Reviewed by Erik Osborne, PA-C, Co-Founder | October 27, 2026
The Quick Answer: Open enrollment for 2027 ACA Marketplace coverage opens November 1, 2026. In most states it runs through January 15, 2027, but December 15 is the deadline to have coverage start January 1 [1]. This year calls for extra review: insurers proposed a median 15% premium increase for 2027 [2], enhanced premium tax credits are gone, and households above 400% of the federal poverty level no longer qualify for any premium tax credit [4]. Before November 1, review your renewal notice, update your income estimate, and compare marketplace plans with alternatives such as Direct Primary Care paired with a coverage layer.
Important: Some alternatives discussed below are not insurance. Direct Primary Care is a membership arrangement with your doctor for primary care services; it is not insurance and doesn’t meet ACA minimum coverage requirements on its own. Health sharing plans are not insurance. Sharing of medical costs among members is voluntary and is not guaranteed the way payment is under an insurance contract.
If you buy your own health coverage, you felt 2026. When enhanced premium tax credits expired at the end of 2025, what enrollees actually paid for premiums rose by an average of 58%, and deductibles climbed by about $1,000 per person [3]. Now 2027 rates are rising again.
The good news: you have a few weeks before open enrollment opens. That is enough time to make a decision based on your real numbers rather than your renewal notice alone. This checklist walks you through it.
Key Dates for 2027 Open Enrollment
| Date | What happens |
|---|---|
| Now through October 31 | Review your renewal notice, gather income estimates, and compare alternatives |
| November 1, 2026 | Open enrollment for 2027 Marketplace coverage opens [1] |
| December 15, 2026 | Deadline to enroll for coverage starting January 1, 2027 in most states [1] |
| January 15, 2027 | Open enrollment ends in most states; enrollments after December 15 generally start February 1 [1] |
State-based exchanges may use different deadlines, and a federal rule that would have shortened the window has been challenged in court. December 15 is the one deadline that works everywhere for January 1 coverage [5].
What Changed for 2027 Marketplace Coverage?
Premiums are up again. ACA Marketplace insurers proposed a median 15% increase for 2027, based on KFF’s analysis of 276 insurers in all 50 states and DC. It is the second double-digit increase in a row, after a median finalized increase of 20% for 2026 [2].
Enhanced subsidies are gone. Under the original ACA rules now back in effect, premium tax credits are generally limited to households up to 400% of the federal poverty level. Above that, there is no federal premium assistance, which is known as the subsidy cliff [4].
Income estimates matter more. For 2026 coverage onward, caps on how much excess subsidy you repay at tax time are gone, so underestimating your income could mean repaying the full difference [5].
Some insurers are leaving. Several carriers are exiting the marketplace for 2027, so do not assume your current plan still exists [5]. Check your renewal notice carefully.
Underlying costs are rising. KFF reports that insurers expect the underlying cost of medical care and prescription drugs to rise about 10% for 2027 [3].
Your Pre-Enrollment Checklist
Work through these steps before November 1:
- Read your renewal notice line by line. Confirm your plan still exists for 2027, and note the new premium, deductible, and out-of-pocket maximum.
- Estimate your 2027 household income carefully. This is especially important for self-employed and 1099 workers with variable income. Your estimate determines your subsidy, and repayment caps no longer apply [5].
- Check where you fall relative to 400% of the federal poverty level. Use the HealthCare.gov or your state exchange’s calculator. Being just above the line can mean losing all premium assistance [4].
- Add up what you actually spent in 2026. Include premiums, deductibles, copays, and prescriptions. Divide by 12 for your true monthly cost.
- List your doctors and prescriptions. Confirm each one is covered in any plan you consider, since networks and formularies change.
- Flag major health needs for 2027. A planned surgery, pregnancy, or ongoing specialist care can change which option fits best.
- Price at least one alternative. Compare your marketplace option to a strategy such as an HDHP with an HSA and Direct Primary Care, or Direct Primary Care paired with a health sharing plan.
- Put December 15 on your calendar. That is the deadline for January 1 coverage in most states [1].
Your Coverage Options, Side by Side
| Option | What it is | Often a fit for | Key trade-off |
|---|---|---|---|
| Subsidized marketplace plan | ACA-compliant insurance with a premium tax credit | Households under 400% of the federal poverty level | Subsidy depends on an accurate income estimate |
| Unsubsidized marketplace plan | ACA-compliant insurance at full price | People with significant health needs above the subsidy cliff | Full premium, rising again in 2027 [2] |
| HDHP + HSA + Direct Primary Care | High-deductible insurance, tax-advantaged savings, and a primary care membership | People who want insurance protection and predictable primary care | Higher deductible for large medical events |
| Direct Primary Care + health sharing | A primary care membership plus a community that shares eligible large costs | Healthy households paying full price, including many 1099 workers | Not insurance; sharing is not guaranteed; pre-existing condition limits |
No single option is right for everyone. The best fit depends on your income, your health, and how you use care.
