How to Sign Up for 2027 Affordable Care Act Health Insurance

Need health insurance in 2027? It’ll likely end up costing more than it did in 2026. The sweeping win for Democrats in the midterm elections could mean a restoration of tax credits to reduce costs, but any changes aren’t likely to come in time for this year’s enrollment.

Your opportunity to pick an Affordable Care Act health plan lasts through Jan. 15 for the federal marketplace and most state exchanges. This 11-week window is the primary time you can sign up for coverage on HealthCare.gov. 

Higher prices and the expiration of enhanced subsidies in the form of tax credits have forced some to forgo health insurance. A million fewer people signed up or re-enrolled through the Health Insurance Exchange during the 2026 Marketplace Open Enrollment Period than did in 2025¹, according to the Centers for Medicare & Medicaid Services. The Kaiser Family Foundation’s analysis cites Congressional Budget Office estimates that enrollment could fall significantly further in 2027². 

However, skipping insurance to save money puts you at risk of greater financial loss if you have an unexpected illness or injury. This year, with prices for everything rising, affording health care has become an even bigger problem for many Americans. Nearly one in five households earning under $55,000/year delayed or avoided going to the ER or urgent care because of concerns over the cost, according to The Penny Hoarder’s 2026 State of Debt report. 

Here is what you need to know about navigating the health insurance marketplace, who qualifies, how subsidies work and how to get covered for 2027.

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What’s Happening With the ACA in 2027?

If you’re currently enrolled in an ACA plan, expect fewer and pricier options for 2027. There are a number of contributing factors, but a big part of it is the expiration of enhanced premium tax credits.

The temporary, pandemic-era enhanced subsidies expired Dec. 31, 2025, after the Republican-led Congress declined to pass an extension. The return of the income cap has meant higher costs for many premiums over the past two years. 

Democrats, who campaigned on restoring expired subsidies, are projected to secure control of both chambers of Congress in the Nov. 3 midterm election. But any potential legislative relief faces a long road. The newly elected Congress will not take office until January 3, 2027, and any legislative package would face challenges and presidential approval. That makes it virtually impossible for policy changes to affect 2027 enrollment prices. For now, consumers must plan around higher premium rates.

When prices go up, people who have plans but are younger and healthier may be more inclined to drop coverage. But that means the remaining applicants are those who use their insurance to cover costs, which makes them a less attractive pool to insurance carriers. As of Oct. 29, 2026, 11 carriers had announced they were leaving at least one state in 2027 while seven had announced they were entering a new state, according to KFF. 

Fewer companies means less competition, giving consumers fewer choices and companies leverage to raise prices, reduce benefits or both.

Additionally, health care, like pretty much everything else, has gotten more expensive this year. So employer-based plans are increasing in price, too, but employers typically pick up 70% or more of the cost of health insurance for their employees. If you’re buying a plan in the marketplace on your own, there’s no employer to absorb any of the additional cost.

Who Can Enroll in a Health Care Marketplace Plan?

Marketplace health insurance is generally available to U.S. citizens and most lawfully present residents currently living in the state where they’re applying. 

Coverage is primarily for those who do not have access to affordable health insurance through an employer. That can include:

• Freelancers, independent contractors and gig workers
• Self-employed business owners 
• Part-time employees whose jobs don’t offer benefits
• Early retirees who don’t yet qualify for Medicare
• College students and recent graduates aging off a parent’s plan
• Unemployed individuals

Marketplace plans are not intended for people already covered by government programs like Medicare, Medicaid, Tricare or CHIP (Children’s Health Insurance Program). 

Under the ACA, no plan can deny you coverage, cancel your policy, or charge you higher premiums because of pre-existing health conditions.

Employer Coverage: Can You Switch to the Marketplace?

While you can technically sign up for a marketplace plan if your employer offers insurance, sticking with your job-based plan is usually more affordable.

Under ACA rules, you can only qualify for premium tax credit subsidies on the marketplace if your employer-sponsored plan is deemed unaffordable or does not meet minimum value standards.

For 2027, an employer’s health plan is considered unaffordable if your required monthly share of the premium exceeds 10.22% of your household income. If your employer’s coverage meets that affordability test, you can still buy a plan on the exchange, but you will have to pay full price without subsidies.

