Health Insurance News, Made Simple
What changed, in plain words, and what to do about it. Checked by our licensed agents and updated when big news comes out.
Figures marked "proposed" or "projected" are not final and can change. This page is general information, not tax or legal advice. Call (888) 708-9396 for guidance on your situation.
Key Dates for 2027 Coverage
Open Enrollment Period
The Open Enrollment Period (OEP) is the annual window during which you can sign up for, change, or cancel a health insurance plan through the Marketplace. For 2027 coverage, Open Enrollment on HealthCare.gov runs from November 1, 2026 through January 15, 2027. Enroll by December 15, 2026 for coverage that starts January 1; enroll between December 16 and January 15 and coverage starts February 1.
Some state-run exchanges use different dates. California, D.C., New Jersey and New York run through January 31; Massachusetts through January 23; Rhode Island through December 31; Idaho ends December 15. A federal rule that would have shortened the national window to December 15 was vacated by a federal court in June 2026, so the January 15 deadline stands for HealthCare.gov states.
If you miss Open Enrollment, you generally must wait until the next annual period unless you qualify for a Special Enrollment Period. Review your plan every year: premiums, networks, and benefits change, and for 2027 several carriers are leaving the Marketplace, so a plan you are auto-renewed into may not be the best fit or may not exist.
Tip: Do not rely on auto-renewal this year. With 2027 rate changes and carrier exits, compare options before December 15. A better plan at a lower cost may be available, and your tax credit amount changes annually based on income and benchmark plan pricing.
Special Enrollment Period (SEP)
A Special Enrollment Period allows you to enroll in or change your health coverage outside of Open Enrollment if you have had a qualifying life event. You generally have 60 days from the qualifying event to enroll, and the Marketplace may ask for proof (a termination letter, marriage certificate, lease, or similar) before your plan becomes active.
Common qualifying events include:
- Loss of job-based health coverage (not including a loss for non-payment or voluntarily dropping a plan)
- Getting married or divorced
- Having or adopting a child, or a foster care placement
- Moving to a new coverage area (prior coverage is usually required)
- Gaining citizenship or lawful presence
- Losing Medicaid or CHIP coverage
- Release from incarceration
Not sure whether you qualify? Contact a licensed broker and we will confirm your window and the documents the Marketplace will ask for.
Advance Premium Tax Credits (APTC)
If your household income is between 100% and 400% of the Federal Poverty Level (FPL), you may qualify for a Premium Tax Credit, also called an Advance Premium Tax Credit (APTC). The credit is paid directly to your insurer to lower your monthly premium, sometimes to $0, and is reconciled on your tax return using Form 8962.
What changed: the enhanced tax credits from the American Rescue Plan and Inflation Reduction Act expired on December 31, 2025. For 2026 and 2027 coverage, the original ACA rules apply: credits phase out between 100% and 400% of FPL and stop entirely above 400% of FPL, even by one dollar. A House bill to extend the enhanced credits passed in January 2026 but has not passed the Senate. If Congress acts after you enroll, any added savings flow to you through a mid-year adjustment or at tax time, so there is no reason to wait to enroll.
Income limits for 2027 coverage (based on the 2026 federal poverty guidelines, 48 contiguous states and D.C.):
| Household size | 100% FPL | 150% FPL | 250% FPL | 400% FPL (cap) |
|---|---|---|---|---|
| 1 person | $15,960 | $23,940 | $39,900 | $63,840 |
| 2 people | $21,640 | $32,460 | $54,100 | $86,560 |
| 3 people | $27,320 | $40,980 | $68,300 | $109,280 |
| 4 people | $33,000 | $49,500 | $82,500 | $132,000 |
Income means Modified Adjusted Gross Income (MAGI) for everyone on your tax return, estimated for the coverage year, not last year's taxes. Below 250% of FPL you may also qualify for Cost Sharing Reductions on a Silver plan, which lower your deductible and copays. Our advisors calculate your exact credit at no charge and help you report income changes during the year so you do not owe money back at tax time.
Understanding Metal Levels
Marketplace plans are categorized into four "metal" tiers (Bronze, Silver, Gold, and Platinum) based on how costs are split between you and the insurance company. These tiers have nothing to do with the quality of care.
- Platinum: You pay ~10% of costs. High monthly premiums, lowest out-of-pocket. Best for frequent health care users.
- Gold: You pay ~20% of costs. Good balance for moderate use.
- Silver: You pay ~30% of costs. Eligible for Cost Sharing Reductions (CSR) if income qualifies, often the best value for those with mid-range incomes.
- Bronze: You pay ~40% of costs. Lowest monthly premiums. Best if you are generally healthy and want protection against major events.
- Catastrophic: Very low premiums, very high deductibles. Available to people under 30 or with a qualifying hardship or affordability exemption.
For 2027 the maximum annual out-of-pocket limit on any Marketplace plan is $12,000 for an individual and $24,000 for a family (up from $10,600 and $21,200 in 2026). HSA-eligible plans allow 2027 contributions of up to $4,500 for self-only coverage and $9,000 for a family.
IRS Form 1095-A
If you enrolled in a Marketplace plan, you will receive Form 1095-A, your Health Insurance Marketplace Statement. It is sent by the Marketplace (not your insurance company) and is required for filing your federal tax return if you received any APTC.
Form 1095-A is typically available in your HealthCare.gov account and mailed by January 31 each year. You will use it to complete IRS Form 8962, which reconciles the credit you received with your actual income. If you skip Form 8962, the IRS can deny future advance credits, so file it even if you expect no change.
Missing or incorrect 1095-A? Submit a request and we will locate your form within 1 business day.
