2027 Health Insurance Open Enrollment: Dates, Income Limits, Subsidies & What to Know

Open Enrollment is the main annual window when most people can enroll in, renew, or change an Affordable Care Act Marketplace health insurance plan for the upcoming year.

For 2027 coverage, Open Enrollment begins November 1, 2026. On the federal Marketplace, HealthCare.gov, the enrollment period runs through January 15, 2027. If you enroll by December 15, 2026, coverage can begin January 1. If you enroll between December 16 and January 15, coverage generally begins February 1.

That makes the period between November 1 and December 15 especially important for anyone who wants uninterrupted coverage beginning January 1.

Open Enrollment matters even more this year because Marketplace insurers proposed a median premium increase of about 15% for 2027, following a median finalized increase of roughly 20% for 2026. Those increases vary substantially by state, carrier, age, ZIP code, plan, and subsidy eligibility, so a 15% national median does not mean every person's premium will rise exactly 15%.

For people buying their own insurance, 2027 is therefore a particularly important year to compare before automatically renewing.

2027 Open Enrollment dates

For states using HealthCare.gov, the important federal dates are:

HealthCare.gov confirms that November 1 is the first day people can enroll, renew, or change Marketplace plans for 2027. After January 15, most people need a qualifying Special Enrollment Period to make changes. Some states operate their own Marketplace rather than HealthCare.gov and may use different deadlines or extensions. Always verify the exact dates for your state.

Who can enroll in Marketplace health insurance?

To enroll in Marketplace coverage, you generally must:

• •live in the United States,
• •be a U.S. citizen, U.S. national, or lawfully present noncitizen who meets the applicable requirements,
• •and not be incarcerated.

People who already have Medicare generally cannot enroll in a Marketplace health or dental plan. Eligibility for Marketplace coverage and eligibility for financial assistance are separate questions. Someone may be able to buy a Marketplace plan but receive no subsidy.

How income affects Marketplace subsidies in 2027

Marketplace financial assistance is primarily delivered through the Premium Tax Credit, often called a subsidy.

For 2027, the enhanced premium tax credits that temporarily removed the traditional upper-income cutoff are no longer in effect. Under the standard ACA structure, premium tax credit eligibility generally runs from 100% through 400% of the Federal Poverty Level, assuming the applicant also meets the other requirements.

The Marketplace bases subsidies on the household's expected income for the year of coverage, not simply what the household earned last year. Finalized 2027 savings estimates become available beginning November 1.

For the 48 contiguous states and Washington, D.C., the 2026 Federal Poverty Guidelines are:

Alaska and Hawaii have higher poverty guidelines. These figures are useful for understanding the structure of assistance, but an applicant should not assume a particular subsidy until the Marketplace calculates it.

What happens if your income is above 400% of the Federal Poverty Level?

Under the standard ACA rules applying again after the expiration of the temporary enhanced credits, households with income above 400% FPL generally are not eligible for a federal Premium Tax Credit. That can matter enormously for middle- and higher-income households because they may be exposed to the full unsubsidized premium. Someone above the subsidy limit may therefore want to compare: unsubsidized Marketplace plans, off-Marketplace ACA-compliant plans, catastrophic coverage if eligible, employer-sponsored coverage if available, or private medically underwritten coverage where legally available and appropriate.

The right choice depends heavily on health history, prescriptions, provider needs, household income, and risk tolerance.

What if your income is below 100% FPL?

People below 100% FPL may fall into a very different category. In Medicaid expansion states, many low-income adults may qualify for Medicaid instead of Marketplace subsidies. In non-expansion states, some adults can fall into what is often called the coverage gap, where their income is too low for Marketplace tax credits but they do not meet their state's Medicaid rules.

There are limited exceptions under federal Premium Tax Credit rules for certain people below 100% FPL. Medicaid and CHIP applications can generally be made year-round, not only during Open Enrollment.

Cost-sharing reductions: the subsidy many people overlook

Premium subsidies lower the monthly premium. Cost-sharing reductions (CSRs) can lower what someone pays when actually using medical care — deductibles, copayments, coinsurance, and the annual out-of-pocket maximum.

This is why a Silver plan can sometimes be dramatically better than a Bronze plan for a lower-income household — even if the Bronze premium looks cheaper.

Does employer coverage affect Marketplace subsidies?

Yes. If an employer offers coverage that meets the ACA's affordability and minimum-value requirements, the employee may not qualify for Marketplace subsidies. For 2027, job-based coverage is considered affordable if the employee's required contribution toward the lowest-cost plan is no more than 10.22% of household income. Family members may sometimes qualify for Marketplace assistance even when the employee does not.

Can health insurance companies reject you because of a pre-existing condition?