Important Deadlines for 2027 Coverage

To avoid gaps in health care, be aware of key deadlines:

• Nov. 1: Open enrollment began.
• Dec. 15: Deadline if you want your new coverage to take effect on Jan. 1, 2027.
• Jan. 15: The final deadline to enroll. If you enroll between Dec. 16 and Jan. 15, your coverage begins Feb. 1, 2027.

Note that some states have extended deadlines, including California, New Jersey, New York and Rhode Island. Check your state exchange’s site for their deadlines.

Special Enrollment Periods if You Miss the Deadline

If you miss open enrollment, you cannot buy an ACA plan mid-year unless you experience a Qualifying Life Event, which triggers a 60-day Special Enrollment Period.

Common qualifying life events include:

• Loss of existing health coverage: Losing job-based benefits, aging off a parent’s plan at age 26 or losing Medicaid eligibility.
• Changes in household size: Getting married, having a baby, adopting a child or getting a divorce.
• Relocation: Moving outside your current plan’s service area.
• Income or status changes: Gaining lawful citizenship/residency status or losing income so that you qualify for premium tax credits.

What Kind of Health Insurance Plans Are Available?

Plans fall into four “metal” tiers that represent how you and the insurer split average health care costs:

Metal Tier	Monthly Premium	Out-of-Pocket Costs	Best For
Bronze	Lowest	Highest (High deductibles)	Healthy individuals who want worst-case disaster protection. Many Bronze plans can be paired with a Health Savings Account.
Silver	Moderate	Moderate	The most popular choice. The only tier eligible for Cost-Sharing Reductions.
Gold	Higher	Low	People who have regular doctor visits, ongoing treatments, or expensive maintenance prescriptions.
Platinum	Highest	Lowest	Those who anticipate extensive medical procedures or frequent specialist visits and want minimal out-of-pocket bills.

Within these tiers, pay attention to the provider network type:

• Health Maintenance Organization (HMO): Requires you to stay strictly within network facilities and obtain referrals from a primary care doctor to see specialists.
• Preferred Provider Organization (PPO): Allows you to see in-network or out-of-network doctors without referrals, but out-of-network care costs more.
• Exclusive Provider Organization (EPO): Covers care only with in-network doctors except in emergencies, but typically doesn’t require specialist referrals and doesn’t require you to choose a primary care provider.
• Point of Service (POS): A hybrid that requires referrals from your primary physician but allows you to see out-of-network providers for an extra cost.

What Do the Plans Cover?

Plans vary in coverage, so it’s important to review all your options before making any decisions. But all Marketplace plans must offer these 10 essential health benefits, according to federal Marketplace’s website:

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

While the services may be covered, the associated cost can differ substantially. Before you start reviewing plans, it’s a good idea to make a list of what you get with your current coverage and what medical needs you have, including the doctors you see and prescriptions you take, so you can compare coverage and prices.

How Much Do Marketplace Plans Cost? 

You’ll pay different monthly premiums and out-of-pocket deductibles depending on the plan level you select. Your exact cost will vary depending on your ZIP code, age, household size and income. 

In general, you’ll need to fall between 100% and 400% of the federal poverty level to qualify for standard ACA premium tax credits. For 2026, 100% of the FPL for one person is $15,960, and 400% is $63,840. (The 2026 FPL guidelines are used to calculate 2027 plan subsidies.)

If your income is below 100% FPL, you’ll typically be routed to your state’s Medicaid program. If you live in a state that hasn’t expanded Medicaid, you may fall into the “coverage gap” — meaning you don’t qualify for Medicaid or ACA subsidies. In this case, you may qualify for an exemption to purchase catastrophic coverage.

If your income exceeds 400% FPL, standard unsubsidized pricing applies to your household, which means you are no longer eligible for federal ACA premium tax credits. The Donald Trump administration announced it was sending a $500 check to roughly 1 million unsubsidized enrollees who purchased health insurance through the federal marketplace (not a state-based exchange) in 2026 and didn’t receive any premium tax credits. If you’re among them, you should’ve already received your check from the Treasury Department.

