Quick answer: For 2027 US health coverage, don't let your plan auto-renew. Marketplace insurers have proposed a median 15% premium rise and seven insurers are leaving the Marketplace in 20 states, while employers expect their health costs to climb 8.2%. Open your renewal notice, list your doctors and prescriptions, estimate your 2027 income carefully, and compare plans on total yearly cost (premium plus likely out-of-pocket spending), not on the monthly premium alone. HealthCare.gov open enrollment runs November 1, 2026 to January 15, 2027; enroll by December 15 for coverage that starts January 1.
Every autumn the same envelope arrives, or the same email from HR, and every autumn it is tempting to click "keep my current plan" and get on with life. This year that shortcut could cost hundreds or even thousands of dollars. This open enrollment checklist for 2027 walks you through everything you need to check, in order, whether your coverage comes from the ACA Marketplace or from your job. It includes a total-cost worksheet you can print, a worked example with numbers, and a three-week plan that gets you finished well before the deadline.
Note: this guide covers US health insurance. UK and Australian readers: the "compare total cost, not the headline price" habit still applies to private cover and other insurance.
In this guide:
- Why 2027 open enrollment is different
- Key dates and deadlines
- The 2027 open enrollment checklist (10 steps)
- How to compare plans on total cost (worked example)
- Which plan type fits your situation?
- Extra checks for employer plans
- A calm 3-week open enrollment plan
- Printable total-cost worksheet
- FAQ
Key takeaways
- 2027 is the second year in a row of double-digit Marketplace premium increases, and seven insurers are leaving, affecting consumers in 20 states.
- Auto-renewal is risky this year: your plan, network, drug list or even your insurer may change without you noticing.
- The subsidy "cliff" is back: for 2027 coverage, premium tax credits stop above roughly $63,840 for a single person and $132,000 for a family of four (400% of the federal poverty level).
- The cheapest monthly premium is not always the cheapest plan. Add premium, deductible and out-of-pocket maximum for three scenarios before choosing.
- If your income is under 250% of the poverty level, a Silver plan may come with extra cost-sharing reductions you can't get on Bronze or Gold.
Why 2027 open enrollment is different
Health insurance has quietly become one of the fastest-rising essentials in the household budget. Overall US consumer prices rose 3.7% in the 12 months to September 2026, according to the Bureau of Labor Statistics. Marketplace premiums are rising far faster.
Here is what changed, in plain language:
- Marketplace premiums are up again. Across 276 insurers in all 50 states and DC, the median proposed premium increase for 2027 is 15%, per the Peterson-KFF Health System Tracker (August 2026), after a median 20% rise for 2026. Insurers cite medical cost trends of around 10%, labor shortages, GLP-1 drug demand and a sicker risk pool.
- The enhanced subsidies are gone. The extra premium tax credits in place from 2021 to 2025 were not extended. KFF found that the average amount subsidized enrollees actually paid rose 58% in 2026.
- Insurers are leaving. The Commonwealth Fund (October 2026) reports that seven insurers are leaving the Marketplace for 2027, affecting consumers in 20 states. If yours is one, you'll be matched to a replacement plan unless you choose your own.
- Out-of-pocket limits are higher. The 2027 federal cap on what you can be asked to pay for covered in-network care in a year is $12,000 for an individual, up from $10,600 in 2026 (healthinsurance.org, 2026).
- Job-based plans are getting pricier too. Employers expect health benefit costs per employee to rise 8.2% in 2027, the highest increase since 2003, according to Mercer's preliminary 2026 survey of more than 1,800 US employers. 59% plan cost-cutting changes, such as higher deductibles.
To make this concrete: KFF's example of a 40-year-old in Indianapolis earning $65,000 shows her monthly payment for the same Silver plan going from $316 in 2025 to $477 in 2026, with $546 proposed for 2027. That is the kind of jump that quietly breaks a household budget if nobody looks.
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Key dates and deadlines for 2027 coverage
| Coverage type | Window | Deadline that matters most |
|---|---|---|
| HealthCare.gov states | Nov 1, 2026 – Jan 15, 2027 | Dec 15 for coverage starting Jan 1 |
| State-run exchanges | Most open Nov 1 (Idaho Oct 15; Connecticut and Massachusetts Oct 23) | Varies: Jan 31 in CA, DC, NJ, NY, RI; Dec 15 in Idaho |
| Employer plans | Set by your employer, often 2–4 weeks in Oct–Nov | Check your HR portal; windows are short |
| Medicare (if you help a parent) | Oct 15 – Dec 7, 2026 | Dec 7 |
Marketplace dates: healthinsurance.org, updated August 2026. Always confirm on your own state's exchange.
