalized benchmark silver premiums | 13 percent |
| Increase on HealthCare.gov | 11 percent |
| Increase on state-run platforms | 16 percent |
| Rise in benchmark premiums from 2025 to 2026 | 26 percent |
Why Prices Keep Climbing
KFF’s page reports the figures, and the causes behind them are more complicated than any single number suggests, so what follows is general background rather than a finding. In general, premiums in the individual market follow the cost of care, the health of the people who enroll, and the rules around subsidies. When healthier people leave a risk pool, the people who remain tend to use more care on average, and insurers raise prices to cover that. Hospital prices, drug spending, and the use of services also push in the same direction. Which of these factors weighs most in a given state differs, and a local insurance department filing is the best place to see the reasoning for your own area.
Benchmark increases also say little about the cheapest plans. In some areas a low-cost bronze plan rose by less than the benchmark, and in others a new entrant priced below the incumbents, so the lowest-priced option can differ from last year’s. Looking only at your old plan’s renewal price can therefore hide a better deal sitting a few rows down the list.
A caution about percentages is warranted. A 13 percent average rise does not mean your bill rises 13 percent. Your price depends on the plan you hold, the insurer’s local rate, your age, your location and, above all, whether you receive a subsidy that changes with your income.
The Loss of Enhanced Tax Credits and the Shrinking Market
The biggest shift in the marketplace came from policy rather than from insurers. Enhanced premium tax credits expired at the end of 2025. Under the earlier, more generous rules, there was no income ceiling for help. With the enhanced credits gone, KFF says, people with incomes above 400 percent of the federal poverty level no longer qualify for premium tax credits and pay the full cost of coverage. That edge is often called the subsidy cliff, since a household can lose thousands of dollars of help by crossing it with a single extra dollar of income.
Who Feels the Cliff
The cliff matters most to people whose income sits just above the line: self-employed workers, early retirees who are not yet eligible for Medicare, and older adults whose premiums run high because insurers can charge them more than younger buyers. For these households, the full unsubsidized price of a benchmark plan can be a large share of income. If your income is near the threshold, it is worth confirming whether adjustable parts of it, such as certain retirement or health savings contributions, can legitimately lower your income for the purpose of the credit. A tax professional can advise.
To picture the cliff, consider an illustration with invented round numbers. Suppose a plan costs $700 a month and a household qualifies for a $400 monthly credit, so it pays $300. If a small raise nudges income just over 400 percent of the poverty level, the credit vanishes and the household pays the full $700, which is more than double the old bill. Real situations vary, but the shape of the problem is the same, which is why a careful look at income before you enroll is worth the effort.
Enrollment Has Already Fallen
KFF’s figures show the effect on enrollment. Plan selections during 2026 open enrollment fell by 1.2 million compared with 2025. Effectuated enrollment, meaning people who selected a plan and paid, was down 12 percent, or 2.6 million, to 19.2 million in February 2026. The individual market as a whole shrank by 18 percent by June 2026, from 25.2 million people to 20.5 million. Looking ahead, KFF cites the Congressional Budget Office as projecting that Marketplace enrollment will fall from a 2025 peak of 22.4 million to 13.1 million in 2027.
These are very large moves, and a projection is not an outcome. Still, they point to something worth knowing as a shopper: smaller markets tend to attract fewer insurers and give those that remain more room to raise prices, so the effects on choice and cost can reinforce each other.
States That Fill the Gap
Some states have used their own money to replace part of the lost federal help. KFF reports that New Mexico fully backfilled the lost federal assistance in 2026 and continues to do so in 2027, and that California is expanding a partial backfill to households with incomes between 165 percent and 200 percent of the poverty level. If you live in a state with its own program, the net price shown on the exchange may already include that help, so compare the final amount you pay and not just the federal credit. If you live elsewhere, it is still worth asking an enrollment counselor whether any state or local program exists. Programs differ in who qualifies, how much they pay, and whether they last, so a benefit that existed last year should be confirmed again rather than assumed.
Insurer Exits, Eligibility Changes and Enforcement
Several developments overlap this season, and they affect different people. Some change who sells plans, some change who can get help paying for them, and some change how enrollments are verified.
Carriers Coming and Going
By late October, 11 carriers had announced plans to exit at least one state for 2027, and seven had announced plans to enter a new state, according to KFF. The most striking departure is Cigna, which is leaving the individual market in all 11 states where it operates. If your current plan is from an insurer that is leaving, you will normally receive a notice saying that the plan is ending. You will need to choose a replacement during open enrollment, and some exchanges may map you automatically to a new plan from another carrier, which may not be the best choice for your doctors or your budget.
