ACA Open Enrollment Starts Nov. 1 With Benchmark Premiums Up 13 Percent. Expect Your Patients' Coverage to Shift in January.
HealthCare.gov opens Nov. 1 after a 26 percent benchmark jump this year. Insurer exits and lost subsidies mean more patients will switch or drop plans.
Idea in Brief
The News
Open enrollment for 2027 Affordable Care Act Marketplace coverage runs Nov. 1, 2026, to Jan. 15, 2027, on HealthCare.gov, and benchmark silver premiums are up an average 13 percent, KFF reports.
What Changes
Insurers are exiting states, Cigna is leaving the individual market in all 11 of its states, some lawfully present immigrants lose tax credits, and every HealthCare.gov buyer can now pick an HSA-eligible plan, CMS says.
Why It Matters
Patients who stay insured may move into plans with new networks or high deductibles, and some will drop coverage. Front desks should expect more eligibility surprises in January.
Open enrollment for 2027 Affordable Care Act coverage begins Nov. 1 and runs through Jan. 15, 2027, on HealthCare.gov, and the average benchmark silver premium is rising 13 percent after a 26 percent jump this year.
The Centers for Medicare and Medicaid Services (CMS), which runs HealthCare.gov, published its Plan Year 2027 plans and prices fact sheet on Oct. 30. The benchmark figures come from KFF's open enrollment preview, which tallied finalized rates across states. For practices, the practical question is not what a silver plan costs but how many patients will arrive in January with a different card, a different network or none at all.
What did CMS announce?
CMS emphasized affordability for subsidized buyers and plan choice. Its fact sheet says more than 75 percent of people who buy through HealthCare.gov can find a plan at or below $50 a month, and that for tax credit eligible enrollees the federal government pays nearly 90 percent of the lowest-cost premium, compared with 85 percent in 2020.
It also says every HealthCare.gov buyer now has access to plans eligible for a health savings account (HSA), a change it credits to the 2025 law it calls the Working Families Tax Cuts, with an average of 35 HSA-eligible plans per enrollee. On average, CMS says, enrollees can choose among 100 plans from five to six insurers.
What does the fact sheet leave out?
The year-over-year price change. The CMS fact sheet does not report benchmark premium growth. KFF does: finalized benchmark silver premiums for 2027 rose an average 13 percent, 11 percent in HealthCare.gov states and 16 percent in states with their own exchanges. Insurers had proposed a median 15 percent.
By The Script Pad's arithmetic, a 26 percent increase followed by a 13 percent increase compounds to about 42 percent over two years (1.26 times 1.13 equals 1.42), which matches KFF's own estimate. A benchmark plan that cost $500 a month in 2025 would cost about $712 in 2027. Subsidized enrollees are shielded from much of that, but the enhanced premium tax credits expired after 2025, so the shield is thinner than it was, and unsubsidized buyers pay the full increase.
The fact sheet and the rate filings describe the same market from opposite ends. Practices will meet the result at the front desk: fewer patients on Marketplace plans, and more of those who remain in high-deductible coverage.
Clinical Pearls
- Finalized benchmark silver premiums for 2027 rose an average 13 percent, after a 26 percent increase from 2025 to 2026, according to KFF.
- Benchmark premiums rose 11 percent in HealthCare.gov states and 16 percent in states that run their own platforms, KFF found.
- As of Oct. 29, 11 insurers had announced plans to exit at least one state for 2027, and Cigna is leaving the individual market in all 11 states where it sells.
- CMS says enrollees have an average of 100 plans from five to six insurers, and an average of 35 HSA-eligible plans.
- The Congressional Budget Office projects Marketplace enrollment falling from 22.4 million in 2025 to 13.1 million in 2027, as cited by KFF.
- Starting in 2027, people denied or removed from Medicaid solely for not meeting work requirements also lose eligibility for premium tax credits, KFF notes.
Who is likely to lose or change coverage?
Several groups at once. KFF reports that effectuated Marketplace enrollment was down 12 percent, or 2.6 million people, by February 2026, and that individual market enrollment fell 18 percent by June, from 25.2 million to 20.5 million. The Congressional Budget Office projects Marketplace enrollment falling from a peak of 22.4 million in 2025 to 13.1 million in 2027. By our arithmetic that is a decline of 9.3 million people, or about 42 percent, in two years.
Insurer exits will force switching even among patients who keep coverage. As of Oct. 29, 11 carriers had announced plans to leave at least one state for 2027, and Cigna is leaving the individual market in all 11 states where it participates, according to KFF. Seven carriers are entering new states, which means new networks to verify.
Eligibility rules are also narrower. Under the 2025 budget law, only lawful permanent residents, Cuban and Haitian entrants and certain Compact of Free Association residents keep premium tax credit eligibility among lawfully present immigrants, KFF explains. Starting in 2027, people denied or removed from Medicaid solely for not meeting work requirements lose eligibility for premium tax credits in those states. That links this enrollment season to the Medicaid work rule a federal judge partly blocked this week.
What else changes for 2027?
Caps on repaying excess advance premium tax credits are eliminated beginning with the 2026 tax year, and because the first filings under that rule happen in early 2027, enrollees will pick 2027 plans before seeing how uncapped repayment works, KFF notes. A rule that would have shortened open enrollment to nine weeks was vacated, and expanded catastrophic plan eligibility was paused by a June court decision, leaving narrower groups such as people under 30. Our earlier coverage explains CMS's proposal for pre-enrollment verification starting with 2028 subsidies and the IRS premium tax credit rules for 2027.
Some states are filling part of the gap. New Mexico fully replaced lost federal assistance in 2026, California is extending its partial backfill to households at 165 to 200 percent of the federal poverty level, and Rhode Island and Virginia are creating new state subsidies for 2027, according to KFF.
What should practices do now?
Plan for January. Re-verify eligibility and network status at the first 2027 visit for every patient with individual market coverage, and flag patients whose carrier is leaving your state. Expect more patients in HSA-eligible and other high-deductible plans, which means more point-of-service balances early in the year, and make sure cost estimates and payment plans are ready. Patients who ask where to get help can be pointed to HealthCare.gov or their state exchange before Jan. 15, and practices that see many Medicaid expansion patients should watch for those who lose Medicaid and assume they can fall back on subsidized Marketplace coverage. In some states, they cannot.
Reported, fact-checked and edited by The Script Pad's editorial staff. See How we use AI.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