Medicare Information
Medicare is the federal health insurance program for people 65 or older, and for some younger people with disabilities or specific conditions. It consists of several parts:
- Part A: Hospital insurance (inpatient care, skilled nursing, hospice)
- Part B: Medical insurance (outpatient services, preventive care, doctor visits)
- Part C (Medicare Advantage): Private plans that bundle Parts A and B, often with extra benefits
- Part D: Prescription drug coverage
- Medicare Supplement (Medigap): Plans that help cover gaps in Original Medicare
What to know for 2027
- Annual Enrollment Period: October 15 to December 7, 2026 for changes effective January 1, 2027. Medicare Advantage members get a second window from January 1 to March 31, 2027.
- Part D out-of-pocket cap: $2,400 in 2027 (up from $2,100 in 2026). The maximum Part D deductible rises to $700.
- Part B premium: projected at about $209.50 per month for 2027 (final figure is announced by CMS in the fall).
- Stand-alone Part D premiums: a federal premium stabilization program that held premiums down ends after 2026, so review your drug plan rather than letting it renew.
Our licensed advisors can help you compare Medicare Advantage and Supplement plans available in your area. We represent multiple carriers and provide unbiased guidance at no cost. You can also contact Medicare.gov or call 1-800-MEDICARE for information on all Medicare options.
Checklists
Before you enroll
- Legal names, dates of birth and Social Security numbers for everyone on your tax return
- Home address and the ZIP code you will live in during the coverage year
- Best estimate of 2027 household income (MAGI), with pay stubs or last year's return handy
- Immigration documents for any non-citizen applicant
- Employer coverage details if anyone is offered a job-based plan (Appendix A)
- Your doctors, hospitals and prescriptions so we can check networks and formularies
After you enroll
- Pay the first premium so coverage activates (the carrier will not activate it without payment)
- Create your carrier account and download digital ID cards
- Upload any documents the Marketplace requests within the deadline on your notice
- Report income or household changes within 30 days to keep your credit accurate
- Keep Form 1095-A for your taxes and file Form 8962
- Save (888) 708-9396 for claims questions and annual reviews
Proof for a Special Enrollment Period
- Loss of coverage: termination letter, COBRA notice or Medicaid denial dated within 60 days
- Marriage: certificate plus proof one spouse had coverage in the prior 60 days
- Move: lease, deed or utility bill at the new address, plus proof of prior coverage
- Birth or adoption: birth certificate, hospital record or placement letter
- Send documents within 30 days of picking a plan so your start date is protected
Helpful Tools & Links
Glossary
- Premium
- The amount you pay every month to keep your plan, whether or not you use it.
- Deductible
- What you pay for covered services before the plan starts sharing costs. Preventive care is free before the deductible.
- Copay
- A fixed dollar amount you pay for a visit or prescription, for example $30 for a primary care visit.
- Coinsurance
- Your percentage share of a bill after the deductible, for example 20% of a hospital stay.
- Out-of-pocket maximum
- The most you pay in a year for covered in-network care. After you reach it the plan pays 100%.
- APTC
- Advance Premium Tax Credit. A federal subsidy paid to your insurer each month to lower your premium.
- CSR
- Cost Sharing Reductions. Extra savings on deductibles and copays for incomes up to 250% of FPL, only on Silver plans.
- MAGI
- Modified Adjusted Gross Income. The income figure the Marketplace uses to decide your credit.
- Benchmark plan
- The second-lowest-cost Silver plan in your area. Your tax credit is calculated from its price.
- Network
- The doctors, hospitals and pharmacies that contract with your plan. Out-of-network care costs more or is not covered.
- HMO / PPO / EPO
- HMO: in-network only, referrals required. PPO: any provider, higher cost. EPO: in-network only, no referrals.
- Formulary
- The list of prescription drugs a plan covers, grouped into tiers with different copays.
- Prior authorization
- Approval the plan requires before it will pay for certain services or drugs.
- EOB
- Explanation of Benefits. The statement showing what was billed, what the plan paid and what you owe. It is not a bill.
- SEP
- Special Enrollment Period. A 60-day window to enroll after a qualifying life event.
- Form 1095-A / 8962
- 1095-A reports your Marketplace coverage and credits; 8962 reconciles them on your tax return.
Frequently Asked Questions
Is your service really free?
Yes. Our advisory and enrollment services are completely free to you. We are licensed insurance brokers compensated directly by insurance carriers when you enroll in a plan through us. You never pay a fee, surcharge, or markup of any kind.
Do you work with all insurance carriers?
We have access to plans from all major insurance carriers available in your area through both the federal Marketplace and private (off-exchange) markets. Our advisors are not incentivized to recommend any single carrier.
Can I keep my current doctor?
This depends on the plan's network. During your consultation, we verify that your preferred doctors and specialists participate in the plans we recommend before enrollment. This is a standard part of our advisory process.
My carrier is leaving the Marketplace for 2027. What happens?
Your current plan ends December 31, 2026. The Marketplace may auto-assign you to a similar plan from another carrier, but that plan may not include your doctors or drugs. Compare options yourself (or with us) before December 15 so you choose the replacement rather than being assigned one.
What if I need to change my plan after enrolling?
You may change plans during Open Enrollment each year. Changes outside Open Enrollment require a qualifying life event. Your dedicated broker will guide you through any mid-year changes and is available year-round for assistance.
What is the difference between an HMO and a PPO?
HMO (Health Maintenance Organization) plans generally require you to use in-network providers and get referrals to see specialists. They typically have lower premiums. PPO (Preferred Provider Organization) plans offer more flexibility, since you can see any provider without a referral, but usually cost more. Our advisors help you weigh these tradeoffs based on your specific health needs.