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What to Know About ACA Open Enrollment for 2027

You can choose or switch your health plan starting Nov. 1, and it’s important to prepare for a few key changes

7-minute read

Rachel Nania,

AARP

Published October 26, 2026

Illustration of a heart with a heartbeat line between a green checkmark and a blue medical shield on an orange background.

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The open enrollment period for health insurance through the Affordable Care Act (ACA) marketplace begins on Nov. 1 in most states, and experts say there are a few key changes enrollees should know about before they sign up or change their coverage for 2027.

Here’s what you can expect.

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Premium hikes

Many enrollees can expect an increase in their monthly premiums for 2027 health plans.

The health policy nonprofit KFF reports that insurers are proposing a median premium increase of 15 percent for next year, which, according to Matt McGough, an ACA policy analyst at KFF, “represents the second straight year of double-digit premium increases.”

One reason for the hike, experts say, is rising health care costs, including higher provider fees and soaring prescription drug prices. But lower enrollment also plays a role, notes Stacey Pogue, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms.

Last year’s premium increase coincided with the expiration of enhanced premium tax credits, which left coverage unaffordable for many who had relied on the assistance in previous years. ACA marketplace enrollment fell by about 3 million from 2025 to 2026, according to federal data. “And we’re continuing to see that decline happen throughout the remainder of 2026,” McGough says. People who drop their health coverage tend to be younger and healthier, Pogue says, leaving a pool of sicker people. “And that raises the premiums,” Pogue adds.

When is open enrollment?

Nov. 1: Open enrollment begins in most states
Dec. 15: Last day to enroll for coverage that begins on Jan. 1
Jan. 15: Last day to enroll for coverage for the year; coverage starts Feb. 1

Dates may vary in some states that run their own exchanges.

Older adults are hit hardest

The rise in premiums has been especially hard for older adults who are not yet eligible for Medicare, McGough says. For starters, premium costs tend to rise with age, since older adults are more likely to have health conditions that require care. This population is also less likely to qualify for remaining federal subsidies that offset their monthly premiums because they tend to earn higher incomes than their younger peers.

About one-third of all marketplace enrollees are between the ages of 50 and 64, according to 2023 data, and without subsidies, their premiums are up to three times higher than those of younger adults, KFF reports.

“This is really serious for [older adults],” McGough says. “Some of them may have to consider going back to work and pick up a part-time job just to be able to meet their own affordability needs.”

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Shopping for a new plan

If you find you can no longer afford your current health plan, you can shop around for one with a lower premium — such as a bronze plan, a category of ACA health plans that usually has the lowest monthly premiums — during the open enrollment period.

Just know that “there’s an inverse relationship between premiums and cost sharing,” McGough says. Meaning if you select a plan with a lower monthly premium, you will likely have a higher deductible, or the amount of money you have to pay out-of-pocket for your health care, before your insurance kicks in. The average deductible for a bronze plan in 2026 was about $7,500, according to KFF research.

It’s important to keep in mind, McGough says, that “you have to be able to pay the full amount of your deductible if a medical emergency does occur.”

When comparing plans, also check whether the plan covers the doctors you see, the hospital where you prefer to get care and the prescription drugs you take, Pogue says.

“There are a lot of things people have to weigh when they’re switching plans, and in some cases, you might have to figure out which one of those things is your priority because you might not have an option that’s got all the doctors you care about and your drugs covered in the formulary,” Pogue says. “So there are sometimes some trade-offs people have to make in that process.”

A few additional points worth mentioning:

Brokers may be busy: If you get your insurance through a broker — “and lots of folks do,” Pogue says — you’ll want to reach out to them sooner than later. The federal government put a moratorium on new agents that assist people in finding coverage during this ACA open enrollment season. Existing agents can still help enrollees, but without new agents filling positions for people who have retired or left for other reasons, it’s possible it may be harder to schedule time with a broker this year.
Beware of scams: Any time prices go up, “there are always scammers on the outside trying to take advantage of the chaos or the confusion of the price increases,” Pogue says. Be wary of anything that seems too good to be true. There are insurance plans sold outside the marketplace, but these are not ACA-compliant, meaning they may not cover preexisting conditions or include other consumer protections, Pogue says.
Estimate your income carefully: Subsidies are based on your expected income for 2027, not what you made in 2026, and it’s important to have this estimate as accurate as possible, McGough says. Otherwise, you could have to pay money back when you file your federal tax return.

More restrictions for immigrants

Many immigrants who previously qualified for savings on their ACA plans will no longer be eligible in 2027.

For coverage in 2027, immigrants who qualify for marketplace subsidies include:

Lawful permanent residents
Cuban-Haitian entrants
Compact of Free Association (COFA) migrants

Some insurers are exiting the marketplace

While six insurers are joining the ACA marketplace in 2027, 11 have said they will leave and not offer plans next year, KFF reports. In some states, multiple insurers have announced plans to leave.

“Obviously, this varies widely by state in the U.S., but the result is that consumers are going to have fewer choices,” McGough says. “Maybe a plan that they’ve been enrolled in for a few years is now no longer available in their area, and they are going to have to put in the time to do their research and try to find the best next available option.”

Experts say this trend could continue now that the enhanced premium tax credits have expired. “During the enhanced premium tax credit era, there was this influx of enrollment, and we saw a lot of insurers joining. And as they’ve expired, we’re seeing some insurers really rethink their position,” McGough says.

List grows for states running their own exchanges

Oregon is joining the list of states running their own exchanges in 2027. This means that if you live in Oregon, you can no longer sign up for ACA insurance on healthcare.gov; you must use the state’s website.

Below, you’ll find the states that operate their own exchanges, with links to their websites.

AARP Calls for Consumer Protections in Marketplace Plans

By Miriam Cross 

Adults ages 50 to 64 who rely on health insurance marketplaces to obtain and maintain health coverage generally have greater medical needs than younger populations and can be charged up to three times more than younger enrollees because of their age. With premiums rising higher every year, maintaining affordability for these plans is essential.

That’s why AARP is asking for enhanced premium tax credits for Affordable Care Act (ACA) marketplace plans, which expired at the end of 2025, to be permanently restored, “so that small-business owners, self-employed older adults and early retirees can keep the coverage they count on,” wrote Bill Sweeney, senior vice-president for government affairs at AARP, in October in response to a request for information from the U.S. Senate Committee on Finance. The enhanced premium tax credits were introduced in 2021 and expanded upon federal tax credits already available to low-income enrollees, reducing the cost of marketplace plans across the board.

Sweeney flagged other ways to protect older consumers who are not yet eligible for Medicare from the high cost of marketplace insurance.

AARP also encourages the use of “standardized” plans. These types of plans align cost-sharing rules for benefits, regardless of which insurers offer them, making it easier for consumers to compare.

AARP opposes any movement to let catastrophic or short-term “junk” plans with weak consumer protections be sold in health insurance marketplaces alongside ACA-compliant plans. These plans typically dangle low premiums but are not required to cover the 10 essential health benefits that marketplace plans must include, such as no-cost preventative health screenings and emergency care. They may not provide coverage at all until consumers have hit an extremely high deductible. AARP pushed back on a proposal to make these bare-bones plans more widely available on health insurance marketplaces in a March letter to the Center for Medicare & Medicaid Services as well.

“Restoring enhanced tax credits while building on consumer protections must be the foundation of any effort to make coverage more affordable and more accessible,” wrote Sweeney in October.

Rachel Nania is an award-winning health editor and writer at AARP.org, who covers a range of topics including diseases and treatments.

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