Millions of Americans who buy their own health insurance face a harder shopping season than usual this fall. Rate requests are rising again, some insurers are leaving the exchanges, and the enhanced subsidies that eased costs have expired.
In this article we will discuss when enrollment opens, what is driving the proposed price increases, what to do if your plan is ending, and a practical method for comparing plans, with the caveat that the facts here are US-based and the details differ by state.
Open Enrollment Starts November 1 in Most States
Open enrollment for Affordable Care Act Marketplace coverage for 2027 begins on November 1 in most states, according to healthinsurance.org. The Marketplace is the system of exchanges, run either by the federal government through HealthCare.gov or by individual states, where people without job-based or government coverage can compare and buy private plans. Some states run their own exchanges and set their own calendars, so the start and closing dates are not identical everywhere.
That last point matters in practice. The closing date, the last day on which you can pick a plan for the coming year, differs by state and exchange, and this article cannot give a single date that fits every state. Check the date on your own exchange now and put it on your calendar with a reminder a week or two earlier. Choosing a plan close to the final day leaves no room for the extra steps that some people will face this year.
Extra Identity Checks May Slow You Down
HealthCare.gov states that consumers may need to complete extra identity-verification steps before they can enroll, and it advises people to allow more time. In practice that means you should not leave your application to the last evening. If you are asked to upload or mail documents, the review can take days, and a delay can push your effective date later than you planned.
Who This Affects
The people most affected fall into three groups. The first is those who have a Marketplace plan now and normally let it renew. The second is those whose insurer is leaving their area. The third is those who pay the full price with no subsidy, because they bear the entire increase themselves. Each group has a different best move, and the sections below take them in turn.
It is also worth saying what open enrollment is for. Outside this window, most people can only change Marketplace coverage if they have a qualifying life event, such as losing other coverage, moving to a new area, getting married or having a child. Missing the window without such an event can mean going without a plan for most of the year, which is a risk no one should take lightly with an illness or injury always possible. The rules for special enrollment periods vary and can change, so confirm them on the official exchange if you think you qualify.
Premium Requests Climb for a Second Year
The headline number is a median proposed rate increase of about 15 percent for individual-market plans in 2027, according to a Peterson-KFF analysis as reported by Becker’s Payer. It is the second straight year of double-digit requests. A median means half of the insurers’ requests are higher than that figure and half are lower, so many people will see something different depending on where they live and which insurer they use.
Healthinsurance.org reported a wide spread by state. Weighted average increases are under 7 percent in Vermont, New York, Iowa and Utah, and a proposed 29 percent in Arizona. These are proposals, not final rates. State regulators review them and may trim them, and the final approved numbers can come in lower, so look at the real prices on the exchange when you log in.
A practical way to treat the headline is as a warning, not a bill. If your current plan has a proposed increase well above the median, that is a signal to shop more carefully, since a competing plan in the same metal tier may cost far less. If the increase is small, you still lose nothing by checking, because the network and drug coverage may have changed even where the price did not.
Why Rates Keep Rising
Several forces push premiums up, and the reports tie a specific one to this year. Enhanced subsidies expired at the end of 2025, enrollment dropped in 2026, and the remaining pool of enrollees became older and sicker, according to Becker’s. That matters because insurance depends on mixing people who use a lot of care with people who use little. When healthier people leave, the average cost of those who remain rises, and insurers raise rates to cover it.
Beyond that, the general reasons premiums rise in any year apply here as well: the cost of hospital care, prescription drugs and clinician pay increase, and insurers include a cushion for uncertainty. The specific mix differs by insurer and state, and regulators publish rate filings that explain each request, which can be worth reading if you want the detail.
There is a second-order effect that readers sometimes miss. When premiums rise faster than incomes, more healthy people decide the coverage is not worth the cost and drop it, which worsens the pool and pushes the next year’s rates up again. Economists call this a spiral, though it is usually slower and less dramatic than the word suggests, because subsidies cushion many enrollees from the sticker price. The expiry of the enhanced subsidies is why the cushion is thinner this year than it was.
