Open Enrollment Guide: How to Review Your Plan for 2027

Check the Dates Before Anything Else

The enrollment window for 2027 coverage is the one thing you cannot fix later, and published guidance currently disagrees about when it closes.

Open enrollment on HealthCare.gov begins 1 November 2026. That much is consistent. The end date is not: some sources give the traditional 15 January 2027, others give 15 December 2026, citing finalised CMS rule changes that shorten the window. State-run marketplaces set their own dates, and several have historically extended beyond the federal deadline.

What is consistent across all of them: enrol by 15 December 2026 for coverage starting 1 January 2027. Anything later starts in February at the earliest, if it is permitted at all.

So treat 15 December as your deadline regardless of what the closing date turns out to be, and confirm the current dates on HealthCare.gov or your state exchange before November. Getting this wrong costs a year of coverage.

Employer plans run on their own schedule set by the employer, usually in the autumn, and that deadline is unrelated to the Marketplace one.

The Repayment Trap Is the Big Change

If you buy on the Marketplace and your income varies, this is the most consequential thing on the page.

Advance premium tax credits are estimates, reconciled against actual income when you file. Historically, if you underestimated your income, the amount you had to repay was capped. Those caps have been eliminated. You now repay the full excess.

Combine that with the return of the 400% subsidy cliff and the exposure becomes severe: someone who projects income below the threshold, receives credits all year, and ends up above it repays the entire year's credit — potentially thousands or tens of thousands of dollars, arriving as a tax bill.

Three defences. Estimate conservatively rather than optimistically. Update your income on the exchange during the year whenever it changes, which adjusts the advance credit going forward. And if you are near the threshold, treat income planning as part of the enrolment decision — see choosing coverage when self-employed, which covers the levers.

What Costs Are Doing

PwC's Health Research Institute, surveying actuaries at 27 US health plans covering more than 103 million employer-sponsored and 8 million individual marketplace members, projects the group medical cost trend for 2027 at 9% — the highest since 2010.

Which means the plan you auto-renew into is unlikely to cost what it costs today, and the difference between plans is likely to be larger than last year. Inertia is more expensive in a rising market than a flat one.

The 2027 Numbers

An additional $1,000 catch-up contribution applies from age 55. FSA limits for 2027 had not been announced at the time of writing — the IRS typically releases them in the autumn, so check before setting your election.

Do the Arithmetic, Not the Premium

Compare plans on total annual cost across two scenarios rather than on the monthly figure.

A normal year: twelve months of premium plus your expected out-of-pocket spending, based on what you actually used last year.

A bad year: twelve months of premium plus the out-of-pocket maximum. This is your worst case, and it is the number the insurance exists to cap.

A plan with a low premium and a high maximum wins the first scenario and loses the second. Which matters more depends on whether you could absorb the bad year.

Pull last year's Explanation of Benefits statements to get your actual usage rather than guessing — see how to read them. And if you are on a family plan, check whether the deductible is embedded or aggregate, which our guide to deductibles and out-of-pocket maximums explains.

Four Things That Change Without Telling You

Auto-renewal carries your enrolment forward. It does not carry forward the plan you thought you had.

The formulary. Drug lists are revised annually. A medication on a preferred tier this year can move to a higher tier or off the list entirely, and the cost difference can exceed the premium difference between plans. Run every medication you take through the specific 2027 formulary. See reducing prescription costs.

The network. Providers join and leave. Verify each doctor you actually see on the carrier's own 2027 directory, and check the address — clinicians practise at multiple locations and only some may be contracted. See how to check network status.

Provider tiers. Tiered networks are increasingly common, and being in network is no longer a single status. A doctor in a lower tier may carry substantially higher coinsurance than one in the preferred tier, on the same plan.

The pharmacy benefit manager. If your employer changes the company administering the drug benefit, mail-order prescriptions do not transfer automatically. They stop, and you re-authorise them in January. For anyone on maintenance medication this is a predictable and preventable gap.

Coordinate With a Spouse

Where both partners have employer coverage available, putting the whole family on one plan is frequently not the cheapest structure.

Employer subsidies vary by tier, and some employers heavily subsidise employee-only coverage while contributing little toward dependants. Splitting — one partner with the children, the other on employee-only — can cost meaningfully less than a single family plan.

Run both employers' numbers side by side. This takes an hour and is one of the few genuinely large savings available during enrolment.

The FSA Decision

Health FSA funds are generally use-it-or-lose-it, subject to a limited carryover or grace period where the plan offers one.

Two rules. Fund it against known, dated expenses — orthodontics, planned procedures, regular prescriptions — rather than an optimistic estimate. And if you have money left late in the year, spend it on eligible items rather than forfeiting it; the eligible list is broader than most people assume.

Note the interaction: a general-purpose health FSA disqualifies you from contributing to an HSA. If you are choosing an HSA-qualified plan, a limited-purpose FSA is the compatible option.

Eligibility Changes for 2027

Two changes affect who can obtain subsidised Marketplace coverage.

