ACA Enrollees May See Insurer Pullouts in 24 States and Higher Premiums as Open Enrollment Starts November 1

Open enrollment for 2027 Affordable Care Act coverage starts November 1 in most states, and many consumers will discover that the plan they have now will not be available next year. Insurers are pulling back from the marketplace in more than 20 states, and hundreds of thousands of enrollees have plans scheduled to end at the close of 2026, according to healthinsurance.org's guide to 2027 changes. The site's September count put insurer exits at 24 states.

That makes inaction more dangerous than usual. For people whose plans are ending, the consumer guide warns that “the auto-renewal process will use an algorithm to pick a new plan for you.” The substitute plan may come with a different doctor network, a different list of covered drugs, or a higher deductible.

Premiums are rising as well, and not uniformly. A KFF and Peterson analysis of 2027 premiums found the median proposed rate increase for marketplace plans is about 15%, while enhanced federal subsidies that helped reduce premiums expired at the end of 2025. For household budgets, a few minutes of comparison shopping in November could help avoid an expensive surprise later.

Higher Prices and Plans That Are Ending

Final approved premium increases vary sharply by state, ranging from about 3% in Vermont to nearly 28% in Arizona, according to healthinsurance.org's state-by-state rate tracker. Subsidies increase when the benchmark silver plan in an area becomes more expensive, so many people who receive subsidies will be partly protected from the rise. Those who do not qualify for subsidies, including people buying plans directly from insurers, will face the full increase.

Out-of-pocket costs are also increasing. The maximum amount an individual can be required to pay for covered care in 2027 rises to $12,000, up from $10,600 in 2026. For families, the cap increases to $24,000. That limit matters most for people with chronic illnesses, scheduled surgeries, or an expected pregnancy.

Eligibility rules are becoming stricter for some groups. Beginning in 2027, lawful permanent residents, Cuban-Haitian entrants, and Compact of Free Association migrants are the only lawfully present immigrants who qualify for marketplace subsidies. Others, such as refugees and asylees, may still buy coverage but must pay full price. Adults 30 and older generally need a hardship or affordability exemption to buy a catastrophic plan.

At the beginning of 2026, 87% of marketplace enrollees received premium subsidies, so the way subsidies are calculated will shape most shoppers' final bills. The best way to see the actual price is to log in and request a fresh quote using updated income information.

Some states are trying to soften the impact. Virginia is launching a state premium program for households between 138% and 250% of the federal poverty level, Rhode Island has set aside $19 million to replace part of the lost federal support, and Oregon is moving to its own state-run enrollment platform.

Senators Question Coverage Losses

This enrollment season follows a turbulent year. The Centers for Medicare & Medicaid Services announced that it had canceled about 315,000 plan-year 2026 enrollments covering more than 760,000 people, retroactive to August 31. CMS said the cancellations were tied to unauthorized broker enrollments without verified documentation and to enrollees insurers could not reach, according to Becker's Hospital Review on the senators' investigation.

Thirteen senators, led by Sens. Ron Wyden, D-Ore., and Bernie Sanders, I-Vt., sent letters to 10 insurers accusing them of working with the administration to terminate qualified enrollees without enough notice. The senators asked the companies to respond by November 6. AHIP, the insurer trade group, said plans support affordable coverage for eligible Americans along with “strong program integrity measures to safeguard consumers and taxpayers.” CMS has reinstated some enrollees whose terminations were found improper, though the total number is unclear.

Overall, individual market enrollment fell about 18%, or roughly 4.6 million people, between June 2025 and June 2026, according to a KFF analysis of individual market enrollment.

MedicalDaily previously reported on a proposed CMS rule that would require subsidy checks before payments begin. If finalized, that proposal would generally apply to 2028 coverage rather than this open enrollment period, with a verification window opening August 1, 2027.

What to Do Before the Deadlines

On HealthCare.gov, open enrollment runs through January 15, according to the site’s official deadlines, and shoppers must choose a plan by December 15 for coverage to begin January 1. Some state marketplaces use different dates. California, New York, and New Jersey run later, while some states close sooner, so residents should check their state exchange directly.

Start by logging in and reading any notice from your insurer about 2027. If your plan is ending, pick a replacement yourself instead of relying on automatic placement. Compare total costs, not just monthly premiums, by adding the deductible and out-of-pocket maximum to a full year of premiums.

Make sure your doctors, hospitals, and prescriptions are covered under any new plan. People who take expensive medications should review each drug in the plan's formulary, since coverage can differ sharply even among plans with similar premiums.

Update your income estimate and household size. Subsidies are based on projected 2027 income, and an outdated estimate can lead to repayment of part of the tax credit at tax time. Keep pay stubs, tax returns, and immigration documents ready in case the marketplace asks for verification, and answer any request quickly to avoid losing financial help.

Free help is available. Marketplace navigators and certified assisters can guide shoppers through plan choices at no cost, and HealthCare.gov lists local assistance by ZIP code. Be careful with unsolicited calls or messages from brokers offering to change your plan, since unauthorized broker activity was a major reason for this year's cancellations.

If you have questions about a termination or a missing subsidy, contact your marketplace directly and keep records of every call. The next key dates to watch are insurers' responses to the senators on November 6, the December 15 deadline for January coverage, and the January 15 close of enrollment on HealthCare.gov.

Common Questions Answered

When does 2027 open enrollment begin? November 1 in most states. HealthCare.gov enrollment ends January 15, with a December 15 cutoff for coverage starting January 1.

What if my insurer is leaving my state? Choose a new plan yourself. If you do nothing, the marketplace may automatically place you in a plan that does not match your doctors or prescriptions.

How much are premiums increasing? The median proposed increase is about 15%. Final approved increases range from about 3% in Vermont to nearly 28% in Arizona.

Will I lose my subsidy? Not necessarily. Update your income and household information, and respond quickly to any verification request.

Does the new verification rule affect 2027 coverage? No. The CMS proposal would generally begin with 2028 plans if finalized.

Where can I get free help? Marketplace navigators and certified assisters provide free enrollment assistance. HealthCare.gov lists local options by ZIP code.