To choose a health plan during open enrollment, add up what each plan would cost you for a full year, not just the monthly premium. Total cost is the premiums plus what you would pay for care: deductible, copays, coinsurance, up to the out-of-pocket maximum. Check that your doctors and prescriptions are covered, then pick the plan with the lowest total cost for the amount of care you realistically expect. On HealthCare.gov, open enrollment for 2027 coverage runs from November 1, 2026 to January 15, 2027. Enroll by December 15 if you want coverage to start January 1.
Key takeaways
- Compare plans on total yearly cost: twelve months of premiums plus your expected out-of-pocket spending, capped at the plan’s out-of-pocket maximum.
- For 2027, no Marketplace plan can make you pay more than $12,000 (self-only) or $24,000 (family) in covered in-network costs (CMS, as of October 2026).
- The larger premium tax credits of 2021–2025 have ended. As of October 2026, the 2027 credit is limited to households at or below 400% of the poverty line, which is $63,840 for one person.
- In the example, the cheaper Bronze plan wins only in a low-use year. Once allowed charges pass $4,500, the Gold plan costs less in total.
Know the dates first
On HealthCare.gov, open enrollment for 2027 coverage starts November 1, 2026 and ends January 15, 2027. Enroll or switch by December 15, and pay your first premium, for coverage to start January 1. If you sign up between December 16 and January 15, coverage starts February 1 (HealthCare.gov; CMS, as of October 2026). After January 15, you can only enroll if a life event, such as losing other coverage, moving or having a baby, gives you a Special Enrollment Period.
A 2025 federal rule would have shortened this window starting with 2027 coverage. Court rulings in 2026 blocked several of that rule’s provisions, and CMS confirmed the November 1 to January 15 window. The litigation is still going on. States that run their own exchanges set their own deadlines, and several run later than January 15, so check your state’s exchange if you don’t use HealthCare.gov.
If you already have a Marketplace plan and do nothing, you may be automatically re-enrolled. Your premium, network and drug list can still change for the new year. Log in, update your income and household information, and compare plans before December 15.
The four numbers that decide what you pay
- Premium. What you pay every month whether or not you use care. You owe it all year.
- Deductible. What you pay for covered care before the plan starts sharing costs. Many plans cover preventive care and some office visits before the deductible, so read the plan summary.
- Copays and coinsurance. Your share after the deductible: a flat fee (copay) or a percentage (coinsurance), such as 20% of the allowed charge.
- Out-of-pocket maximum. The most you pay for covered in-network care in a year. After you hit it, the plan pays 100%. Premiums don’t count toward it. For 2027 the federal ceiling is $12,000 for self-only coverage and $24,000 for other coverage (CMS, as of October 2026). Many plans set lower limits.
The premium is certain. The rest depends on how much care you use. A good choice balances a cost you know you will pay against a cost you might pay.
How the metal tiers compare
Marketplace plans are grouped by how much of the average enrollee’s covered costs the plan pays. This share is called actuarial value. Metal tiers say nothing about the quality of care or the size of the network. Two Gold plans can have very different doctors and drug lists.
| Tier | Plan pays, on average | You pay, on average | Typical trade-off | Often suits |
|---|---|---|---|---|
| Bronze | 60% | 40% | Lowest premium, highest deductible | Healthy people who mainly want protection from a large bill; people who want an HSA-compatible plan |
| Silver | 70% | 30% | Moderate premium and deductible | Anyone eligible for cost-sharing reductions, which come only with Silver plans |
| Silver with extra savings | 73%–96% | The rest, depending on how much savings you qualify for | Silver premium with much lower deductibles and copays | Lower-income enrollees who qualify for cost-sharing reductions |
| Gold | 80% | 20% | Higher premium, low deductible | People with regular care, ongoing prescriptions or a planned procedure |
| Platinum | 90% | 10% | Highest premium, lowest cost when you use care | Heavy users who want predictable costs, where offered |
| Catastrophic | Not rated by tier | Most costs until the deductible | Very low premium, very high deductible | People under 30, or those with a hardship or affordability exemption |
Bronze and catastrophic plans have a new feature. Under the 2025 tax law, they count as HSA-compatible starting January 1, 2026, so you can pair one with a health savings account (IRS, as of October 2026). That can make a Bronze plan more attractive if you can afford to fund the account.
What the end of the enhanced subsidies means for 2027
From 2021 through 2025, a temporary law made premium tax credits larger and removed the income ceiling. Those enhancements expired at the end of 2025. Extensions have been debated in Congress, but as of October 2026 none has become law. The IRS’s 2027 tables follow the pre-2021 rules (IRS Rev. Proc. 2026-26).
- The 400% ceiling is back. The credit is available only if household income is at or below 400% of the federal poverty line. For 2027 coverage this uses the 2026 guidelines: $15,960 for one person and $33,000 for a family of four in the 48 contiguous states and DC (HHS). For one person, 400% is $63,840.
- Expected contributions are higher. In 2027, a household between 300% and 400% of the poverty line is expected to pay 10.22% of income for the benchmark Silver plan. The credit covers the rest (IRS).
Here is how the cliff works for a single adult. At $60,000 of income, which is 375.9% of the poverty line, you are expected to pay at most $6,132 a year, or $511 a month, for the benchmark Silver plan. Any premium above that is covered by the credit. At $65,000 (407.3%), you get no credit at all and pay the full price. If your income is near the line, estimate it carefully. Pre-tax retirement or HSA contributions lower the modified adjusted gross income used for the credit. If your actual income ends up higher than you estimated, you may have to repay some or all of the advance credit at tax time.
Worked example: Bronze vs. Gold under three levels of use
A single adult with no premium tax credit compares two illustrative plans. They are not real plans, so use the figures from your own plan summaries.
