If you buy your own health insurance, open enrollment is the one stretch of the year when you can pick or change a plan without needing a special reason. Right now is that stretch for 2027 coverage, and the picture looks different from a few years ago. Subsidy rules have changed, premiums have risen, and some deadlines have shifted.
This guide explains how ACA health insurance works, what the plan tiers mean, how subsidies are calculated, and what to check before you enroll. Because rules and prices change, treat the dates and dollar figures here as a starting point and confirm them on HealthCare.gov or your state’s marketplace.
What Is ACA Health Insurance?
ACA health insurance refers to individual and family plans that comply with the Affordable Care Act, usually bought through the federal marketplace at HealthCare.gov or through a state-run exchange. Plans sold this way must meet consumer protections that don’t apply to every kind of coverage.
No denials for pre-existing conditions. Insurers can’t turn you away or charge more because of your health history.
Essential health benefits. Plans must cover a standard set of categories, including doctor visits, hospital care, emergency services, prescription drugs, maternity care, mental health services, and pediatric services.
Limited pricing factors. Premiums can vary based on age, location, family size, and tobacco use, but not on health status.
Annual out-of-pocket limits. Every compliant plan has a cap on what you pay for covered in-network care in a year. That cap changes annually, so check the current figure on HealthCare.gov.
No annual or lifetime dollar limits on essential benefits.
Short-term health plans and many other products sold outside the marketplace aren’t ACA-compliant and can exclude pre-existing conditions or skip required benefits. That’s an important difference when comparing prices.
The Four Metal Tiers
Marketplace plans come in four tiers named after metals. The tier describes how costs are split between you and the insurer, not the quality of care or the size of the network.
| Tier | Insurer Pays (Average) | You Pay (Average) | Typical Trade-Off |
|---|---|---|---|
| Bronze | About 60% | About 40% | Lower premium, higher deductible |
| Silver | About 70% | About 30% | Moderate premium; the tier that unlocks extra cost-sharing help for some |
| Gold | About 80% | About 20% | Higher premium, lower out-of-pocket costs |
| Platinum | About 90% | About 10% | Highest premium, lowest out-of-pocket costs; not offered everywhere |
These percentages describe average costs across all enrollees, not what you’ll pay for any one service. A bronze plan can still leave you with a large deductible before most coverage begins, while a gold plan front-loads cost into the premium.
There’s also a catastrophic plan option, generally for people under 30 or those with a hardship exemption, with low premiums and very high deductibles.
How Premium Tax Credits Work
Most people who buy through the marketplace qualify for premium tax credits, which lower the monthly premium. The credit is based on your expected household income compared with the federal poverty level and the cost of a benchmark plan, which is the second-lowest-cost silver plan in your area. You can take the credit in advance each month or claim it when you file your taxes.
This is the area where the rules have changed most.
The enhanced credits are gone. In 2026, the enhanced premium tax credits expired, and enrollment in the marketplaces declined as a result. Congress has not passed an extension for 2027, and insurers are pricing their plans on the assumption the credits stay expired. kffhealthcareinsider
The income cutoff is back. People with incomes above 400% of the federal poverty level no longer qualify for premium tax credits and must pay the full price of their plans. That abrupt cutoff is often called the subsidy cliff, because a small increase in income can mean losing the entire credit. foxsanantonio
The effect can be large, particularly for older adults. One analysis found a 60-year-old earning $65,000 pays on average about $10,389 more per year toward premiums now that the enhanced credits have ended. That’s an average for one example, and your own numbers will differ by state, plan, and income. kff
Some states are trying to help. Several states that run their own exchanges are using state-funded subsidies to offset the loss, and some are continuing or expanding that help for 2027. Ask your state marketplace what’s available where you live. kff
Because your credit depends on income you estimate in advance, it’s worth being careful with that estimate. If your actual income ends up different, you may owe some credit back or receive more when you file taxes, and recent changes to the rules affect how that works. Confirm the details with the IRS or a tax professional.
Cost-Sharing Reductions
If your income is within a certain range, generally between 100% and 250% of the poverty level, enrolling in a silver plan can qualify you for cost-sharing reductions. These lower your deductible, copays, and out-of-pocket maximum, effectively making a silver plan act like a richer plan. For some people, a silver plan with these reductions can be a better value than a gold or bronze plan even if the premium looks higher. Check this before you pick a tier.
Medicaid and the Coverage Gap
Income at the lower end may qualify you for Medicaid instead of marketplace coverage. In states that expanded Medicaid, adults generally qualify at incomes up to 138% of the federal poverty level. States that haven’t expanded Medicaid have different rules, and some low-income adults fall into a gap where they earn too much for Medicaid but too little for marketplace subsidies. The marketplace application screens for Medicaid eligibility, so you’ll be directed appropriately.
2027 Open Enrollment: What to Know
Dates. HealthCare.gov open enrollment runs from November 1, 2026, to January 15, 2027. Reporting on the exact deadlines has shifted over the past year, and some sources still reference December 15. The practical rule that holds either way is that coverage begins on the first of the month after you enroll, and enrolling by December 15 is generally how you secure coverage starting January 1. Because deadlines can be changed, confirm them on HealthCare.gov before you plan around the last day. curetodayjoingerald
State exchanges differ. States running their own exchanges set independent deadlines, which often extend beyond the federal timeline. If your state runs its own marketplace, use its official site for dates. blavity
Platform changes. Oregon residents will use the state-run Explore Health platform for 2027 coverage instead of HealthCare.gov. If you’re in a state that has recently changed platforms, watch for communications about how to re-enroll, because auto-renewal doesn’t always carry over smoothly. healthinsurance
Identity verification. People in states that use HealthCare.gov may need to complete extra steps to confirm their identity before enrolling for 2027. Start early so a verification step doesn’t push you past a deadline. healthinsurance
Premiums are rising again. Marketplace premiums are increasing for a second straight year, with insurers pointing to higher medical costs and the loss of the enhanced credits. That makes comparing plans, even if you’re staying with the same insurer, more important than usual. foxbaltimore
Outside open enrollment. After the window closes, you can generally enroll only if you qualify for a special enrollment period, typically within 60 days of a qualifying life event such as losing other coverage, getting married, having a baby, or moving to a new area.
