Open Enrollment 2027: What Changed and What to Do

Health insurance open enrollment for 2027 starts tomorrow — November 1, 2026 — and this year is not like the last few. The extra premium subsidies are gone, insurers are asking for double-digit price increases, and several eligibility rules have changed. What you do in the next few weeks decides what you pay for all of 2027.

The dates that matter

Date	What it means
November 1, 2026	Open enrollment begins — you can buy, renew, or switch plans for 2027.
December 15, 2026	Deadline to enroll for coverage starting January 1, 2027.
December 16, 2026 – January 15, 2027	Enrollment still open, but coverage starts February 1, 2027.
After January 15, 2027	Closed — you can only enroll with a qualifying life event (job loss, move, new baby, marriage).

These are the federal HealthCare.gov dates, which most states follow; state-run marketplaces can set different deadlines. Medicaid and CHIP enrollment stay open year-round for people who qualify.

What changed for 2027

More changed between last fall and this one than in several years before it. Here are the five changes that hit your wallet hardest:

1. The extra subsidies are gone

The enhanced premium tax credits of 2021–2025 expired at the end of 2025 and were not renewed. The original subsidies remain, but they stop at 400% of the federal poverty level: about $63,840 for a single person and $132,000 for a family of four for 2027 coverage.

This is the change that surprises people most. A raise, bonus, or freelance payment that nudges your household over the line drops the credit to zero — the old cliff is back, and it's steep.

2. Premiums are climbing

Insurers have proposed a median increase of about 15% for 2027, according to KFF's review of 276 insurers. Nine carriers, including Cigna, are exiting parts of the individual market, leaving shoppers with fewer plans and less competition.

3. If you underestimate your income, you repay all of it

Starting with 2026 tax returns, there is no cap on repaying excess advance premium tax credits. If your actual income beats the estimate you gave at enrollment, you repay the full extra credit at tax time. Estimate carefully — and update your application mid-year if your income changes.

4. Out-of-pocket maximums are up

The most any marketplace plan can make you pay for covered in-network care in 2027 rises to $12,000 for an individual and $24,000 for a family, up from $10,600 and $21,200. Premiums don't count toward the cap — but the cap itself is what protects you from catastrophic bills, and it's still there.

5. New flexibility — and new restrictions

Bronze and catastrophic plans now work with an HSA, a new tax-advantaged option at the cheapest tier. From January 1, 2027, fewer lawfully present immigrants qualify for tax credits — mostly citizens, green card holders, and a few other groups — and states must begin Medicaid work requirements.

UK readers: this covers the US marketplace; in the UK core healthcare comes through the NHS.

How to shop: total-cost math, not sticker price

Plans come in metal tiers that split costs differently when you get care:

Tier	Typical premium	Typical out-of-pocket cost	Best for
Bronze	Lowest	Highest	Healthy people wanting catastrophic protection; now HSA-compatible
Silver	Medium	Medium	The sweet spot — only tier eligible for cost-sharing reductions
Gold	Higher	Lower	Regular care users who want predictable costs
Platinum	Highest	Lowest	Heavy care users — do the math, the premium often eats the savings

Five moves to make before December 15

1. Update your application, don't just renew. Log in, update your income estimate and household info, and see what credits you qualify for now.
2. Check your doctors and prescriptions. Plans change networks and drug formularies every year — a cheaper premium is no bargain if your doctor is suddenly out of network.
3. Compare the full menu. With carriers exiting and prices shifting, a different plan or tier may cover more for less than what you're paying now.
4. If you're near the 400% line, plan your income. A year-end bonus, freelance payment, or IRA withdrawal could push you over the cliff and erase your credit entirely.
5. Look for state-level help. Virginia is adding state-funded subsidies, Rhode Island has allocated $19 million for premium assistance, and Oregon is launching its own marketplace — check whether your state added relief this year.

The cheapest premium isn't always a deal, and the priciest plan isn't always best — the right plan is the one with the lowest total cost for the care you actually expect to use.

Medicare runs on a separate calendar: Annual Enrollment is October 15 – December 7, 2026 for Medicare Advantage and Part D changes — December 7 is the deadline there, not January 15.

Frequently asked questions

What happens if I do nothing and let my plan auto-renew?

The marketplace can re-enroll you, but your premium, subsidy, and network may all change silently until the first bill arrives.

Can I enroll after January 15, 2027?

Generally no — unless a qualifying life event (job loss, move, new baby, marriage) triggers a Special Enrollment Period. Medicaid and CHIP stay open year-round for those who qualify.

How do I know if I qualify for a tax credit?

Credits go to households with projected 2027 income between 100% and 400% of the federal poverty level without affordable job-based coverage. Enter your estimate on HealthCare.gov or your state exchange — and remember the 400% cliff is now absolute.

Is a bronze plan with an HSA a good idea?

It can be if you're healthy and can fund the HSA — lowest premium plus triple-tax-advantaged savings. But deductibles are high, so keep enough liquid to cover yours. Compare it against a silver plan with cost-sharing reductions first — it's new for 2027.

Why did my premium jump if I didn't change plans?

The market changed around you: enhanced credits expired, insurers raised rates a median ~15%, and some carriers left. Your plan didn't get worse — the environment did, which is exactly why shopping matters.

Open enrollment rewards the people who show up. Block an hour before December 15: log in, update your numbers, compare total costs, and check your state for new relief. One evening of shopping can easily save hundreds across 2027.