A Table of the Key Numbers
| Item | What was reported |
| Open enrollment start | November 1 in most states |
| Median proposed individual-market increase | About 15 percent |
| States with lowest weighted average increases | Vermont, New York, Iowa, Utah (under 7 percent) |
| Highest proposed weighted average | Arizona (29 percent) |
| Share of enrollees with premium subsidies in 2026 | 87 percent |
| Individual out-of-pocket maximum | $12,000 in 2027, up from $10,600 in 2026 |
| HSA limit, self-only | $4,500, up from $4,400 |
| HSA limit, family | $9,000, up from $8,750 |
Exits Leave Hundreds of Thousands Choosing Again
The second big story is insurers pulling back. Healthinsurance.org reported insurers exiting Marketplaces in 24 states, and said hundreds of thousands of enrollees have plans that end when 2026 does. If you are one of them, you will usually receive a notice from your insurer or the Marketplace. Do not ignore it, because a plan that ends is not a plan that quietly continues under another name.
Becker’s gave several examples. UnitedHealthcare is leaving Georgia at the end of 2026, where KFF reported a proposed 54 percent increase, and it remains in 29 states. Molina is cutting back to six marketplace states. Cigna is rolling back its exchange coverage in a move affecting about 369,000 members. Centene, which sells plans under the Ambetter name, is leaving Delaware and New Hampshire but adding 55 counties elsewhere.
Not every change is a loss. Seven states gain one new carrier each: California, Colorado, Georgia, Indiana, Minnesota, Ohio and Texas. A new carrier does not guarantee a better deal, since new entrants may have narrow networks or unfamiliar drug lists, but more competition in a county can restrain prices over time.
The pattern across these examples is churn rather than collapse. Some companies shrink their footprint, some expand, and the map of who sells what, county by county, shifts from year to year. That is why a blanket statement such as insurers are leaving the Marketplace is less useful than a local check: the question for you is which insurers sell plans where you live, and what each one offers.
If Your Plan Is Ending
When a plan ends, the Marketplace may automatically assign you a new one. Healthinsurance.org recommends that people choose replacement coverage deliberately, or with the help of a broker, instead of accepting whatever is assigned. The reason is plain: an automatic replacement may have a different network, a different drug list and a different price from the plan you chose, and you may not notice until a claim is denied or a prescription costs more than expected.
What to Check Before Accepting a Replacement
Look at four things in order. First, confirm that your regular doctors, specialists and hospital are in the new plan’s network. Second, check that your prescriptions are covered and at which price tier. Third, compare the total yearly cost, not just the monthly bill. Fourth, check whether you will keep any progress toward your deductible, which usually resets when you change insurers. If you are in the middle of treatment, ask the new insurer about continuity of care before you commit.
A broker or navigator can be especially helpful here. They can search by doctor name, compare formularies across carriers and explain the details of a transition, such as whether a pending referral or prior authorization carries over. Bring your insurance card, a list of medicines with doses, and the names of your clinicians, and ask them to check each against the new plan instead of relying on general assurances.
Subsidies Shape the Real Price
Most people on the Marketplace do not pay the sticker premium. Healthinsurance.org reported that 87 percent of Marketplace enrollees qualified for premium subsidies during the 2026 open enrollment. A premium tax credit lowers your monthly premium based on your expected income and the cost of a benchmark plan in your area, which is usually the second-lowest-cost silver plan.
That design has a useful effect. Because the subsidy is tied to the benchmark premium, an increase in the benchmark should raise the subsidy as well. However, healthinsurance.org cautioned that other plans may not change at the same rate as the benchmark, so your net cost could still move up or down. And consumers without subsidies, who are often people with higher incomes, bear the full increase.
Estimating Income Carefully
Subsidies depend on your projected income for the coming year, which you estimate when you apply. The credit is reconciled when you file your taxes, so if you earn more than you predicted, you may have to repay some of the credit, and if you earn less, you may receive more. Think through changes you expect, such as a raise, a new job, a change in household size, self-employment income or a spouse starting work, and update your estimate if it changes during the year. Tax professionals can advise on your specific situation.
Unsubsidized Shoppers
If you pay the full price, your calculation is different, because every dollar of the increase comes from you. Spend more time comparing plans, including those off the Marketplace, though off-Marketplace plans do not carry subsidies, so for unsubsidized buyers the comparison is mostly about network and total cost. A broker can show plans from several insurers side by side at no extra charge to you, since brokers are usually paid by the insurer.
