The short version: Compare 2027 plans on total yearly cost, not the premium alone. Check that your doctors and prescriptions are covered, and enroll by December 15 for coverage starting January 1.
Open Enrollment on HealthCare.gov started November 1. If you already have a Marketplace plan, it’s tempting to let it renew. This year, it’s worth a closer look.
Insurers asked for a median rate increase of about 15% for 2027, according to healthinsurance.org. The extra federal subsidies that lowered premiums from 2021 to 2025 have also ended. So the plan that worked last year may cost more, or a different plan may now fit you better.
In my office, I see families pick the plan with the lowest monthly premium, then get surprised by a big bill later. This guide walks through how to compare plans the way I do with clients: total cost, doctors, prescriptions and the savings you qualify for.
Key dates for 2027 coverage
You have until January 15 to enroll, but the date that matters most for most families is December 15.
| If you enroll by | Your coverage starts |
|---|---|
| December 15, 2026 | January 1, 2027 |
| January 15, 2027 (last day) | February 1, 2027 |
If you do nothing, HealthCare.gov may renew you into the same or a similar plan. Your premium and your savings can change, so look before that happens.
Start with the metal levels
The metal level tells you how costs are split between you and the plan, not the quality of care. On average, the plan pays this share of covered in-network costs:
| Level | Plan pays (average) | You pay (average) | Often fits |
|---|---|---|---|
| Bronze | 60% | 40% | Rarely see a doctor; want the lowest premium |
| Silver | 70% | 30% | Lower incomes who get extra savings (see below) |
| Gold | 80% | 20% | Regular care, ongoing prescriptions |
| Platinum | 90% | 10% | High expected costs (not offered everywhere) |
Those are averages across a typical year, not what each bill will look like. Two plans at the same level can still have very different deductibles and copays.
Catastrophic plans are another choice, but generally only for people under 30 or with a hardship exemption. A rule that would have opened them to more people was stayed by a court in July 2026.
Bronze and catastrophic plans also qualify for a health savings account. See our guide on HSAs and your health plan.
Add up the total yearly cost
The best way to compare is to add the premium for the whole year to what you’d likely pay for care. I look at two numbers for each plan:
- A quiet year: 12 months of premium, plus a few visits and your regular prescriptions.
- A bad year: 12 months of premium, plus the plan’s out-of-pocket maximum.
Here’s an example with made-up numbers, not real plans:
| Plan A | Plan B | |
|---|---|---|
| Monthly premium | $300 | $420 |
| Premium for the year | $3,600 | $5,040 |
| Out-of-pocket maximum | $9,000 | $4,000 |
| Bad year total | $12,600 | $9,040 |
Plan A costs less in a quiet year. Plan B costs less if something big happens, like a surgery, a hospital stay or a new baby. The right choice depends on what you expect next year and how much risk you’re comfortable with.
Know the four cost words
Every plan summary uses the same terms. Here’s what each one means for your wallet:
- Deductible: what you pay for covered care before the plan starts sharing costs. Many plans cover some visits before the deductible, so check.
- Copay: a set amount for a service, like $40 for a doctor visit.
- Coinsurance: your percentage of a bill after the deductible, like 20%.
- Out-of-pocket maximum: the most you pay for covered in-network care in a year. After that, the plan pays 100%.
For 2027, no Marketplace plan’s out-of-pocket maximum can be higher than $12,000 for one person or $24,000 for a family, per Milliman’s summary of the federal limits. Many plans set theirs lower.
Check your doctors and hospitals
A low price doesn’t help if your doctor isn’t in the plan’s network. Before you choose, look up each doctor, specialist and hospital you use in the plan’s provider directory.
The plan type tells you how strict the network is:
- HMO and EPO: you generally must use in-network providers, except in an emergency. HMOs often need a referral to see a specialist.
- PPO: you can usually see out-of-network providers, but you’ll pay more.
