ACA Open Enrollment 2027 Begins as Premiums Rise 13%

Open enrolment for 2027 health insurance on the Affordable Care Act (ACA) marketplaces began on Sunday 1 November in most US states, with benchmark premiums rising by an average of 13% and many middle-income buyers no longer eligible for any federal help. It is the second consecutive year of double-digit increases, following a 26% jump in benchmark premiums from 2025 to 2026, according to the health policy research group KFF.

The enrolment window opens two days before the US midterm elections. For the roughly 19 million people who buy their own insurance through HealthCare.gov or a state exchange, the choices made in the next six weeks will determine what they pay next year.

When Is ACA Open Enrollment for 2027?

On HealthCare.gov, the federal marketplace, the key dates are:

• 1 November 2026: open enrolment begins.
• 15 December 2026: last day to enrol in or change plans for coverage starting on 1 January.
• 15 January 2027: open enrolment ends. Plans chosen between 16 December and 15 January start on 1 February.
• After 15 January: you can only enrol or change plans if you qualify for a Special Enrollment Period, for example after losing other coverage.

States that run their own exchanges can set different deadlines, so residents of those states should check their state marketplace.

How Much Are Premiums Rising?

KFF found that insurers had proposed a median increase of 15%, but finalised benchmark silver premiums, the plans used to calculate subsidies, are up 13% on average for 2027. The increase is 11% in states using HealthCare.gov and 16% in states that run their own platforms. Taken together with last year’s rise, benchmark silver premiums have increased by 42% on average between 2025 and 2027.

Insurers blame a higher-than-usual rise in the underlying cost of medical care, which is also affecting employer plans, and the expiry of enhanced premium tax credits at the end of 2025. KFF’s analysis of insurer filings found that changes to the mix of people buying coverage added about four percentage points to premiums in 2026, and insurers expect a similar additional effect in 2027 as healthier customers drop out.

Who Still Gets a Subsidy?

Most enrollees still receive a premium tax credit that cushions the increase, because subsidies rise with the benchmark premium. But people with incomes above 400% of the federal poverty level no longer qualify for any premium tax credit now that the enhanced credits have expired, and must pay the full cost. KFF says this group will be “particularly hard hit”.

Some states have stepped in. New Mexico fully replaced the lost federal assistance in 2026 and saw enrolment grow while it fell nationally. California is continuing its state subsidies and expanding them in 2027 to partially replace the lost credits for households earning between 165% and 200% of the poverty level. KFF also notes that some lawfully present immigrants will no longer qualify for subsidised marketplace coverage.

Is Marketplace Enrollment Falling?

Yes. By February 2026, the number of people enrolled and paying premiums had fallen by 12%, or 2.6 million, from a year earlier to 19.2 million. The Congressional Budget Office projects that enrolment will fall from a peak of 22.4 million in 2025 to 13.1 million in 2027.

Choice is also shrinking in places. As of 29 October, 11 insurers had announced plans to leave at least one state for 2027, while seven planned to enter a new state, KFF said. Cigna is leaving the individual market in all 11 states where it currently sells such plans.

What Has Changed for Brokers and Fraud Checks?

The federal government has tightened rules after investigations into brokers who enrolled people or switched their plans without their knowledge. In September, the Department of Health and Human Services said it had cancelled coverage for about 760,000 people it described as “phantom” enrollees. It also temporarily paused the registration of new agents and brokers on the federal platform until February 2027; the Centers for Medicare and Medicaid Services estimates that about 19,000 new brokers would otherwise have registered.

That could make it harder for some consumers to find enrolment help this year, particularly as funding for Navigator programmes, which offer free assistance, has also been cut, KFF said. Some new requirements on consumers have been paused by the courts.

What Should Consumers Do Now?

Experts generally advise current enrollees not to let their plan renew automatically without checking: premiums, insurer networks and subsidy amounts change each year, and a plan that was the best value in 2026 may not be in 2027. Updating income estimates is especially important for the self-employed and freelancers, whose subsidies depend on projected earnings; our guide to self-employment tax explains how that income is taxed. Free help is available through HealthCare.gov and official state marketplaces, and consumers should be wary of anyone who asks for payment to enrol them.

MediaPavilion also covers wider US health news, including the FDA’s recent approval of a once-weekly insulin for children.

Featured image: A hospital emergency department entrance in the United States, by Harrison Keely / Wikimedia Commons, CC BY 4.0. Illustrative file photo.

Sources

• KFF — 9 Things to Watch for the 2027 ACA Open Enrollment Period (2026).
• KFF — How Much and Why ACA Marketplace Premiums Are Going Up in 2027 (3 August 2026).
• HealthCare.gov — Dates and deadlines for 2027 health insurance (2026).