Open enrollment for 2027 Affordable Care Act health insurance begins Nov. 1 in most states, with consumers facing rising premiums, additional enrollment checks and changes to financial assistance. Idaho, Connecticut and Massachusetts opened enrollment earlier. Overall participation is expected to decline further following the expiration of enhanced subsidies at the end of 2025, which policy experts say led millions to drop or lose coverage during the first months of 2026.
The Trump administration attributes falling enrollment to its campaign against fraud, including the cancellation in August of policies covering 760,000 people suspected of being improperly enrolled. A small number have since regained coverage. New safeguards from the Centers for Medicare & Medicaid Services apply to people enrolling with agents or brokers through the federal marketplace, which serves 29 states. State exchanges operate under separate rules.
Federal marketplace customers using an agent must receive a confirmation code or link by text, email or automated phone call to authorize that agent to act for them. Those classified as high-risk must also verify their identity. That category includes first-time applicants, existing customers whose applications involve moving between states, people using a new or different agent and those whose monthly premiums are $30 or less.
Identity checks will run through a CMS-approved third party, such as Experian. People unable to pass may need to contact its help desk or apply themselves through healthcare.gov and upload identification. Stacey Pogue, a senior research fellow at Georgetown University's Center on Health Insurance Reforms, said legitimate applicants could encounter difficulties because they lack a credit file, have moved or have changed their names.
Access to brokers could also tighten. A September CMS rule prevents agents who were not registered with the federal marketplace in 2026 from assisting with 2027 enrollments until at least February, after open enrollment ends. CMS cited disproportionate compliance concerns involving newly registered agents. Two industry groups filed lawsuits in October challenging the restriction. Florida brokerage owner Jason Fine said it would complicate seasonal hiring for small agencies, while Pogue urged consumers who need assistance to arrange appointments early.
Affordability remains a concern after the loss of enhanced subsidies increased consumers' payments in 2026 and eliminated assistance for higher earners. Premiums are slated to rise 15% for the upcoming year, following an average increase of 26% last year. Most marketplace customers will still qualify for subsidies. Because assistance is tied to the cost of an area's second-lowest-price silver plan, it can offset premium increases. HealthInsurance.org analyst Louise Norris said overall affordability should remain similar for most people.
Income limits nevertheless leave some households without assistance. Subsidies end above four times the federal poverty level, which during this enrollment season means $63,840 for one person, $86,560 for a couple and $109,280 for a family of three. Agents and policy experts recommend comparing coverage, premiums and deductibles before renewing. Insurer participation is changing, with Cigna among companies withdrawing from all or some of their ACA coverage areas.
The annual ceiling on out-of-pocket expenses will increase 13% in 2027, reaching $12,000 for individual coverage and $24,000 for families. Lower limits apply to households earning up to 2.5 times the federal poverty level. Separately, the One Big Beautiful Bill Act, passed last year, removes subsidy eligibility for many lawfully present immigrants, including H-1B visa holders, refugees, asylees, people with temporary protected status and applicants awaiting green cards. Eligibility remains for permanent residents, certain Cuban and Haitian immigrants, and citizens of Micronesia, the Marshall Islands or Palau.