Juggling your own plan, your children's coverage and a parent's Medicare review at once? Our guide to the sandwich generation and money has ideas for sharing that load.
The 2027 open enrollment checklist (10 steps)
1. Find and actually read your renewal notice
Look for four things: the new monthly premium (after any subsidy), the deductible, the out-of-pocket maximum, and whether your plan or insurer is ending. If you are being moved ("crosswalked") to a new plan, treat it as a brand-new choice.
2. Make your "care list" for next year
List every doctor and specialist your family sees, every regular prescription (name and dose), any planned care, and your preferred pharmacy and hospital. You'll check every plan against this list.
3. Check networks and drug lists for every plan you consider
Networks and drug lists (formularies) change every year. Use each plan's provider and drug search, or call the insurer. A cheaper plan that drops your doctor or moves your medication to a higher tier is not cheaper.
4. Estimate your 2027 household income honestly
Marketplace subsidies are based on what you expect to earn in 2027, and for 2027 coverage they use the 2026 poverty guidelines: $15,960 for one person and $33,000 for a family of four (HealthCare.gov). Under the IRS 2027 table (Rev. Proc. 2026-26), the share of income you are expected to pay for the benchmark Silver plan ranges from 2.15% at the lowest incomes to 10.22% between 300% and 400% of the poverty level. Above 400%, roughly $63,840 single or $132,000 for a family of four, there is no premium tax credit at all.
With variable or freelance income, use a realistic middle estimate and update it if things change; too low an estimate can mean repaying credit at tax time.
5. Know where you sit relative to the subsidy cliff
Just above 400% of the poverty level, you pay the full unsubsidized premium. The Commonwealth Fund estimates that a 40-year-old just over the threshold who paid $445 a month in 2025 could owe $719 a month in 2027. Health Savings Account (HSA) contributions lower your modified adjusted gross income, which can sometimes bring you back under the line, so if you are close, ask a tax professional or free Marketplace navigator to run the numbers.
6. Check whether you qualify for extra Silver-plan savings
Cost-sharing reductions lower your deductible, copays and out-of-pocket maximum, but only on Silver plans. HealthCare.gov is explicit: if you qualify, you must pick a Silver plan to get them. They are generally available to households earning up to 250% of the poverty level, which for 2027 coverage means up to about $39,900 for one person or $82,500 for a family of four.
7. Compare at least three plans on total yearly cost
This is the step most people skip, and it is the one that saves the most. You'll find the method and a worked example in the next section.
8. Look at the out-of-pocket maximum as your "worst-case bill"
In a bad health year, could your household find this amount? If not, a lower out-of-pocket maximum or a dedicated savings pot may matter more than a few dollars of premium. A sinking fund for out-of-pocket health costs turns a frightening unknown into a planned line in your budget.
9. Choose actively, don't auto-renew
Even if you keep the same plan, log in and select it yourself so your price, subsidy and income estimate are confirmed.
10. Confirm, pay and save the paperwork
Coverage usually does not start until the first premium is paid. Save your confirmation, your plan's Summary of Benefits and Coverage, and the insurer's member services number in one place, next to your other household bills.
If health insurance is the bill that tips your whole month into panic, the problem is often the system around it, not you. Step III of our workbook series, The Matriarch's Money Reset: Own the System (digital PDF), helps you build a calm household budget system with room for big, irregular costs like deductibles and premiums.
How to compare plans on total cost (with a worked example)
A landmark study in the Journal of Health Economics found that only 14% of insured Americans could correctly answer questions about deductibles, copays, coinsurance and out-of-pocket maximums (Loewenstein et al., 2013, as reported by NPR). If insurance language makes your eyes glaze over, you are in the large majority. The fix is to stop comparing features and start comparing dollars.
The formula: Total yearly cost = (monthly premium × 12) + what you would pay out of pocket for the care you expect.
Run it for three scenarios: a quiet year (check-ups and a few prescriptions), a typical year for you (based on last year's actual care), and a bad year (you hit the out-of-pocket maximum).