Even if your insurer is staying, check whether it is leaving your county, whether the plan name has changed or whether the provider network has been trimmed. A familiar logo on a letter can hide a different product.
New Limits on Who Gets Help
KFF lists several eligibility changes that bring different consequences for different groups. Lawfully present immigrants such as refugees and asylees keep access to the Marketplace but lose eligibility for premium tax credits. Repayment caps on excess premium tax credits are eliminated beginning with the 2026 tax year, which means that someone whose income ends up higher than estimated can owe back the full excess when they file taxes. And people who are denied or removed from Medicaid for missing work requirements become ineligible for premium tax credits. The law requires 43 states plus the District of Columbia to implement those work requirements by early 2027.
The repayment change deserves special attention because it links directly to your income estimate. Previously, the amount a household had to repay was limited depending on income. With the caps eliminated, an unexpected raise, bonus or burst of freelance income late in the year can lead to a bill that is much larger than it used to be.
If you are in one of the affected groups, do not assume that coverage is simply out of reach. Lawfully present immigrants can still buy a plan at full price, and many people who lose Medicaid coverage have other routes to insurance, including coverage through an employer or a family member. A navigator or a legal aid organization can explain the options that apply to your situation, and it is better to ask early than to go without coverage by default.
Verification and Enforcement
In September, according to KFF, the Department of Health and Human Services cancelled coverage for about 760,000 enrollees it labeled phantom, a term for registrations that officials said did not belong on the rolls. A list of about 1.2 million people was sent to insurers for review, and some reinstatements have been reported. HHS also paused new agent and broker registrations until February 2027. For consumers, the main lesson is practical: confirm that your own enrollment is active, respond quickly to any request for documents, and be cautious about brokers who contacted you without being asked.
Court Rulings That Change the Picture
Litigation has altered some of the rules, according to KFF. The requirement that enrollees reconcile their tax credits, known as failure to reconcile, will not disqualify people from premium tax credits for 2027. Expanded eligibility for catastrophic plans has been paused. Because these matters are being decided in court, additional changes may arrive before or after the enrollment period closes, which is another reason to check the official exchange before you finalize anything.
Choosing a Plan: Premium, Deductible, Network and Drugs
With prices up, many people will be tempted to pick the lowest monthly premium and move on. That can be a costly mistake. The monthly premium is only one of several costs, and the cheapest plan on the page is often the one that leaves you with the largest bill when you use it.
Metal Tiers in Plain Terms
Marketplace plans are grouped into bronze, silver, gold and platinum tiers, plus catastrophic plans for a small group. The tiers describe how costs are shared between you and the insurer, not the quality of care. Bronze plans generally carry the lowest premiums and the highest deductibles. Gold and platinum plans cost more each month and pay a larger share when you use care. Silver sits in between, and it matters for another reason: people with lower incomes may qualify for cost-sharing reductions, which lower deductibles and out-of-pocket costs but only on silver plans.
The Four Checks
Compare premium, deductible, out-of-pocket maximum, network and drug list, and do so for each plan you are considering. The premium is what you pay every month. The deductible is what you pay for covered services before the plan begins to share costs, although some services are covered earlier. The out-of-pocket maximum is the most you can owe in a year for covered, in-network care, and it caps your worst case. The network determines which doctors and hospitals are covered at in-network rates, and the drug list, called a formulary, determines which medicines are covered and at what tier.
Use the following table as a checklist when you compare two or three finalists.
| Check | What to look for |
| Premium | The amount you pay after any tax credit, month by month |
| Deductible | How much you pay before sharing begins, and which services skip it |
| Out-of-pocket maximum | Your worst-case yearly cost for in-network care |
| Network | Whether your doctors, hospital and specialists are listed as in network |
| Drug list | Whether each of your medicines is covered and what it costs |
| Insurer status | Whether the carrier is staying in your area for 2027 |
Cost Sharing in Practice
Here is an illustration with invented numbers. Imagine a bronze plan with a premium of $400 a month and a $7,000 deductible, and a silver plan with a premium of $500 a month and a $3,000 deductible. A healthy person who sees a doctor twice a year may do better with the cheaper bronze plan, saving $1,200 in premiums over the year. A person facing surgery or ongoing treatment could end up paying thousands more under bronze before the plan contributes. The right answer depends on how much care you expect to use, and on how much cash you could produce if a large bill arrived.
