ACA Open Enrollment 2027 opens on Saturday, November 1, 2026, and millions of Americans who buy their own health insurance are about to face a second straight year of double-digit price rises, smaller subsidies and fewer choices. The Affordable Care Act Marketplace is the main route to coverage for people who do not get affordable insurance through a job and do not qualify for Medicare or Medicaid, and this enrollment season — running to January 15, 2027, in most states — will test whether many of them can still afford to stay covered. Enroll by December 15, 2026, for coverage that starts on January 1, 2027.
The headline numbers, from KFF's closely watched analysis of insurer filings, are stark. Finalized benchmark silver premiums for 2027 are up 13 percent on average, after a 26 percent jump from 2025 to 2026. That leaves benchmark premiums 42 percent higher than in 2025. Insurers had proposed a median increase of 15 percent. In states using HealthCare.gov, benchmark silver premiums rise 11 percent; in states running their own exchanges, they rise 16 percent. Behind the averages sit two forces: the underlying cost of care is rising faster than usual, and the loss of the enhanced premium tax credits has changed who stays in the market, pushing premiums up further. KFF's analysis of filings found insurers estimated that risk-pool changes added about four percentage points to premiums in 2026, and expect a similar additional effect in 2027.
KFF published its "9 Things to Watch for the 2027 ACA Open Enrollment Period" days before the window opens, drawing on insurer rate filings, enrollment data and Congressional Budget Office projections. Its central finding is that the market enters 2027 smaller, more expensive and more fragile than it was two years ago. During the 2026 open enrollment period, plan selections fell by 1.2 million from 2025. By February 2026, effectuated enrollment — people who paid their premiums and stayed enrolled — was down 12 percent, or 2.6 million people, to 19.2 million. The broader individual market, which includes plans bought directly from insurers or brokers as well as Marketplace plans, fell 18 percent by June 2026, from 25.2 million to 20.5 million people, a loss of more than 4.6 million.
The Congressional Budget Office now projects ACA Marketplace enrollment will fall from a peak of 22.4 million in 2025 to 13.1 million in 2027. Several insurers have told regulators they expect the market to keep deteriorating in 2027, as some people who managed to keep coverage in 2026 can no longer make the numbers work. The Center on Budget and Policy Priorities, in its own open-enrollment guidance published October 27, urged shoppers to visit HealthCare.gov or their state-based marketplace to compare plans and check what financial help they qualify for, warning that coverage has become more expensive because of both the expired credit enhancements and changes in the 2025 reconciliation law.
The timing sharpens the politics. Open enrollment opens three days before the November 3 midterm elections, in which cost of living is the dominant issue: an Emerson College poll released October 30 put cost of living first among vote issues at 34 percent, and a Pew Research Center survey cited by AFP found 84 percent of early voters listed the economy as their biggest concern. Health costs sit squarely inside that anxiety. The Centers for Medicare and Medicaid Services has also raised out-of-pocket maximums for 2027 to 12,000 dollars for an individual and 24,000 dollars for a family, up 13.2 percent.
The story of 2027 premiums starts with the enhanced premium tax credits created by the American Rescue Plan Act and extended by the Inflation Reduction Act. From 2021 through 2025, those enhancements raised credit amounts across the board, capped the cost of a benchmark silver plan at 8.5 percent of income, and removed the income limit on who could qualify. They expired on December 31, 2025, and Congress has not renewed them. The House passed an extension in early 2026, but the Senate had not acted as of mid-October, so 2027 plans are priced without them.
What remains is the ACA's original, less generous subsidy formula. Most enrollees still get a subsidy, and because those credits rise with premiums, many will see their net premium rise less dramatically than the headline gross premium. But the protection is uneven. People with incomes above 400 percent of the federal poverty level — 63,840 dollars for an individual and 132,000 dollars for a family of four — no longer qualify for any premium tax credit and must pay the full cost. That "subsidy cliff" is back, and for someone just over the line, earning a little more can cost far more in premiums. The 2025 reconciliation law, known as the One Big Beautiful Bill Act, also took financial help away from many people with lawful immigration status, and changed other Marketplace rules that take effect for 2027.
Insurers cite two further pressures. First, medical costs themselves are rising: KFF notes that some employer plans have also seen steep increases, so the pressure is not unique to the Marketplaces. Second, the risk pool has worsened. When healthier people drop coverage because it costs more, the remaining pool is sicker on average, which pushes premiums up again — a cycle KFF warns could continue into 2027 as additional healthier enrollees leave.
