What’s Changing in Health Insurance for 2027

On this page

• Marketplace plans
• Medicaid
• Medicare
• Taxes and HSAs
• Frequently asked questions

Marketplace plans

• No subsidy above 400% of the poverty level: the enhanced premium tax credits expired at the end of 2025 and haven’t been renewed, so the pre-2021 income cap is back for 2027. See what a subsidy is in health insurance for how the credit works.
• Open enrollment runs November 1, 2026 to January 15, 2027 on HealthCare.gov, with a December 15 deadline for coverage starting January 1. Some state-run exchanges run longer; see when open enrollment starts.
• Out-of-pocket maximum rises to $12,000 for one person, $24,000 for a family, effective January 1, 2027, for every metal level including bronze. See what an out-of-pocket maximum is.
• The low-income monthly special enrollment period (100-150% of the poverty level) ends after plan year 2026. There’s no more year-round monthly sign-up window at that income level starting in 2027.
• Catastrophic plans are limited to people under 30, or anyone with a hardship or affordability exemption certificate, reverting to the older eligibility rule for 2027.
• Fewer lawfully present immigrants qualify for premium tax credits. Starting with 2027 coverage, only green card holders, certain Cuban and Haitian entrants and COFA migrants can get them.
• Cigna is exiting the Marketplace in all 11 states where it currently sells plans, on and off the exchange, affecting roughly 350,000 to 369,000 people. Several smaller insurers are leaving individual states too, and a handful are entering. If your insurer is one of them, see what to do if your insurance company leaves the Marketplace.
• Proposed 2027 premiums average around 15% higher nationally before subsidies, according to insurers’ rate filings.

Medicaid

• Work requirements start January 1, 2027 in states that expanded Medicaid: most non-pregnant adults 19-64 in the expansion group must show 80 hours a month of work, school or volunteering, or qualify for an exemption. A few states are starting earlier. See Medicaid work requirements for who’s exempt.
• Renewals for expansion adults move to every 6 months, for redeterminations scheduled on or after January 1, 2027.
• Retroactive coverage shrinks for applications filed on or after January 1, 2027: expansion adults get 1 month of retroactive coverage before their application date, and everyone else gets 2 months, down from 3.

Medicare

• Part D out-of-pocket cap rises to $2,400 (from $2,100 in 2026), effective January 1, 2027.
• The maximum Part D deductible rises to $700 (from $615), and the base beneficiary premium is set at $41.33.
• The Part D Premium Stabilization Demonstration ends after 2026. It had held down some stand-alone drug plan premiums; without it, some enrollees could see a bigger premium jump for 2027.
• Medicare Advantage’s out-of-pocket maximum rises to $9,850 in-network and $14,800 combined (from $9,250 and $13,900), effective January 1, 2027.
• 15 more drugs get government-negotiated prices starting January 1, 2027, including Ozempic, Rybelsus and Wegovy, Xtandi and Ibrance.
• The Part B premium is projected around $209.50 a month (up from $202.90), based on the 2026 Medicare Trustees Report. CMS hasn’t announced the official 2027 figure yet; that usually comes in November.

Taxes and HSAs

• HSA contribution limits rise to $4,500 for self-only coverage and $9,000 for family coverage for 2027, up from $4,400 and $8,750. The 55-and-older catch-up contribution stays at $1,000. See what an HSA is.
• The employer “affordable coverage” threshold rises to 10.22% of household income (from 9.96%), for plan years beginning in 2027.
• There’s no cap on repaying excess advance premium tax credit at tax time. That change started with 2026 coverage and continues for 2027. If your income comes in higher than you estimated, you may owe back the full difference. See do you have to pay back the premium tax credit.

See how these changes affect your 2027 premium: compare quotes by ZIP code.

Frequently asked questions

When does open enrollment for 2027 coverage start?

November 1, 2026, on HealthCare.gov, running through January 15, 2027. Enroll by December 15 for coverage that starts January 1. Some states run their own exchanges with later deadlines.

Are the bigger premium tax credits coming back for 2027?

Not as of late September 2026. They expired at the end of 2025, the House passed a 3-year extension in January 2026, and the Senate hasn’t voted on it.

Do Medicaid work requirements apply to me in 2027?

Only if you’re a non-pregnant adult age 19-64 covered through your state’s Medicaid expansion group and don’t qualify for an exemption, such as being a caregiver for a young child or having a medical condition that limits your ability to work.

Is my Medicare Part B premium going up in 2027?

Probably, based on early projections of about $209.50 a month, but CMS hasn’t set the official 2027 premium yet.

This article is general information, not insurance, tax or legal advice. Some 2027 figures, like the Part B premium, are projections until federal agencies finalize them. Last reviewed September 2026.