Another practical tip is to run your numbers twice, once with your best guess of income and once with a slightly higher or lower figure, to see how sensitive your subsidy is. If a small change in income causes a large swing in what you owe, you may want to be more careful with your estimate and revisit it during the year. People with variable income, such as freelancers and seasonal workers, are the most exposed to surprises at tax time.
Costs Beyond the Premium
A low monthly premium can hide a high bill later. For 2027 the individual out-of-pocket maximum rises to $12,000 from $10,600 in 2026, according to healthinsurance.org. The out-of-pocket maximum is the most you can be asked to pay in a year for covered, in-network care before the plan pays everything else. Premiums do not count toward it.
For people with health savings accounts, contribution limits also rise: $4,500 for self-only coverage and $9,000 for family coverage, up from $4,400 and $8,750. An HSA is available only with certain high-deductible plans, and contributions are generally tax-advantaged, but the rules are specific, so confirm eligibility with the plan documents or a tax professional.
An Illustration of Total Cost
Here is an illustration with invented round numbers, not real plan data. Suppose Plan A has a premium of $400 a month, a $1,000 deductible and an out-of-pocket maximum of $5,000. Plan B has a premium of $300 a month, a $5,000 deductible and an out-of-pocket maximum of $9,000. Plan B looks cheaper by $1,200 over a year. But if you have a serious illness, your worst-case yearly cost on Plan A would be $4,800 in premiums plus $5,000, or $9,800, against $3,600 plus $9,000, or $12,600, on Plan B. If you rarely use care, Plan B may win. The right answer depends on how much care you expect to use.
Metal Tiers in Brief
Marketplace plans come in metal tiers: bronze, silver, gold and platinum. The tiers describe how costs are split between you and the plan, not the quality of care. Bronze plans have the lowest premiums and the highest deductibles, while gold and platinum have higher premiums and lower costs when you use care. Silver plans are the ones that can carry extra cost-sharing reductions for eligible lower-income enrollees, which is a reason some people with modest incomes find silver cheaper overall than bronze.
None of this makes one tier right for everyone. A healthy person who wants protection against a catastrophe and who has savings to cover a high deductible may reasonably choose bronze. Someone who sees specialists often or takes expensive medicine may do better with gold, even though the premium is higher, because the plan pays more of each bill. The deciding factor is your expected use of care, not the color of the label.
Catastrophic Plans
Catastrophic plans have changed. Healthinsurance.org reported that, after a court ruling, consumers aged 30 and older generally need a hardship or affordability exemption to buy one. If you are under 30, or qualify for an exemption, a catastrophic plan may be an option, but it is built for protection against very large bills rather than for routine care.
Eligibility Changes for Lawfully Present Immigrants
Starting with 2027 coverage, the rules for who can get federal subsidies are narrower for lawfully present non-citizens, according to healthinsurance.org. Only lawful permanent residents, Cuban-Haitian Entrants and Compact of Free Association migrants can get federal subsidies. Refugees, asylees, Temporary Protected Status holders, and people on work or student visas lose eligibility for those subsidies.
For affected households this can change the price of coverage sharply, because the subsidy is often what makes a plan affordable. People in these groups should check their status against the Marketplace’s rules, read any notices they receive and talk to a navigator, a licensed broker or an immigration or legal-aid organization about their situation.
Families with mixed status, in which some members are eligible and others are not, can face especially complicated choices, since eligibility is assessed person by person and the household’s overall income still matters. If someone in your household is affected, ask for help before you apply, and keep copies of all documents you submit. Do not guess on an application, because incorrect information can lead to delays or to having to repay a credit later. This article gives general information only, and individual eligibility depends on details that only the Marketplace can confirm.
Comparing Plans in a Sensible Order
Louise Norris of healthinsurance.org put it simply: “Even if you’re happy with your coverage, it’s important to compare plans during open enrollment.” Auto-renewal can feel convenient, but this year the price, the network or even the insurer may be different from what you had.