From 2026, lawfully present immigrants who are ineligible for Medicaid because of their immigration status and have incomes below 100% of the federal poverty level are no longer eligible for subsidised Marketplace coverage.

From 2027, eligibility for premium tax credits is further restricted to defined categories of lawfully present immigrants. Refugees, people granted asylum, and survivors of trafficking are among those who will no longer qualify.

If this may affect your household, check your eligibility on the exchange during enrolment rather than assuming continuity from last year.

The Review, in Order

1. Confirm the enrolment dates for your marketplace or employer, and diarise 15 December.
2. Pull last year's EOBs to establish actual usage.
3. Estimate 2027 income carefully if buying on the Marketplace, remembering the repayment caps are gone.
4. Check your subsidy position against the 400% threshold.
5. Run every medication through the 2027 formulary.
6. Verify every provider on the 2027 directory, including tier.
7. Calculate total cost for a normal year and a bad year, for each plan.
8. Coordinate with your spouse's options if both are available.
9. Set HSA and FSA contributions, checking FSA limits when released.
10. Save the Summary of Benefits and Coverage as a PDF. You will need it for any billing dispute.

Two Situations

The auto-renewal that changed underneath

Someone lets their plan roll over, assuming continuity. In January they discover a maintenance medication has moved to a higher formulary tier, and that their specialist is now in a lower provider tier with higher coinsurance.

Neither change was hidden — both were in the plan documents issued before enrolment closed. Neither was noticed, because nothing prompted a review.

The cost difference across the year exceeded what a different plan would have cost in premium. The window to change had closed.

The income estimate that became a tax bill

A self-employed enrollee estimates income below the subsidy threshold and receives advance credits through the year. A strong final quarter pushes actual income above 400% of the poverty level.

Because the repayment caps no longer apply and the cliff is a vertical drop, the entire year's advance credit becomes repayable at filing.

Updating the income estimate on the exchange when the position changed would have reduced the advance credit going forward and limited the reconciliation.

Both are composite illustrations of common patterns, not accounts of specific individuals.

Frequently Asked Questions

When does open enrollment for 2027 close?

It opens 1 November 2026. The closing date is being reported inconsistently, with some sources citing 15 December 2026 and others 15 January 2027 following rule changes, and state exchanges set their own. Confirm on HealthCare.gov or your state marketplace, and enrol by 15 December for a 1 January start regardless.

Can I change plans after the deadline?

Only with a qualifying life event — marriage, birth, adoption, loss of other coverage, a permanent move. Deciding you chose badly is not one, and the expiry of a short-term plan is not either.

What happens if I underestimate my income?

You repay the excess advance credit in full when you file. The caps that used to limit repayment have been eliminated, and above 400% of poverty the entire credit becomes repayable.

Is a high-deductible plan the right choice?

It depends on your usage and reserves. It usually wins in a low-usage year and on tax treatment; a lower-deductible plan often wins where you have recurring specialist visits or brand-name prescriptions. Run both scenarios.

Are the HSA limits higher for 2027?

Yes — $4,500 for self-only and $9,000 for family coverage, plus $1,000 catch-up from age 55.

Should I take the employer's supplemental life insurance?

Compare it against an individual policy before electing. Employer coverage is typically not portable, so it ends when the job does — see employer versus individual coverage.

What if my employer changes the pharmacy benefit manager?

Mail-order prescriptions do not transfer. Re-authorise them in early January to avoid a gap.

Can I have both an FSA and an HSA?

Not a general-purpose health FSA alongside an HSA. A limited-purpose FSA, covering dental and vision, is compatible.

The Short Version

Confirm your dates first — the closing date for 2027 Marketplace enrolment is being reported inconsistently, and 15 December 2026 is the deadline that matters for coverage starting 1 January.

Then, if you buy on the Marketplace, take the income estimate seriously. Repayment caps on excess advance credits have been eliminated and the 400% cliff is back, so an optimistic estimate can turn into a full-year repayment at filing.

And do not auto-renew without checking three things: your medications against the 2027 formulary, your doctors against the 2027 directory including their tier, and the total cost of each plan in a bad year rather than a normal one. With medical cost trend projected at 9%, the plan you have is not the plan you had.

Sources and Editorial Note

Marketplace enrolment dates, subsidy eligibility rules, the elimination of advance premium tax credit repayment caps and immigrant eligibility changes for 2026 and 2027 are documented by KFF and reflect the 2025 budget reconciliation law. Reporting on the 2027 enrolment window closing date is currently inconsistent following finalised CMS rule changes; confirm current dates with HealthCare.gov or your state exchange. HSA and HDHP limits for 2027 were announced by the IRS in May 2026. The 2027 group medical cost trend projection is from PwC's Health Research Institute survey of actuaries at 27 US health plans.

FSA and dependent care limits for 2027 had not been published at the time of writing. This article is general information, not tax, legal or medical advice — plan terms, formularies, networks and employer schedules vary, and figures are adjusted annually. Confirm against your own plan documents and marketplace, and contact your state insurance department with complaints.