Extra Considerations for Freelancers and 1099 Workers
Self-employed income rarely lands in a neat number, and that makes 2027 enrollment trickier.
- Build your income estimate from a range. Use a conservative estimate, and update your marketplace application during the year if your income changes significantly.
- Watch the cliff. If your income sits near 400% of the federal poverty level, small changes can have a large effect on your premium [4].
- Think about timing. Many health sharing programs accept members year-round, but returning to a marketplace plan generally requires open enrollment or a qualifying life event. Decide deliberately before December 15.
Tax note: This is general educational information, not tax or legal advice. Talk with a qualified tax professional about how subsidies, HSA contributions, and deductions apply to your specific situation.
For a deeper look, see our guide to Health Insurance for Freelancers in 2026: Your Complete Coverage Strategy.
Frequently Asked Questions About 2027 Open Enrollment
When is open enrollment for 2027 health insurance? Open enrollment for 2027 Marketplace coverage opens November 1, 2026. In most states, it runs through January 15, 2027, and December 15 is the deadline for coverage starting January 1 [1].
Are ACA premiums going up in 2027? Insurers proposed a median increase of 15% for 2027, according to KFF’s analysis of filings from all 50 states and DC [2]. Your actual change depends on your plan, location, and subsidy.
Are the enhanced ACA subsidies coming back for 2027? The enhanced premium tax credits expired at the end of 2025. Unless Congress acts, the original subsidy rules apply, including the 400% federal poverty level cutoff [4].
What happens if I miss the December 15 deadline? In most states you can still enroll through January 15, 2027, with coverage generally starting February 1 [1]. After open enrollment closes, you typically need a qualifying life event to enroll.
Can I switch from a marketplace plan to Direct Primary Care and health sharing? Yes, but plan carefully. DPC and health sharing are not insurance, and returning to marketplace coverage generally requires open enrollment or a qualifying life event.
Should I just auto-renew my current plan? Not without checking. Premiums, networks, and even plan availability are changing for 2027 [2][5], so a quick comparison is worth the time.
Next Steps
This year, the few weeks before November 1 matter more than usual. A careful review now can help you avoid overpaying for a plan that no longer fits, or losing a subsidy because of an income estimate.
At Journey Health Advisors, we help individuals, families, and self-employed professionals compare marketplace plans, Direct Primary Care, and health sharing side by side, with no carrier bias and no pressure. Bring your renewal notice, and we will walk through the numbers with you.
Speak with an advisor at Journey Health Advisors: 1 (844) 580-6055 | journeyhealthadvisors.com/contact
Related Reading:
- Health Insurance for Freelancers in 2026: Your Complete Coverage Strategy
- Your Health Insurance Premium Went Up in 2026: Here Is What to Actually Do About It
- Health Sharing Plans Explained: How They Work, What They Cost, and Who They Fit
- How Much Does Direct Primary Care Cost in 2026? Real Prices by Region and Practice
REFERENCES
[1] healthinsurance.org. “What are the deadlines for the ACA’s open enrollment period?” healthinsurance.org, August 2026. https://www.healthinsurance.org/faqs/what-are-the-deadlines-for-the-acas-open-enrollment-period/
[2] KFF. “How Much and Why ACA Marketplace Premiums Are Going Up in 2027.” KFF, updated August 3, 2026. https://www.kff.org/affordable-care-act/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/
[3] KFF. “In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase for 2027, Following a Steep Climb This Year.” KFF, July 2026. https://www.kff.org/affordable-care-act/in-preliminary-rate-filings-aca-marketplace-insurers-largely-propose-double-digit-premium-increase-for-2027-following-a-steep-climb-this-year/
[4] KFF. “Mapping the Uneven Burden of Rising ACA Marketplace Premium Payments due to Enhanced Tax Credit Expiration.” KFF, November 2025. https://www.kff.org/affordable-care-act/mapping-the-uneven-burden-of-rising-aca-marketplace-premium-payments-due-to-enhanced-tax-credit-expiration/
[5] Benefit Champs. “What Changed for 2027 Open Enrollment (Updated Sept 2026).” Benefit Champs, September 2026. https://benefitchamps.com/resources/articles/what-changed-2027-open-enrollment/
Journey Health Advisors | journeyhealthadvisors.com | 1 (844) 580-6055 | 8810 Blakeney Professional Drive, Suite 100, Charlotte, NC 28277