Illustrative example (hypothetical numbers): Maya is 41, single, and buys coverage on the Marketplace. After her subsidy, she is choosing between three plans. To keep it simple, assume she pays the full cost of care until her deductible, then 20% coinsurance until the out-of-pocket maximum.
| Bronze | Silver | Gold | |
|---|---|---|---|
| Monthly premium (after subsidy) | $310 | $450 | $560 |
| Yearly premium | $3,720 | $5,400 | $6,720 |
| Deductible / out-of-pocket max | $7,500 / $10,000 | $4,000 / $9,000 | $1,500 / $7,500 |
| Quiet year ($500 of care) | $4,220 | $5,900 | $7,220 |
| Typical year ($6,000 of care) | $9,720 | $9,800 | $9,120 |
| Bad year (hits the max) | $13,720 | $14,400 | $14,220 |
(Silver, typical year: the $4,000 deductible plus 20% of the remaining $2,000 = $4,400, plus $5,400 in premiums = $9,800.)
- Bronze wins in a quiet year and, surprisingly, in the worst year too, because the premium savings outweigh the higher maximum.
- Gold wins in a steady "middle" year, because its low deductible kicks in quickly.
- Bronze's real risk is cash flow: Maya could need up to $7,500 early in the year before her plan pays much.
- Under 250% of the poverty level, cost-sharing reductions could make Silver far cheaper than shown.
Real plans also include free preventive care and some copays before the deductible, so use the worksheet below with your own plans' details.
Which plan type fits your situation?
This is not a recommendation for any one person, just a starting point for your own comparison.
| If this sounds like you… | Compare first | Watch out for |
|---|---|---|
| Healthy, few doctor visits, solid emergency savings | Bronze or HSA-eligible plan | Having the deductible in cash if something happens |
| Income under ~250% of the poverty level | Silver (for cost-sharing reductions) | Picking Bronze to save on premiums and losing the extra savings |
| Regular prescriptions, therapy or specialist visits | Gold, or Silver with low copays | Drug tiers and whether copays apply before the deductible |
| Income just above the subsidy cliff | Bronze + HSA contributions; ask for help modeling income | Underestimating income and repaying credits at tax time |
| Planned surgery, pregnancy or ongoing treatment | Plan with the lowest out-of-pocket maximum that keeps your doctors | Network changes for your hospital or specialist |
About HSAs: all Marketplace Bronze and Catastrophic plans remain HSA-eligible in 2027. The IRS limits for 2027 are $4,500 for self-only coverage and $9,000 for family coverage, plus a $1,000 catch-up from age 55 (Rev. Proc. 2026-24, reported by The Tax Adviser). Money in an HSA rolls over year to year, which makes it a natural home for your medical sinking fund.
Extra checks if your insurance comes from your job
Job-based coverage is often subsidized generously, but it is still a big number. In 2025, covered workers paid an average of $1,440 a year toward single coverage and $6,850 toward family coverage, out of total premiums of $9,325 and $26,993 (KFF Employer Health Benefits Survey 2025). KFF's 2026 survey is due on October 22, 2026.
- Compare employee-only, employee + spouse and family tiers. Sometimes it is cheaper for each partner to take their own employer's plan and put children on whichever is cheaper.
- Look for the employer HSA contribution. If your employer adds money to an HSA when you choose the high-deductible plan, count that as a discount on your total cost.
- Check the deductible change, not just the premium. With 59% of employers planning cost-cutting changes for 2027, a stable paycheck deduction can hide a much higher deductible.
- Review paid add-ons (dental, vision, accident cover) and set any FSA amount from predictable costs only, since most FSA money must be used within the plan year.
Many women end up being the household's unofficial benefits manager on top of everything else. If that is you, our article on the hidden cost of the mental load might feel very familiar.
A calm 3-week open enrollment plan
Open enrollment feels overwhelming mostly because it gets left to the last evening. Split it into three short sessions.
Week 1 (about 45 minutes): Gather
- Find your renewal notice and put the deadline in your calendar.
- Write your care list and pull last year's medical spending from your insurer account.
- Estimate your 2027 household income.
Week 2 (about 60 minutes): Compare
- Shortlist three plans, including your current one, and check each against your care list.
- Fill in the worksheet for all three scenarios.