- Bronze: $450 a month ($5,400 a year), $7,500 deductible, 40% coinsurance, $10,000 out-of-pocket maximum.
- Gold: $650 a month ($7,800 a year), $1,500 deductible, 20% coinsurance, $7,000 out-of-pocket maximum.
For simplicity, all care goes through the deductible and coinsurance, and “charges” means the in-network allowed amount for the year.
| Scenario | Allowed charges | Bronze: care + premiums | Bronze total | Gold: care + premiums | Gold total | Lower-cost plan |
|---|---|---|---|---|---|---|
| Low use (checkups, a few visits) | $1,000 | $1,000 + $5,400 | $6,400 | $1,000 + $7,800 | $8,800 | Bronze, by $2,400 |
| Medium use (ongoing condition, imaging) | $8,000 | $7,700 + $5,400 | $13,100 | $2,800 + $7,800 | $10,600 | Gold, by $2,500 |
| High use (surgery or hospital stay) | $60,000 | $10,000 + $5,400 | $15,400 | $7,000 + $7,800 | $14,800 | Gold, by $600 |
The Gold plan costs $2,400 more a year in premiums. That gap is made up once your allowed charges reach $4,500, the break-even point in this example. Below that, Bronze is cheaper. Above it, Gold is cheaper. In a very bad year, both plans hit their caps, and Gold still comes out $600 ahead because its maximum is $3,000 lower.
The cheaper plan isn’t always the better choice for you. The question is which mistake you can afford. If you choose Bronze and have a bad year, you pay $15,400 instead of $14,800. If you choose Gold and stay healthy, you pay $2,400 more than you needed to. If a $10,000 bill would force you onto a credit card, the lower out-of-pocket maximum is worth a lot. Our guide on whether to use a loan for medical bills shows how expensive that path can get.
A checklist before you click “enroll”
- Doctors and hospitals. Search the plan’s provider directory for each doctor you want to keep, then confirm with the office. Networks change every year.
- Prescriptions. Look up each drug on the plan’s formulary. Note the tier and whether it needs prior authorization.
- Plan type. HMOs and EPOs generally don’t cover non-emergency out-of-network care. PPOs do, at a higher cost. Out-of-network costs often don’t count toward the in-network maximum.
- Silver if you qualify for extra savings. If your income qualifies you for cost-sharing reductions, they are available only on Silver plans. A Bronze plan with a lower premium can cost you more over the year.
- Budget for the deductible. Whatever plan you choose, set money aside for the deductible. A line for medical costs in a budget that works keeps a surprise bill from becoming debt.
When the lowest premium is a bad idea
- You already know you’ll need care. A pregnancy, a scheduled surgery or a chronic condition with regular specialist visits usually pushes you past the break-even point. A high-deductible plan then costs more in total.
- You have no savings for the deductible. A plan you can’t afford to use isn’t really protection. Unpaid medical bills can end up in collections.
- Your doctors or drugs aren’t covered. A cheap plan that excludes your specialist or puts your medication on a high tier can cost more than a higher-premium plan that includes them.
- You qualify for cost-sharing reductions. Skipping Silver means giving up lower deductibles and copays you are entitled to.
- You have an affordable job-based plan. If your employer offers coverage that counts as affordable, you generally can’t get a premium tax credit on the Marketplace. Compare against your employer’s plan before you switch.
Choosing a plan with a bigger premium has its own downside. If you are young, healthy and have a solid emergency fund, paying for Gold year after year can mean thousands spent on protection you rarely use. If job loss is a risk this year, plan ahead for coverage changes as part of preparing your finances for a layoff. Losing job-based coverage opens a Special Enrollment Period.
FAQ
When is the deadline to enroll for January 1 coverage?
On HealthCare.gov, enroll or change plans by December 15, 2026, and pay your first premium. Open enrollment continues to January 15, 2027, but coverage chosen after December 15 starts February 1. State-run exchanges may have different dates.
Can I still get a premium tax credit if I earn more than 400% of the poverty line?
Not for 2027 under current law as of October 2026. The enhanced credits that removed the income ceiling expired after 2025, and Congress has not enacted an extension. If your income is close to the cutoff, pre-tax retirement or HSA contributions can bring you under it.
Do premiums count toward the out-of-pocket maximum?
No. The maximum covers deductibles, copays and coinsurance for covered in-network care. Premiums, out-of-network bills and services the plan doesn’t cover are extra. That is why the worked example adds premiums on top.
Is a Bronze plan a good choice if I want an HSA?
It can be. Starting in 2026, Bronze and catastrophic plans count as HSA-compatible under the 2025 tax law. The tax savings on your contributions can offset part of the higher deductible. That only helps if you actually fund the account.
What happens if I do nothing during open enrollment?
If you have Marketplace coverage, you may be automatically re-enrolled in the same or a similar plan. Your premium and tax credit may change, especially with the enhanced credits gone. Update your application so your credit is based on current income.
Sources
- HealthCare.gov, Dates and deadlines for 2027 health insurance, accessed Oct 2026
- CMS/CCIIO, Statement regarding City of Columbus v. Kennedy (Aug 4, 2026), accessed Oct 2026
- HealthCare.gov, The “metal” categories: Bronze, Silver, Gold & Platinum, accessed Oct 2026
- CMS, Premium Adjustment Percentage, Maximum Annual Limitation on Cost Sharing and Required Contribution Percentage for 2027 (Jan 29, 2026), accessed Oct 2026
- IRS, Revenue Procedure 2026-26 (2027 applicable percentage table), accessed Oct 2026
- HHS ASPE, Poverty Guidelines (2026), accessed Oct 2026
- IRS, One, Big, Beautiful Bill provisions, accessed Oct 2026
This article is general education, not individualized financial, tax or legal advice.