ACA Open Enrollment Is Under Way: 5 Ways to Cut Your 2027 Health Insurance Costs

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If you need health insurance for 2027, it will probably cost more than it did in 2026.

You can shop for an Affordable Care Act plan through Jan. 15 on the federal marketplace and most state exchanges. This 11-week enrollment period is the main opportunity to sign up for coverage on HealthCare.gov.

Rising prices and the loss of enhanced subsidies have pushed some people to go without coverage. According to the Centers for Medicare & Medicaid Services, about 1 million fewer people signed up or renewed coverage through the Health Insurance Exchange during the 2026 Marketplace Open Enrollment Period than in 2025. A Kaiser Family Foundation analysis, citing Congressional Budget Office estimates, says enrollment could drop even more in 2027.

But going uninsured to save money can expose you to far greater costs if you face an unexpected illness or injury. With prices rising across the board, paying for health care has become an even bigger burden for many Americans. Nearly one in five households earning under $55,000 a year delayed or avoided ER or urgent care visits because of cost concerns, according to The Penny Hoarder’s 2026 State of Debt report.

Here’s what you should know about the health insurance marketplace, who is eligible, how subsidies work, and how to secure coverage for 2027.

What Is Changing for ACA Coverage in 2027?

If you already have an ACA plan, expect fewer choices and higher prices for 2027. Several factors are driving that shift, but a major one is the end of enhanced premium tax credits.

The temporary subsidies introduced during the pandemic expired at the end of 2025 after Congress did not renew them. With the income cap restored, many premiums have become more expensive over the past two years.

When rates rise, healthier younger enrollees are more likely to drop coverage. That leaves a smaller pool of applicants who tend to use more health care, which can make the market less attractive to insurers. As of late October 2026, 11 carriers had said they would leave at least one state in 2027, while seven had announced plans to enter a new state, according to KFF.

Fewer insurers mean less competition, which can leave consumers with fewer choices and give companies more room to increase premiums, cut benefits, or both.

Health care costs are also climbing more broadly, just like many other expenses. Employer plans are getting more expensive too, but employers usually cover 70% or more of the premium. If you buy coverage on the marketplace yourself, there is no employer to absorb any of the added cost.

Who Can Buy a Marketplace Plan?

Marketplace coverage is generally available to U.S. citizens and most lawfully present residents living in the state where they apply.

It is mainly meant for people who do not have access to affordable employer coverage. That can include:

• Freelancers, independent contractors, and gig workers
• Self-employed business owners
• Part-time workers whose employers do not offer benefits
• Early retirees who are not yet eligible for Medicare
• College students and recent graduates aging off a parent’s plan
• People who are unemployed

Marketplace plans are not designed for people already covered by government programs such as Medicare, Medicaid, Tricare, or CHIP.

Under the ACA, insurers cannot deny you coverage, cancel your policy, or charge more because of a pre-existing condition.

Employer Coverage: Can You Leave for the Marketplace?

You can enroll in a marketplace plan even if your employer offers insurance, but employer coverage is usually the cheaper option.

ACA rules allow premium tax credit subsidies on the marketplace only if your job-based coverage is unaffordable or does not meet minimum value requirements.

For 2027, employer coverage is considered unaffordable if your share of the monthly premium is more than 10.22% of your household income. If your employer plan meets the affordability test, you may still buy marketplace coverage, but you would have to pay full price without subsidies.

Key Dates for 2027 Coverage

To avoid a gap in coverage, keep these deadlines in mind:

• Open enrollment begins: Enrollment opens in early fall.
• Early December deadline: To have coverage start at the beginning of the year, you must enroll by this date.
• Final enrollment deadline: If you sign up after the early December cutoff and before the final deadline, your coverage starts the following month.

Some states, including California, New Jersey, New York, and Rhode Island, have later deadlines. Check your state exchange’s website for details.

Special Enrollment Periods If You Miss Open Enrollment

If you miss open enrollment, you generally cannot buy an ACA plan midyear unless you have a Qualifying Life Event, which gives you a 60-day Special Enrollment Period.

Common qualifying life events include:

• Loss of existing coverage: Losing job-based insurance, aging off a parent’s plan at 26, or losing Medicaid eligibility
• Household changes: Getting married, having a baby, adopting a child, or getting divorced
• Moving: Relocating outside your current plan’s service area
• Income or status changes: Gaining lawful citizenship or residency status, or losing income and becoming eligible for premium tax credits

What Types of Plans Are Available?

Marketplace plans are grouped into four “metal” tiers based on how costs are shared between you and the insurer:

Within each tier, also look at the provider network type:

• Health Maintenance Organization (HMO): You must stay in network and usually need a referral from a primary care doctor to see specialists.
• Preferred Provider Organization (PPO): You can see in-network or out-of-network doctors without referrals, though out-of-network care costs more.
• Exclusive Provider Organization (EPO): Usually covers only in-network care except in emergencies, but generally does not require specialist referrals or a primary care doctor.
• Point of Service (POS): A hybrid plan that requires referrals from your primary doctor but allows out-of-network care for an added cost.