If a doctor matters to you, call the office and ask if they’ll be in network for the 2027 plan by name.
Check your prescriptions
Each plan has its own drug list, called a formulary. Search it for every medicine you take, and note the tier. A drug on a higher tier can cost much more each month, even on a plan with a lower premium.
See what savings you qualify for
Many people who buy a Marketplace plan get help paying for it. What you get depends on your expected 2027 income and household size.
- Premium tax credit: lowers your monthly premium. For 2027, households earning up to 400% of the federal poverty level may qualify, and are expected to pay between 2.15% and 10.22% of income for a benchmark silver plan, under IRS Rev. Proc. 2026-26 (summary). Above 400%, there’s no credit.
- Extra savings on silver plans: if your income is at or below 250% of the poverty level, a silver plan can come with a lower deductible and copays. These cost-sharing reductions are only available with silver.
- NC Medicaid: if your income is lower, you may qualify for NC Medicaid instead. Your HealthCare.gov application will tell you.
Estimate your income carefully. Starting with 2026 returns, there’s no cap on paying back extra credit you received, according to NATP. If your income ends up higher than you estimated, you may owe the full difference at tax time. Update your application during the year if your income or household changes. Tax rules depend on your situation, so ask before you make changes.
Your Open Enrollment checklist
- List your doctors, hospitals and prescriptions.
- Estimate your 2027 household income, including raises, side work and unemployment.
- Compare at least three plans, including one bronze or silver and one gold.
- For each plan, add up a quiet year and a bad year.
- Check the network and the drug list for every name on your list.
- Enroll by December 15 for coverage starting January 1.
- Pay your first premium on time. Your coverage doesn’t start until you do.
Ready to compare?
See 2027 plans and prices for your household, with me as your agent. It takes a few minutes, and the price is the same as on HealthCare.gov.
Frequently asked questions
Can I just keep my 2026 plan?
You can, if it’s still offered. But premiums, networks and drug lists change every year, and so can your savings. Compare it with two or three other plans before December 15.
Is the plan with the lowest premium the best deal?
Not always. A low premium often comes with a higher deductible and out-of-pocket maximum. Add up the premium for the year plus a bad-year total before you decide.
Why did my premium go up so much?
Two reasons for many families: insurers raised rates for 2027, and the extra federal subsidies from 2021 to 2025 ended. Households above 400% of the poverty level no longer get any premium tax credit.
What’s the difference between an HMO and a PPO?
An HMO generally covers only in-network care and may need referrals for specialists. A PPO lets you go out of network, at a higher cost. HMOs often have lower premiums.
Does it cost more to enroll through an agent?
No. Marketplace plan prices are the same whether you enroll on your own or with a licensed agent. An agent can help you compare plans and check doctors and drugs.
Need help with this?
I help families in Cary, Raleigh, Apex, Morrisville, Holly Springs and Fuquay-Varina understand their options in plain language, in English, Hindi or Nepali. There’s no pressure to buy anything.
About the author
Yogesh Parajuli, EA is an IRS Enrolled Agent, a licensed North Carolina life and health insurance agent (NC License #18677737) and a notary public. He leads Triangle Tax and Insurance in Cary, NC, and has been preparing taxes since 2016. He helps families and small businesses in English, Hindi and Nepali.
General information, not advice for your situation. Coverage, cost and eligibility depend on the plan and your situation. Triangle Tax & Insurance is a licensed insurance agency. We are not the Health Insurance Marketplace or HealthCare.gov.
Sources: healthinsurance.org: 2027 ACA open enrollment, what’s changing · Milliman: 2027 ACA out-of-pocket maximum limits · Taxpayers.net: 2027 ACA subsidy status and Rev. Proc. 2026-26 · NATP: premium tax credit repayment for 2026 · Health Reform: Beyond the Basics: metal levels and cost-sharing reductions · BenefitChamps: what changed for 2027 Open Enrollment