Examples include diabetes, cancer history, heart disease, autoimmune conditions, asthma, depression or anxiety, pregnancy, previous surgeries, chronic pain conditions, and many other diagnoses. This is one of the most important differences between ACA-compliant coverage and certain medically underwritten private plans.

Does pregnancy count as a pre-existing condition?

ACA Marketplace plans cannot deny or surcharge someone because of pregnancy. Marketplace plans must include pregnancy, maternity, and newborn care as part of the ACA's essential health benefits.

Someone who is pregnant should pay particularly close attention to OB/GYN network participation, hospital network, deductible, maternity coinsurance, newborn coverage rules, out-of-pocket maximum, and whether anticipated specialists are in network. The cheapest monthly premium is often not the cheapest total-cost plan during a pregnancy.

What do ACA Marketplace plans have to cover?

All Marketplace plans cover the ACA's 10 categories of essential health benefits:

• •Outpatient care
• •Emergency services
• •Hospitalization
• •Pregnancy, maternity, and newborn care
• •Mental health and substance-use treatment
• •Prescription drugs
• •Rehabilitative and habilitative services and devices
• •Laboratory services
• •Preventive and wellness services and chronic-disease management
• •Pediatric services, including pediatric oral and vision care

The fact that a category is covered does not mean every service is free or that every physician, hospital, drug, or treatment is covered identically. Plan details still matter enormously.

How prescription drug coverage works

Marketplace plans must include prescription drugs as an essential health benefit, but each insurer has its own formulary — its covered-drug list. A drug can be covered differently depending on the carrier and plan. Plans may categorize prescriptions into tiers: generic, preferred brand, non-preferred brand, and specialty. A lower-tier medication generally has lower cost sharing than a higher-tier one.

Specialty medications require extra research

Before enrolling, verify:

• •Whether the exact medication is on the formulary
• •Which formulary tier it falls into
• •Whether prior authorization is required
• •Whether step therapy applies
• •Whether quantity limits apply
• •Whether the medication must be obtained from a specific specialty pharmacy
• •Whether the drug is subject to a copay or percentage-based coinsurance

A plan that costs $100 less per month can become vastly more expensive if it places an important specialty medication at 40% or 50% coinsurance.

Prior authorization, step therapy, and specialty pharmacy requirements

• •Prior authorization — the insurer requires the prescribing physician to demonstrate the medication or service meets certain criteria before coverage.
• •Step therapy — the patient may need to try one or more lower-cost medications first before a more expensive one is approved.
• •Specialty pharmacy — high-cost drugs may need to be filled through a designated pharmacy rather than a normal retail pharmacy.

What if your medication is not on the formulary?

Do not assume you will simply pay a normal copay. Depending on the plan, the medication may not be covered, may require a formulary exception, may require prior authorization, may require trying another drug first, or may expose you to substantial out-of-pocket costs. The provider can sometimes request an exception based on medical necessity, but approval is not guaranteed. This is why prescription matching should be part of the enrollment decision.

Bronze, Silver, Gold, and Catastrophic plans

Marketplace plans are commonly organized into metal categories. The categories describe how costs are divided between the insurance company and enrollee across a standard population — they do not represent medical-care quality.

PPO, HMO, EPO, and network differences

• •HMO — more restricted provider network, may require referrals for specialist care.
• •EPO — typically no referrals required, but usually little or no out-of-network coverage for non-emergency care.
• •PPO — more flexibility for specialists and out-of-network care, though PPO availability in the individual Marketplace varies by area.

Always verify doctors, specialists, hospitals, laboratories, behavioral-health providers, and prescription pharmacies against the specific plan network.

Marketplace PPO vs. private PPO coverage

People often use "private insurance" to describe several different products. An ACA Marketplace plan is itself private insurance issued by a private carrier, but it is sold under ACA rules. Separately, some consumers may qualify for medically underwritten private coverage outside the Marketplace — which can have very different eligibility requirements, networks, benefit structures, maternity coverage, prescription benefits, mental-health coverage, pre-existing-condition rules, and enrollment periods.

A healthier person who receives little or no ACA subsidy may sometimes find private alternatives worth comparing. Someone with substantial medical conditions, expensive medications, pregnancy needs, or strong subsidy eligibility may find ACA coverage substantially more appropriate.

Open Enrollment is not the only time private coverage is available

ACA Marketplace coverage is generally restricted to Open Enrollment unless the consumer qualifies for a Special Enrollment Period. Some private plans may accept applications throughout the year, although eligibility may depend on medical underwriting. That can make private coverage particularly relevant for someone who missed Open Enrollment, does not have a qualifying life event, is healthy enough to qualify, and needs individual coverage.

Special Enrollment Periods after January 15

After Open Enrollment ends, people may still qualify for Marketplace coverage after certain life events — losing qualifying health coverage, getting married, having or adopting a child, certain moves, and other qualifying circumstances. People generally have a limited enrollment window around the qualifying event, commonly about 60 days. Medicaid and CHIP enrollment remain available throughout the year for eligible applicants.