What Do Marketplace Plans Cover?

Coverage varies, so it is important to compare all of your options before choosing a plan. Still, every Marketplace plan must include these 10 essential health benefits, according to the federal marketplace website:

• Outpatient care
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care before and after birth
• Mental health and substance use services
• Prescription drugs
• Rehabilitative and habilitative services and devices for injuries, disabilities, or chronic conditions
• Lab services
• Preventive and wellness services, plus chronic disease management
• Pediatric services, including oral and vision care

Even when a service is covered, the cost can vary a lot. Before comparing plans, make a list of what you currently get and what you need, including the doctors you see and the prescriptions you take, so you can weigh coverage against price.

How Much Do Marketplace Plans Cost?

Monthly premiums and deductibles depend on the plan level you choose. Your exact price will also vary based on your ZIP code, age, household size, and income.

In general, standard ACA premium tax credits are available if your income falls between 100% and 400% of the federal poverty level. For the 2026 guidelines used to calculate 2027 subsidies, 100% of the FPL for one person is $15,960, and 400% is $63,840.

If your income is below 100% of FPL, you will usually be directed to Medicaid in your state. If you live in a state that has not expanded Medicaid, you may fall into the coverage gap and not qualify for either Medicaid or ACA subsidies. In that case, you may be eligible for an exemption that lets you buy catastrophic coverage.

If your income is above 400% of FPL, you are generally subject to standard unsubsidized prices and no longer qualify for federal ACA premium tax credits. The Donald Trump administration said it would send a $500 check to roughly 1 million unsubsidized enrollees who bought health insurance through the federal marketplace in 2026 and did not receive premium tax credits. If you were eligible, you should already have received the Treasury Department payment.

How to Enroll in ACA Health Insurance

Start at HealthCare.gov. After you enter your information, you will be redirected to your state’s portal if it operates its own marketplace. For 2027, 21 states plus the District of Columbia run fully state-based health insurance marketplaces.

From the homepage, you can sign up for the first time, review an existing plan, or compare options. If you already have marketplace coverage, automatic renewal may be available, but plan benefits and prices can change from year to year, so it is important to review your choices annually.

Information you will need:

• Legal names, birthdates, and Social Security numbers for everyone in your household, even those not applying for coverage
• Your home address, which determines your state and directs you to a state-run marketplace if applicable
• Your tax returns and projected household income for the coming year for everyone in the household, including W-2s, 1099s, or self-employment earnings; if your income changes or your estimate is wrong, you will need to update it later
• Policy numbers for any existing health coverage you or family members have
• Details about any job-based insurance available to your household, even if you do not plan to use it

You can also enroll by phone through the Marketplace Call Center at 1-800-318-2596, through a verified web broker, or with free in-person help from a certified ACA Navigator. To find help nearby, enter your ZIP code in HealthCare.gov’s local help tool.

Ways to Save on Health Insurance

Even though costs have gone up, there are still ways to lower what you pay for health coverage. Consider both your budget and your medical needs before choosing any of them, but it is worth exploring every option.

Cost-Sharing Reductions

Premium tax credits lower your monthly premium, while Cost-Sharing Reductions can reduce deductibles, copayments, and your out-of-pocket maximum. There are two requirements: your household income must fall between 100% and 250% of FPL, and you must enroll in a Silver plan. For people who qualify, a Silver CSR plan often provides lower deductibles and copays than more expensive Gold plans.

Move Down to Bronze

If you do not qualify for premium tax credits and you are enrolled in a Silver plan, you may want to look at Bronze coverage instead. Bronze plans include high-deductible options that are HSA-eligible. While a high-deductible plan means more out-of-pocket spending before coverage begins, it also lets you open a Health Savings Account. Contributions lower taxable income, and withdrawals can be used tax-free for qualified medical expenses.

Find a Job With Health Benefits

This may not be realistic for everyone, but employer coverage is usually cheaper than buying insurance on the marketplace because employers typically pay 70% or more of employee premiums. There are even lists of companies that offer benefits to part-time workers.

Reduce Your MAGI

Contributions to an HSA or a traditional individual retirement account can lower your modified adjusted gross income. If you are close to the cutoff for premium tax credits or Cost-Sharing Reductions, that reduction could help you qualify. Just be sure your income estimate reflects money you are actually able to set aside next year.

Should You Choose Catastrophic Coverage?

Catastrophic plans have low monthly premiums but very high deductibles. For 2027, the deductible is $12,000 for one person and $24,000 for a family. These plans are meant to protect against worst-case scenarios such as a serious car accident. They are available only to people under 30, or to people of any age who qualify for a hardship exemption such as the death of a close family member, a natural disaster, or bankruptcy. You may also qualify if you are ineligible for Medicaid because your state did not expand Medicaid under the ACA.

Preventive care is still covered when you use an in-network provider. If you qualify for a subsidized Silver plan, that is usually the better financial choice, but if your only options are catastrophic coverage or no insurance, a catastrophic plan can still provide some protection in an emergency.