Network, Drugs and Doctors
Begin with the things that cannot be fixed later. Check that the doctors and hospitals you use are in the plan’s network, using the insurer’s directory and then a phone call to the office, since directories are sometimes out of date. Look up each prescription in the plan’s formulary, the list of covered drugs, and note the tier, because the tier determines your copay or coinsurance. A cheaper plan that excludes your specialist or your medicine is not cheaper.
Be aware that networks come in different types, such as health maintenance organizations that usually require you to stay in network and use a primary doctor for referrals, and preferred provider organizations that offer more freedom at a higher price. Out-of-network care can cost much more, or may not be covered at all except in emergencies, so the plan type is as important as the plan name. Also remember that a hospital being in network does not always mean every doctor who works there is, so ask about the specific clinicians you expect to see.
Total Cost
Next, estimate your total cost: twelve months of premiums, plus the deductible you are likely to reach, plus the copays and coinsurance you expect, capped by the out-of-pocket maximum. Compare the best case, the typical case and the worst case for each plan. Use the exchange’s cost tools, but treat estimates as estimates.
Write the three numbers down for each plan you are seriously considering. The act of putting them side by side often exposes a plan that looked attractive only because one number, usually the monthly premium, was shown in large type. If two plans are close, prefer the one whose worst case you could afford, since a bill you cannot pay is more damaging than a premium that is slightly higher.
| Step | What to compare | Where to look |
| Network | Your doctors, hospital, specialists | Plan directory and doctor’s office |
| Drugs | Each medicine and its tier | Plan formulary |
| Yearly cost | Premium plus deductible plus out-of-pocket maximum | Plan summary of benefits |
| Subsidy | Estimated income and household size | Exchange application |
| Deadline | Your exchange’s closing date | State exchange or HealthCare.gov |
Free Help
Navigators and certified application counselors provide free help in many areas, and licensed brokers can enroll you in a Marketplace plan without charging you. Use the official exchange to find them. Be wary of unsolicited calls or messages offering cheap insurance, and never share your Social Security number or bank details with someone you did not contact yourself.
Final Thoughts
Begin by finding your exchange. If your state runs its own, go to that site, and otherwise use HealthCare.gov. Write down the closing date for your state and set a reminder before it.
Then read any notice from your current insurer. If it says your plan is ending, treat that as the start of your search, not a formality. If it says your plan continues with a new price, log in on the first day of open enrollment and compare it with other plans in your area.
Gather the documents you need: an estimate of your household income for 2027, the names of your doctors, a list of your prescriptions and, if relevant, your immigration documents. Leave time for identity verification. Then compare your options on network, drugs and total cost, using the table above as a checklist.
Finally, confirm your choice and check that you receive a confirmation, then pay the first premium when the insurer requests it, because a plan is not active until you do. Rules, dates and prices may change, so confirm anything important on the official exchange site, and consider talking to a licensed professional about your own situation.
One last point: give yourself credit for acting early. Most of the problems in a hard enrollment year come from rushing, from accepting an automatic assignment without looking, or from learning in February that a doctor is out of network. An hour spent on the comparison in November can prevent months of frustration, and it is the single most reliable thing a shopper controls in a market where prices and carriers are moving.
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Frequently Asked Questions
When Does ACA Open Enrollment Start for 2027?
Open enrollment begins on November 1 in most states. Closing dates differ by state, so check your own exchange.
How Much Are ACA Premiums Going up in 2027?
A Peterson-KFF analysis found a median proposed increase of about 15 percent for individual-market plans. Weighted average proposals range from under 7 percent in Vermont, New York, Iowa and Utah to 29 percent in Arizona.
Can I Keep My Current Plan if My Insurer Is Leaving?
No, a plan ends when the insurer exits. The Marketplace may assign a replacement, but healthinsurance.org recommends choosing one deliberately or with a broker.
Does the Out-of-Pocket Maximum Change in 2027?
Yes. The individual out-of-pocket maximum rises to $12,000 from $10,600 in 2026, according to healthinsurance.org.
Should I Let My Plan Renew Automatically?
Usually it is better to compare first. Prices, networks and drug lists change from year to year, and a plan that suited you may no longer be the best fit.
Who Can Get Federal Subsidies in 2027?
Among lawfully present non-citizens, only lawful permanent residents, Cuban-Haitian Entrants and Compact of Free Association migrants qualify. Check your own eligibility with the Marketplace.