The 2027 season brings a cluster of rule changes that shoppers need to understand before they pick a plan. The first is the insurer shakeout. As of October 29, 11 carriers had announced plans to exit at least one state for 2027, while seven had announced plans to enter a new state. Cigna, the biggest name leaving, is exiting the individual market in all 11 states where it currently participates. In some areas, consumers will have fewer insurers, fewer plan choices and narrower provider networks, and some enrollees will have their coverage disrupted and need to pick a new plan.
The second change is state help filling the federal gap. Some states that run their own exchanges are using state-funded subsidies to offset the lost federal assistance. New Mexico went furthest in 2026, fully backfilling the lost federal help, and its Marketplace enrollment grew even as enrollment fell nationally; the state is continuing that assistance in 2027. California is continuing state-funded subsidies and expanding them to partially backfill lost enhanced credits for households between 165 and 200 percent of the poverty level, after previously covering only households between 138 and 165 percent. New Jersey has maintained its program, while Rhode Island and Virginia moved to create new state-specific subsidies for 2027. The amount of help varies sharply by state and income, so where you live matters more than ever.
The third change is a crackdown on broker fraud that may also shrink enrollment and assistance. In September 2026, the Department of Health and Human Services said it had cancelled coverage for about 760,000 people whom the Centers for Medicare and Medicaid Services described as "phantom" enrollees — people signed up by an agent or broker who had made no premium payment and lacked a Social Security number or immigration document that could be verified in real time. HHS sent insurers a list of about 1.2 million people to review. Some enrollees have since had coverage reinstated, suggesting the criteria also flagged legitimate customers, while others may never get theirs back. Separately, HHS has temporarily paused registration of new agents and brokers in the federally facilitated Marketplace until February 2027 — about 19,000 people who would otherwise have registered, by CMS estimates — and Navigator funding was cut in February 2025, so shoppers may find less free enrollment help this year.
The fourth change hits immigrants. Lawfully present immigrants can still buy Marketplace coverage, but from 2027 only certain groups qualify for premium tax credits: lawful permanent residents (green card holders), Cuban and Haitian entrants, and lawful residents under the Compact of Free Association. Other lawfully present immigrants — including refugees, victims of human trafficking and asylees — can still purchase coverage but will get no subsidy. Without help, many may be unable to afford premiums and could drop coverage. The Congressional Budget Office estimates one million more people will be uninsured as a result of this provision by 2035. Undocumented immigrants remain ineligible to buy Marketplace coverage at any price.
The fifth change is about tax time. Beginning with the 2026 tax year, limits that capped how much enrollees had to repay in excess premium tax credits were eliminated by the reconciliation law. Because the first tax filings under the new rules will not happen until early 2027, people will choose 2027 plans without having seen uncapped repayment in practice. Anyone whose income ends up higher than projected could face a larger tax bill than expected, so estimating income accurately — and updating it when circumstances change — matters more than ever, especially near subsidy thresholds. Contributions to health savings accounts or traditional retirement accounts can lower modified adjusted gross income for some people, but only HSA-eligible plan members can use the HSA route, and not everyone has spare funds to contribute.
The sixth change links Medicaid and the Marketplace. Starting in 2027, in states required to implement Medicaid work requirements, people who lose or are denied Medicaid coverage solely for not meeting those requirements will also be ineligible for premium tax credits. When the reconciliation law was signed, only Georgia had Medicaid work requirements in place; the law now requires 43 states and the District of Columbia to implement them by the start of 2027. People who are working or qualify for an exemption but fail to navigate the reporting rules could therefore find themselves locked out of subsidized coverage until they are no longer eligible for Medicaid for a reason other than work requirements.
Litigation adds a final layer of uncertainty. Court challenges have temporarily paused some Marketplace requirements, including a 2025 federal rule that would have ended open enrollment on December 15; HealthCare.gov currently lists January 15, 2027, as the last day to enroll, though the government has appealed and an appeals court was scheduled to hear the case on October 30. Shoppers should therefore treat December 15 as the safe deadline for January 1 coverage and not assume the January date is settled.
KFF's assessment is blunt about the direction of travel: enrollment is declining, premiums are rising for a second straight year, and several insurers expect the market to keep deteriorating in 2027. Its data also underline the human scale — a projected fall from 22.4 million Marketplace enrollees at the 2025 peak to 13.1 million in 2027 would be a loss of more than nine million covered people in two years, even before counting those who buy outside the Marketplaces.