Losing employer coverage

Losing job-based health insurance is one of the most common reasons someone qualifies for a Special Enrollment Period. A person leaving employer coverage may want to compare COBRA, Marketplace ACA coverage, Medicaid if income has fallen, spouse or domestic-partner employer coverage, and private individual coverage. COBRA can preserve the same employer plan, but the former employee may have to pay the full premium the employer previously subsidized — which can make Marketplace or private coverage significantly less expensive.

Self-employed people and small-business owners

Open Enrollment is particularly important for freelancers, 1099 workers, consultants, sole proprietors, independent contractors, small-business owners, and people whose employer does not offer health benefits. Self-employed households should estimate income carefully because Marketplace subsidies are tied to projected household income. Business income, deductions, self-employment income, capital gains, retirement distributions, and other taxable income can all affect subsidy calculations.

What happens if your income estimate is wrong?

Marketplace subsidies are based on projected income. The actual Premium Tax Credit is ultimately reconciled on the federal income-tax return. If the Marketplace pays too much advance subsidy on someone's behalf, some or all of that amount may have to be repaid depending on the final tax situation. If household income exceeds 400% FPL under the standard 2027 rules, a household generally cannot claim a Premium Tax Credit and may have to repay advance credits it was not entitled to receive. This makes accurate income estimates especially important for business owners, commissioned workers, self-employed individuals, investors, and anyone with highly variable income.

What counts as household income?

Marketplace income calculations generally use Modified Adjusted Gross Income (MAGI). The rules can become complicated for households with self-employment income, dependents, investment income, tax-exempt interest, Social Security income, retirement distributions, capital gains, or multiple earners. Subsidy eligibility is determined using the applicable tax household, not simply whoever happens to live at the same address. Anyone near a subsidy eligibility threshold should be especially careful.

Why you should not automatically renew your current plan

Automatic renewal is convenient, but it does not mean the plan remains the best option. Marketplace premiums can change. Provider networks can change. Prescription formularies can change. Deductibles and copays can change. Carriers may enter or leave markets. Your income and subsidy eligibility may change. HealthCare.gov specifically recommends updating your household and income information and comparing available plans rather than assuming the automatically renewed plan remains optimal.

Why are 2027 premiums rising?

Insurers have cited several major drivers: higher hospital costs, physician and provider cost inflation, rising prescription-drug costs (including specialty medications), GLP-1 utilization, labor shortages and broader healthcare inflation, changes in the individual-market risk pool, and the expiration of the enhanced premium tax credits after 2025. KFF's analysis found a median proposed Marketplace increase of roughly 15% for 2027 after finalized median increases of approximately 20% for 2026. Those are national statistics — actual increases vary widely.

Questions to ask before selecting a 2027 health plan

Before enrolling, compare more than just monthly premium. A strong review should include:

A plan with a lower premium is not automatically the less expensive plan overall.

What information should you gather before Open Enrollment?

Before comparing plans, have the following available: ZIP code and ages of household members, projected 2027 household income and household size, current insurance information and premium, preferred doctors specialists and hospitals, prescription names and dosages, expected procedures, pregnancy or maternity needs, employer coverage information, and any upcoming employment or household changes. That information allows a much more meaningful comparison.

What happens if you enroll but never pay the first premium?

Submitting an enrollment does not necessarily activate coverage. You generally must pay the first premium directly to the insurance carrier for the coverage to become effective.

Can Marketplace plans impose lifetime limits?

ACA-compliant plans cannot impose annual or lifetime dollar limits on essential health benefits. This protection is important for people facing catastrophic illnesses or long-term treatment.

Mental-health and substance-use treatment

Marketplace plans cover mental-health and substance-use disorder services as essential health benefits. Plans cannot deny coverage or increase the premium because someone has a pre-existing mental-health or substance-use condition. However, provider networks, therapy visit costs, medication coverage, and authorization rules still vary.

Dental and vision coverage

Adult dental and routine adult vision services have historically not been required as essential health benefits, though separate dental plans and plans with embedded dental or vision benefits may be available. Pediatric dental and vision services remain part of the essential-health-benefit framework.

Should you choose ACA or private health insurance?

The lowest premium should not be the only consideration.

Frequently Asked Questions

The bottom line for 2027

For anyone buying their own health insurance, 2027 is not a good year to simply let an old plan renew without comparison. Premiums are under substantial upward pressure. Subsidy rules have changed from the enhanced-credit era. Network and prescription details can materially alter the real cost of coverage. And the best option for one household may be completely wrong for another.

For consumers who want help comparing those options without having their information sold to multiple lead companies, HealthNerd can compare Marketplace and private health-insurance options side by side and help identify which route fits the household best.