Every fall, Marketplace health plans update their prices, benefits, and rules for the coming year. Whether you are renewing a current plan or shopping for the first time, knowing what changed helps you avoid surprises and find coverage that fits your budget. Here is what we know so far about the 2027 plan year, what is still being finalized, and what you should do before open enrollment begins.
At a glance
- Open enrollment for 2027 plans runs from November 1, 2026, through January 15, 2027, on HealthCare.gov (state-based Marketplaces may have different dates).
- Out-of-pocket maximums and other cost parameters rose for 2027: the federal ceiling is $12,000 for self-only coverage and $24,000 for a family.
- Enhanced premium tax credit rules expired on December 31, 2025, and were not extended, so the 400% of federal poverty level income cap applies again for 2026 and 2027.
Open enrollment dates for 2027
For most states that use HealthCare.gov, open enrollment for plan year 2027 begins November 1, 2026 and ends January 15, 2027. If you enroll by December 15, 2026, your coverage generally starts January 1, 2027. If you enroll between December 16 and January 15, coverage typically starts February 1.
Some state-based Marketplaces (such as those in California, New York, Colorado, and others) set their own enrollment windows. These may open earlier or close later than the federal dates. Check your state's Marketplace website for exact deadlines.
If you miss open enrollment, you may still be able to sign up through a special enrollment period if you experience a qualifying life event, such as losing other coverage, moving, getting married, or having a baby.
Premium tax credit rules: what changed
The enhanced premium tax credits created by the American Rescue Plan Act and extended through the Inflation Reduction Act made Marketplace coverage significantly more affordable for millions of people. Those enhanced rules expired on December 31, 2025, and were not extended. For 2026 and 2027 coverage, the pre-2021 rules apply again:
- The "subsidy cliff" is back. Households with income above 400% of the federal poverty level generally no longer qualify for a premium tax credit at all.
- Credits are smaller at every income level than under the enhanced rules, so many consumers see higher monthly costs for the same plans.
- Consumers who paid little or nothing for coverage under the enhanced rules may see premiums increase by hundreds of dollars per month.
If your quoted premium looks very different from what you paid in recent years, this change is the most likely reason. The most important step is to check your actual 2027 premium and credit estimate during open enrollment rather than assuming your current costs will carry forward.
Updated out-of-pocket maximums
Each year, the federal government adjusts the maximum amount you can be required to pay out of pocket for in-network essential health benefits. This limit includes deductibles, copays, and coinsurance, but not your monthly premium.
For 2026, the out-of-pocket maximum is $10,600 for an individual and $21,200 for a family. For 2027, the maximum is $12,000 for an individual and $24,000 for a family. These are ceilings, not what a typical plan charges: many plans set their out-of-pocket maximums below the federal limit.
Why this matters: If you have a chronic condition or expect significant medical expenses, the out-of-pocket maximum is the ceiling on your annual spending for covered in-network care. A higher ceiling means slightly more potential exposure in a worst-case year.
Essential health benefit requirements
All Marketplace plans are required to cover ten categories of essential health benefits, including hospitalization, prescription drugs, maternity care, mental health services, and preventive care. For 2027, no major changes to these categories have been announced.
However, CMS periodically updates specific coverage requirements within these categories. For example, preventive care guidelines may expand to include additional screenings or vaccines. Any changes to required coverage for 2027 plans will be reflected in plan documents available during open enrollment.
Changes to special enrollment period rules
Special enrollment periods (SEPs) allow you to enroll outside of open enrollment when you experience certain qualifying life events. In recent years, CMS expanded access to SEPs, including options for consumers in areas affected by natural disasters and a monthly SEP for consumers with household incomes at or below 150% of the federal poverty level. That low-income SEP has since ended: CMS ended it on August 25, 2025, and Marketplaces cannot offer it after plan year 2026.
For 2027, the biggest change is verification: beginning with plan year 2027, HealthCare.gov generally must verify eligibility for new special enrollment period sign-ups before coverage starts, so keep proof of your qualifying event. If you believe you qualify for a special enrollment period, check HealthCare.gov or your state Marketplace for current rules.
State-specific changes
Several states operate their own Marketplace platforms and may implement rules that differ from the federal standard. Changes that could affect 2027 coverage include:
- State subsidy programs: Some states (such as California, Colorado, Maryland, New Mexico, and Washington) offer additional state-funded premium assistance beyond the federal tax credits. Check whether your state has expanded or changed its own program for 2027.
- Individual mandate penalties: A few states (California, Massachusetts, New Jersey, Rhode Island, and the District of Columbia) require residents to maintain health coverage or face a state tax penalty. Verify whether your state's penalty amounts or exemption rules have changed.
- Plan availability: The number of insurers and plan options varies by state and county. New carriers may enter your area, or existing ones may exit. You will see your options when you shop during open enrollment.
What returning enrollees should check before auto-renewal
If you had a Marketplace plan in 2026, your plan may automatically renew for 2027. But auto-renewal does not mean your costs, benefits, or network will stay the same. Before letting your plan roll over, check these items:
- Premium changes. Your plan's monthly premium may increase or decrease. Even if the premium stays similar, your premium tax credit amount may change, which affects what you actually pay.
- Network changes. Your doctors, hospitals, and pharmacies may no longer be in your plan's network for 2027. Confirm with the plan before you renew.
- Formulary changes. If you take prescription medications, verify that they are still covered and at what tier. A drug that was affordable this year could cost more on the same plan next year.
- Deductible and copay changes. Your cost-sharing structure may be different even if you keep the same plan name.
- Income and household updates. If your income or household size changed, update your Marketplace application. Your premium tax credit is based on your estimated income for the coming year, so an outdated estimate could mean you owe money at tax time or miss out on savings.
The safest approach: Log in and actively compare plans during open enrollment, even if you are happy with your current coverage.
What new shoppers should know
If you are enrolling in a Marketplace plan for the first time, here is what to prepare:
- Income estimate for 2027. Your premium tax credit is calculated from your projected annual household income. Gather recent pay stubs, tax returns, or other documentation.
- Household information. The Marketplace considers everyone in your tax household, including a spouse and dependents, when determining eligibility and credit amounts.
- Doctor and medication list. Knowing which providers and prescriptions you need helps you compare plans based on network and formulary, not just premium.
- Budget for total costs. The cheapest monthly premium does not always mean the lowest total cost. Consider deductibles, copays, and coinsurance alongside the premium.
Key deadlines timeline
| Date | What happens |
|---|---|
| May 2026 | CMS finalized the 2027 Notice of Benefit and Payment Parameters (plan rules; 2027 out-of-pocket limits are confirmed) |
| Late October 2026 | 2027 plan details and pricing become available for preview |
| November 1, 2026 | Open enrollment begins on HealthCare.gov |
| December 15, 2026 | Deadline to enroll for coverage starting January 1, 2027 |
| January 15, 2027 | Open enrollment ends on HealthCare.gov; coverage starts February 1 |
| After January 15, 2027 | Enrollment only through a special enrollment period with a qualifying life event |
State-based Marketplaces may have different start and end dates. Check your state's Marketplace for exact deadlines.
What to do next
Primary action: Compare 2027 Marketplace plans when open enrollment begins to see your actual premiums, tax credit estimates, and plan options for your area.
Alternative: Read our guide on how to choose a health insurance plan so you are ready to evaluate your options when 2027 plans become available.
This article provides general educational information, not legal, tax, or financial advice. Plan availability, pricing, subsidies, and benefits depend on individual circumstances, location, and the current plan year, and may change.