Consumer advocates have focused on the subsidy loss. Shaina Goodman, vice president of policy and government affairs at Community Catalyst, told Moneywise: "Because Congress failed to extend the ACA's enhanced premium tax credits, fewer people are eligible for subsidies to help them purchase health insurance, and the tax credits that are still available are significantly smaller than in previous years." The Center on Budget and Policy Priorities echoed the practical advice: compare plans on HealthCare.gov or a state marketplace, check eligibility for financial help, and do not assume last year's plan or price still holds.
State examples show how different the same national story looks locally. In Erie County, Pennsylvania, where residents buy through the state's Pennie marketplace, the Pennsylvania Insurance Department approved a 14.52 percent increase for Highmark and a 9.73 percent increase for UPMC Health Network for 2027. For a 40-year-old non-tobacco user, the lowest-cost gold plan rises from 373.36 dollars in 2026 to 411.34 dollars in 2027, and the lowest-cost bronze plan from 304.12 dollars to 332.41 dollars — before subsidies. Local brokers there report overall increases of 15 to 20 percent depending on household finances. Idaho and Georgia, unusually, opened their enrollment periods earlier in October, while most states open November 1.
Open enrollment is the one moment each year when most Americans without job-based coverage can choose, switch or renew a plan without a qualifying life event, and the 2027 window arrives at a fragile moment for the individual market. Two consecutive years of double-digit premium rises, the return of the subsidy cliff, insurer exits and tighter eligibility rules are all pushing in the same direction: fewer people covered, and a sicker, more expensive risk pool for those who remain. That dynamic matters beyond the people who shop on the exchanges, because uncompensated care, medical debt and delayed treatment spill over into hospitals, employers and family budgets.
It also matters politically, days before voters decide control of Congress. Health costs are the most personal form of inflation: a premium bill lands monthly, in full, unlike a grocery price that can be traded down. The parties have offered sharply different diagnoses — Democrats blame the expired enhanced credits and the reconciliation law's cuts, while the Trump administration has argued its regulations target fraud and that its broader economic policies will bring costs down. Voters will render their verdict on November 3, but the enrollment decisions made in November and December will shape household budgets through all of 2027, whatever the election result.
For shoppers, the practical stakes are immediate. Letting a plan auto-renew without checking could mean a higher bill arriving in January, a lost subsidy, a changed network, or a missing doctor. The KFF findings suggest the shoppers most at risk are those just above the subsidy cliff, those in states with insurer exits, immigrants who lose credit eligibility, and anyone whose income changed during 2026 and has not updated their Marketplace application.
Enrollment opens November 1 in most states, with plan preview already available on HealthCare.gov. The December 15 deadline secures January 1 coverage; enrollments after that date generally start February 1. The final federal deadline is January 15, 2027, subject to the pending court appeal over the enrollment calendar. State-based marketplaces may have different dates, and Idaho and Georgia opened earlier in October.
Watch for three things as the season unfolds. First, early enrollment figures, which will show whether the CBO's projected slide toward 13.1 million is materializing or whether state subsidies and shopper switching soften it. Second, any congressional action on the enhanced credits — an extension, even late, would change 2027 pricing only if it arrived before plans are finalized, but it would reshape the politics of the next cycle. Third, the courts: rulings on the Marketplace regulations and on Medicaid work requirements could restore or remove eligibility for thousands of shoppers mid-season. The November 3 election result will also determine whether any legislative fix is plausible in 2027.
When does ACA Open Enrollment 2027 start and end? In most states it runs November 1, 2026, to January 15, 2027. Enroll by December 15, 2026, for coverage starting January 1, 2027; later enrollments generally start February 1. Idaho and Georgia opened earlier in October, and state-based marketplaces may vary.
How much are premiums rising for 2027? Finalized benchmark silver premiums rise 13 percent on average — 11 percent in HealthCare.gov states and 16 percent in state-based marketplace states — after a 26 percent rise for 2026. Insurers had proposed a median increase of 15 percent.
Do I still get a subsidy? Most enrollees still qualify for a premium tax credit, but the enhanced credits expired at the end of 2025, so help is smaller. Households above 400 percent of the federal poverty level — 63,840 dollars for an individual, 132,000 dollars for a family of four — get no credit at all.
What if my insurer is leaving? Eleven carriers are exiting at least one state for 2027, including Cigna in all 11 of its individual-market states. If your plan disappears, you must pick a new one during open enrollment or risk losing coverage; check that your doctors and medicines are in the new plan's network and formulary.
Can lawfully present immigrants still get subsidized coverage? Only some groups qualify for premium tax credits in 2027: lawful permanent residents, Cuban and Haitian entrants, and Compact of Free Association residents. Refugees, asylees and trafficking victims can still buy coverage but without a subsidy, and undocumented immigrants cannot buy Marketplace coverage.
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