How to Sign Up for ACA Health Insurance

Start by going to HealthCare.gov. When you enter your information, you’ll automatically be routed to your state’s portal if they have their own marketplace. For 2027, 21 states plus the District of Columbia operate fully state-run health insurance marketplaces. 

From the home page, you can either enroll in coverage for the first time, view your existing plan or compare plans. If you already have a plan through the marketplace, you may be able to renew automatically, but keep in mind that plans can change coverage and prices from year to year, so it’s important to review your options each year. 

Information you’ll need:

• Legal names, birthdates and Social Security numbers for everyone in your household, even those not applying for coverage.
• Your home address, which determines the state where you live — if you live in a state that operates a state-run marketplace, you’ll be directed to their site.
• Your tax returns and projected 2027 household income for everyone in your household, including W-2s, 1099s, or self-employment earnings. If your income changes or you estimate incorrectly, you’ll need to update this information later.
• Policy numbers for any existing health coverage you or family members hold.
• Information on any job-based insurance available to your household (even if you decline it).

You can also enroll by phone through the Marketplace Call Center (1-800-318-2596), through a verified web broker, or with free in-person assistance from a certified ACA Navigator. You can find assistance in your area by entering your ZIP code on HealthCare.gov’s “find local help” tool.

Ways You Can Save on Your Health Insurance

While costs may have increased, there are still resources to help you save on health care. You should consider both your financial and health needs when considering any of these, but it’s worth investigating all your options.

Cost-Sharing Reductions

While premium tax credits lower what you pay each month for insurance, CSRs can help you pay less for your deductible and co-payments and reduce your out-of-pocket maximum. There are two caveats: You and your family must earn between 100% and 250% of FPL, and the reductions are only available if you enroll in a Silver-tier plan. For households eligible for CSRs, an upgraded Silver CSR plan typically offers lower deductibles and copays than the pricier Gold plans.

Switch to Bronze

If you don’t qualify for premium tax credits and you’re currently enrolled in a Silver-level plan, you may want to consider switching to a Bronze plan, which includes HSA-eligible High Deductible Health Plans among the options. While an HDHP means you’ll pay more out of pocket before insurance kicks in, the benefit is that you’re then eligible to open a Health Savings Account. Contributing to an HSA reduces your taxable income, and the funds can be withdrawn tax-free to pay for qualified medical expenses. 

Get a Job That Offers Health Insurance

This may not be an option for people who already have jobs that don’t offer health insurance, but this is typically a cheaper way to get health insurance than relying on the marketplace because employers typically cover 70% or more of the premium costs for employees as a benefit. We even have a list of companies that offer benefits to part-time employees.

Lower Your MAGI

If you have an HSA or traditional individual retirement account, your contributions to them directly reduce your modified adjusted gross income. If you’re near the cutoff to qualify for premium tax credits or CSRs, those contributions could bring your MAGI down enough to allow you to qualify. But if you bake the contributions into your projected annual income, make sure you’re prepared to actually set aside that much money in your HSA or IRA next year. 

Should You Switch to Catastrophic Insurance?

Catastrophic health plans offer low monthly premiums but very high deductibles — for 2027, it’s $12,000 for an individual and $24,000 for a family. Basically, this is insurance to cover a worst-case scenario like a serious car accident. The plans are only available to people under age 30, or those of any age who qualify for an approved hardship exemption such as the death of a close family member, a natural disaster or bankruptcy. You can also qualify for catastrophic insurance if you’re ineligible for Medicaid because your state didn’t expand eligibility for Medicaid under the Affordable Care Act. 

Preventive care is still included if you see an in-network provider. If you qualify for a subsidized Silver plan, it’s likely a better financial move, but if your only option is catastrophic or no insurance, a catastrophic plan can at least give you a little financial cushion in case of an emergency.

Tiffany Wendeln Connors is senior managing editor at The Penny Hoarder and a Certified Educator in Personal Finance.

1. Centers for Medicare & Medicaid Services: Exchange Coverage Remains Near Record High as 23.1 Million Enroll in 2026, Over 24 Million Consumers Selected Affordable Health Coverage in ACA Marketplace for 2025 2. Kaiser Family Foundation: 9 Things to Watch for the 2027 ACA Open Enrollment Period

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