Verify Your Doctors and Prescriptions
Do not rely on a plan name or on last year’s experience. Use the exchange’s provider search and then phone the doctor’s office to confirm that they take the specific plan, since directories can be out of date and a carrier may sell several plans with different networks. For medicines, look up each one on the plan’s drug list, and note whether it requires prior approval or is limited to certain quantities. If someone in your household takes an expensive medicine, a plan with a higher premium but better drug coverage may cost less across the year.
Update Your Income Estimate
The credit you receive in advance during the year is based on the income you estimate now. If you have changed jobs, started freelancing, lost work, married or divorced, update the application with realistic numbers. With repayment caps eliminated for the 2026 tax year onward, an estimate that is too low can lead to a large repayment next spring, while one that is too high reduces the help you get each month, although you can recover the difference when you file. For many people with uneven income, a cautious middle estimate is more sensible than an optimistic one.
What Happens if You Do Nothing
If you take no action, many exchanges will automatically renew your current plan, often with an updated premium and a smaller or different subsidy. That sounds convenient, but it can hide a large jump in your net cost, and it can also keep you in a plan that is being discontinued or has a narrower network. Staying with the same plan after an unreviewed renewal is a decision, and an expensive one if you do not look at the new price first.
Special Enrollment Periods and Local Help
Outside open enrollment, you can generally switch plans only if you have a qualifying life event, such as losing other coverage, moving to a new area, having a baby, or certain changes in household status. These special enrollment periods have deadlines of their own, so do not wait until the last day. Free help is available from navigators and certified application counselors, who are trained to explain options and cannot charge you for their help. Your exchange website lists local ones, and a library or community health center may know where to find them.
Final Thoughts: Steps to Take Before You Click Enroll
A sensible order of work keeps the process manageable. First, gather your documents: income estimates for 2027, household members, current plan information, and a list of doctors and medicines. Second, check the official deadline for your state and aim to finish well before it, since sites become slow near the end and verification can require extra documents.
Third, update your application with a realistic income. If you are close to the 400 percent line, talk to a tax professional about whether the credit is available to you and how your income will be measured. Fourth, compare at least three plans using the checklist above, and begin with those from carriers that are staying in your area. Fifth, confirm your doctors and prescriptions by phone, not only online.
Sixth, if you receive a letter or call from a broker you do not know, treat it with caution. HHS paused new broker registrations until February 2027, and the enforcement activity this fall shows that regulators are paying attention to improper enrollments. Use the exchange itself, or a broker you have checked, and never give your information to someone who contacted you first and pressed you to act at once.
Seventh, think about what happens if your circumstances change after you enroll. A job offer, a move or a change in household size can alter your eligibility and the credit you are owed, so report such changes to the exchange when they happen instead of waiting for tax season.
Finally, keep a record. Save the confirmation page, the plan name and the premium, and check your first bill and card in December or early January. If something looks wrong, contact the exchange early, because coverage problems are easier to fix before the first claim than after it. This article offers general information, not insurance, tax or legal advice, and a licensed professional can help with your specific circumstances.
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Frequently Asked Questions
1. When Did ACA Open Enrollment for 2027 Start?
Open enrollment for 2027 coverage started on 1 November in most states. KFF’s page does not give an end date, so check HealthCare.gov or your state exchange for the deadline.
2. How Much Are ACA Premiums Rising in 2027?
KFF reports that finalized benchmark silver premiums rise 13 percent on average, after insurers proposed a median increase of 15 percent. The increase is 11 percent on HealthCare.gov and 16 percent on state-run platforms.
3. Can I Still Get a Premium Tax Credit if I Earn More Than 400 Percent of the Poverty Level?
Not under current rules. Enhanced credits expired at the end of 2025, and people above 400 percent of the federal poverty level no longer qualify for premium tax credits, according to KFF.
4. Which Insurers Are Leaving the Marketplace?
KFF reports that 11 carriers announced exits from at least one state for 2027, and Cigna is leaving the individual market in all 11 states where it operates. Check your own notice and your exchange to see whether your carrier is affected.
5. Should I Let My Plan Renew Automatically?
It is risky to do so without looking, because a plan can renew at a higher net price or with a different network. Review the new premium, doctors and drug coverage first.
6. Does Updating My Income Estimate Matter?
Yes, because the advance credit is based on your estimate. With repayment caps eliminated starting with the 2026 tax year, an estimate that is too low can lead to a larger bill at tax time.