- Confused? Book free help through your exchange or HR team.
Week 3 (about 30 minutes): Choose and lock in
- Pick the best balance of total cost and worst-case risk, enroll actively and pay the first premium.
- Set up a monthly transfer into your medical sinking fund or HSA.
If opening the envelope makes your stomach drop, start with five minutes. Our complete guide to money anxiety explains why money admin can feel so heavy, and our free 7-page workbook preview is a gentle place to begin untangling it.
Printable total-cost worksheet
Print this page or copy the table into a notebook. Fill in one column per plan.
| Line | Plan 1 | Plan 2 | Plan 3 |
|---|---|---|---|
| A. Monthly premium (after subsidy) × 12 | $______ | $______ | $______ |
| B. Deductible | $______ | $______ | $______ |
| C. Out-of-pocket maximum | $______ | $______ | $______ |
| D. My doctors in network? My drugs covered? (Y/N) | ____ | ____ | ____ |
| E. Quiet year: A + small out-of-pocket costs | $______ | $______ | $______ |
| F. Typical year: A + last year's care under this plan's rules | $______ | $______ | $______ |
| G. Bad year: A + C | $______ | $______ | $______ |
| H. Could I pay B in cash in January? (Y/N) | ____ | ____ | ____ |
| I. Employer HSA contribution (subtract from E–G) | $______ | $______ | $______ |
A plan that wins on lines E to G but fails line D or H deserves a second look. Then make a monthly line in your budget for line F minus your premiums, so next year's medical costs are planned rather than a shock. If your salary can't stretch to cover everything at once, our guide to financial priorities when money is tight can help you decide what comes first.
If you are struggling to afford coverage: your exchange application will screen you for Medicaid and CHIP, and some states add their own help (Virginia, for example, is launching a state-funded premium subsidy for 2027). Free enrollment help is available through your state exchange; be wary of unsolicited calls promising "$0 plans".
FAQ
When is open enrollment for 2027 health insurance?
On HealthCare.gov, open enrollment runs from November 1, 2026 to January 15, 2027, and you need to enroll by December 15 for coverage that starts January 1. Some state exchanges open earlier or close later, so check your state's site. Employer windows are set by each employer and are usually much shorter.
What happens if I don't do anything during open enrollment?
Most Marketplace enrollees are automatically re-enrolled in the same plan or, if it is ending, a similar one chosen for them, which may have a different price, network or drug list. With employer plans, doing nothing usually keeps your current elections, though an FSA typically has to be re-elected each year.
Is a Bronze or Silver plan better?
It depends on your income and expected care. Bronze has the lowest premium but the highest deductible; Silver costs more monthly but, under about 250% of the poverty level, may come with cost-sharing reductions that cut your deductible sharply. Compare total yearly cost for a quiet, typical and bad year.
What is the ACA subsidy cliff in 2027?
For 2027 coverage, premium tax credits are generally only available up to 400% of the federal poverty level, which is about $63,840 for one person and $132,000 for a family of four. Earning even slightly above that can mean losing the credit entirely, so estimate your income carefully.
How can I lower my health insurance premium?
Update your income estimate so you get the full subsidy you qualify for, compare all metal levels instead of auto-renewing, and check whether a spouse's employer plan or a state subsidy program is cheaper. A lower premium usually means a higher deductible, so make sure you could cover it.
Sources
- How much and why ACA Marketplace premiums are going up in 2027, Peterson-KFF Health System Tracker, 2026
- More ACA Premium Spikes to Come in 2027 Amid Federal Policy Changes, Commonwealth Fund, 2026
- Employers expect health benefit costs to jump in 2027, Mercer, 2026
- 2025 Employer Health Benefits Survey, KFF, 2025
- Revenue Procedure 2026-26 (2027 applicable percentage table), Internal Revenue Service, 2026
- Federal Poverty Level and Cost-sharing reductions, HealthCare.gov (CMS)
- Consumer Price Index, September 2026, US Bureau of Labor Statistics, 2026
- 2027 ACA open enrollment: What's changing and open enrollment deadlines, healthinsurance.org, 2026
- HSA inflation-adjusted amounts for 2027, The Tax Adviser (AICPA), 2026
- Consumers flunk Health Insurance 101 (Loewenstein et al., Journal of Health Economics), NPR, 2013
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