How to Compare Marketplace Plans
Look past the premium. Total cost includes the premium, deductible, copays, coinsurance, and the out-of-pocket maximum. A low premium paired with a high deductible can cost more if you use care regularly.
Estimate your likely usage. Think about doctor visits, prescriptions, specialists, and any planned procedures, then compare what each plan would cost in a typical year and a bad year.
Check your doctors and hospitals. Confirm they’re in the plan’s network. Networks can change from year to year, and a plan type matters: HMOs generally require in-network care and referrals, PPOs offer more flexibility at a higher cost, and EPOs fall in between.
Check your prescriptions. Plans use formularies that sort drugs into cost tiers, and the same medication can cost very different amounts under different plans.
Compare across tiers, not just within one. Cost-sharing reductions on silver plans can change which tier is the better deal.
Consider your income carefully. If you’re close to the 400% threshold, small income changes can matter a great deal.
Look at HSA eligibility. Some high-deductible plans can be paired with a health savings account, which has tax advantages. Check whether the plan qualifies.
Review the plan’s customer service and ratings. Marketplace sites often show quality ratings.
A Note on Who Can Help
Certified navigators, assisters, and licensed brokers can help you compare plans and complete your application, often at no cost to you since brokers are generally paid by the insurer. HealthCare.gov offers a local help finder. Be cautious about unofficial websites and unsolicited calls, since some imitate the marketplace or sell non-compliant coverage. Make sure you end up on HealthCare.gov or your state’s official exchange.
State-Level Differences
Health insurance is regulated at both the federal and state level, and the experience of buying coverage varies by location. Plan availability, the number of insurers, premiums, state subsidy programs, Medicaid expansion status, enrollment deadlines, and even whether you use HealthCare.gov or a state exchange all depend on where you live. Not every county has the same choices, and some areas have seen insurers leave the market, so your options may differ from a neighbor’s across a state line.
Steps for Choosing a Plan
- Confirm which marketplace you use and the enrollment deadlines that apply.
- Estimate your household income for 2027 as carefully as you can, since it determines your subsidy.
- Check Medicaid eligibility if your income is on the lower side.
- Gather your information. You’ll need household details, Social Security numbers, income estimates, and any current plan information.
- Compare plans across tiers, including estimated yearly cost, not just the premium.
- Check networks and formularies for your doctors and medications.
- Look into cost-sharing reductions if your income qualifies.
- Complete any identity verification early.
- Select a plan and pay your first premium. Coverage generally doesn’t start until the first payment is made.
- Confirm your enrollment by logging into your account and checking that your coverage is listed as active.
- Update your information during the year if your income or household changes.
Common Mistakes to Avoid
- Letting a plan auto-renew without comparing. Premiums, networks, and your subsidy may have changed.
- Choosing the lowest premium without looking at the deductible.
- Underestimating or overestimating income, which affects subsidies and tax-time results.
- Missing the identity verification step.
- Assuming your doctor is in-network without checking.
- Forgetting to pay the first premium, which can cancel the enrollment.
- Confusing short-term plans with ACA-compliant plans.
- Waiting until the last day, when websites are busiest.
Final Thoughts
ACA health insurance still offers real protections, including coverage regardless of health history and a cap on yearly out-of-pocket costs, but the cost picture has shifted. With the enhanced subsidies gone and premiums rising, it pays to look closely at your income, compare plans across all tiers, check your doctors and prescriptions, and confirm deadlines on the official marketplace. If you’re close to the income cutoff or unsure what to choose, a certified navigator or licensed broker can help you work through the numbers.
8. FAQs
When is open enrollment for 2027 ACA coverage?
HealthCare.gov open enrollment runs from November 1, 2026, to January 15, 2027. State exchanges may set different deadlines, and enrolling by December 15 is the usual way to start coverage on January 1, so confirm dates on your marketplace’s official site. curetoday
Are the enhanced ACA subsidies still available?
No. The enhanced premium tax credits expired in 2026. Congress has not passed an extension for 2027. kffhealthcareinsider
What is the 400% poverty level cutoff?
People with incomes above 400% of the federal poverty level no longer qualify for premium tax credits and must pay the full cost of their plans. Check HealthCare.gov for current income thresholds. foxsanantonio
What’s the difference between bronze, silver, gold, and platinum plans?
They describe how costs are shared. Bronze plans typically have lower premiums and higher out-of-pocket costs, while gold and platinum plans cost more each month but cover a larger share of your care. The tier doesn’t indicate quality of care.
Can I be denied ACA coverage because of a pre-existing condition?
No. ACA-compliant plans can’t deny coverage or charge more based on your health history.
What if I miss open enrollment?
You can generally enroll only if you qualify for a special enrollment period, typically within 60 days of a qualifying life event such as losing other coverage, marriage, a birth, or a move.
Are short-term health plans the same as ACA plans?
No. Short-term plans aren’t ACA-compliant and can exclude pre-existing conditions or required benefits, so comparing their prices with marketplace plans isn’t like-for-like.
Can a broker or navigator help me enroll?
Yes. Certified navigators, assisters, and licensed brokers can help you compare plans and enroll, often at no cost to you. HealthCare.gov has a tool to find local help.