What to know about Marketplace open enrollment

The Marketplace helps you find health insurance if you don’t have coverage through your employer, Medicare, Medicaid, or another source.

Each state has a Marketplace of available health plans. Marketplace plans are offered by private insurance companies. The plans cover things like doctor visits, hospital care, prescription drugs, preventive care, and mental health services.

How Marketplace open enrollment works

Marketplace open enrollment happens each year. During this time, you can apply for coverage, renew your plan, or choose a different plan for next year. The Marketplace offers individual and family plans. Marketplace plans differ by state. A Marketplace health plan may be an option if you do not have insurance through a job, Medicare, Medicaid, or another source.

Important dates for 2027 coverage

• November 1: Open enrollment begins. This is the first day to enroll, renew, or switch plans.
• December 15: Enrollment deadline for coverage starting January 1.
• January 15: Open enrollment ends. Final deadline to sign up or switch plans. Coverage begins February 1
• After January 15, you can only enroll if you qualify for a Special Enrollment Period.

Find the Marketplace in your state and check your state’s enrollment deadlines. Some states have different deadlines.

Try to start before the deadline. You will need time to update your application, review your current plan, and compare your choices.

Special enrollment periods for Marketplace plans

Can I enroll outside of open enrollment?

You may be able to enroll in or change Marketplace coverage after certain life changes. This is called a Special Enrollment Period. Examples include losing other health coverage, moving, getting married, having a baby, or adopting a child.

The rules and the time you have to enroll depend on the life change. Apply as soon as you can and be ready to send documents if the Marketplace asks for them. Check whether you qualify for a Special Enrollment Period.

If you lost coverage, read PAF’s Health Plan Cancellations and What to Do Next. You may be able to apply for Medicaid or the Children’s Health Insurance Program, also called CHIP, at any time during the year.

What’s changing for Marketplace plans in 2027?

Plan costs and coverage may change

The plan you had in 2026 may cost more or less in 2027. Its doctors, hospitals, pharmacies, covered medications, benefits, and plan rules may also change. The amount of financial help available to you may change too.

Read your renewal information and review the full 2027 plan details before you renew. A plan with the same name can still change from one year to the next.

Out-of-pocket limits may be higher

An out-of-pocket maximum is the most you may pay during the year for covered care you receive in your plan’s network. After you reach that amount, the plan generally pays the full cost of covered, in-network care for the rest of the year.

For most Marketplace plans in 2027, the out-of-pocket maximum may be up to $12,000 for one person or $24,000 for a family. Some Bronze plans may have a higher limit, up to $15,600 for one person or $31,200 for a family. Many plans may have lower limits, so check the exact amount for each plan you are considering.

Your monthly premium is separate from this limit. The limit also may not include care outside the plan’s network or services the plan does not cover. Check the plan details so you know which costs count.

Not sure what premium, deductible, copay, coinsurance, or out-of-pocket maximum means? Use PAF’s The Language of Insurance for plain-language explanations.

Should I change my Marketplace plan?

Review your renewal notices

Your health plan and the Marketplace should send you renewal information. Start there. It should tell you whether your plan will continue in 2027 and what may change. If you do not receive this information, contact the plan or sign in to your Marketplace account.

You may decide to keep your plan if it still includes the doctors, medications, and services you use and the costs work for you. Compare other plans if any of these things changed. You may also want to compare plans if your financial help or healthcare needs changed.

Important: Before you decide, check your doctors, medications, and network rules. Then compare the full cost and coverage of the plans available to you.

Remember, a plan with the same name can still change from one year to the next. Check the 2027 plan details before you renew.

PAF’s Health Insurance Network Tips explains how plan networks can affect where you receive care and what you pay.

When should I compare other plans?

You do not have to change plans, but it is important to compare your choices before you renew. Consider other plans if:

• Your monthly premium or other costs are increasing
• Your doctors, hospitals, or pharmacy are leaving the plan’s network
• A medication you take is no longer covered or will cost more
• The plan added new approval, referral or pharmacy rules
• You expect to need different care, treatments or medications in 2027
• Your household income or financial help has changed

If your current plan still meets your needs, you may decide to keep it. Review the full 2027 plan details before making that choice.

Comparing Marketplace plans

Look at the whole plan

Do not compare plans by the monthly premium alone. A plan with a lower premium may have a higher deductible or higher costs when you receive care. Look at the premium after financial help, the deductible, copays or coinsurance, medication costs, and the out-of-pocket maximum together.

The Marketplace may show an estimate of your total yearly costs. Your actual costs will depend on the care and medications you use. Learn how to estimate your total yearly costs.

Use the same information for every plan

Every plan has a Summary of Benefits and Coverage. It explains what the plan covers and gives examples of what you may pay for common services. Use this document to compare the same information across plans.

PAF’s Understanding Your Health Insurance Policy Documents can help you find important information in plan documents.

How do I pick a plan category?

Marketplace plans are grouped into Bronze, Silver, Gold, Platinum, and Catastrophic categories. These categories show how costs are shared by you and the plan. The category is not a quality rating.

• Bronze plans often have lower monthly premiums and higher costs when you receive care. Before choosing one, compare its premium, deductible and out-of-pocket maximum. Looking at these amounts together can help you understand the plan’s costs.
• Silver plans usually fall between Bronze and Gold plans in how costs are shared. If you qualify for extra savings from the Marketplace (also called premium tax credits), you must choose a Silver plan to use them. These savings can lower your deductible, copays and coinsurance.
• Gold and Platinum plans often have higher monthly premiums and lower costs when you receive care. The plans available to you and their costs will depend on where you live.
• Catastrophic plans usually have a high deductible and are available only to certain people (like people under 30 years old and others who qualify for a hardship or affordability exemption through the Marketplace. Premium tax credits cannot be used with a Catastrophic plan.

What to remember about categories

All Marketplace plans cover the same general categories of essential health benefits, although the details and plan rules may differ. Learn what Marketplace plans cover.

Plan categories are not quality ratings. When available, use the plan’s one-to-five-star quality rating to compare quality.

A helpful next step is to compare plans in more than one category using your total yearly cost estimate, doctors, medications, and financial help.

Bronze and Catastrophic plans can work with a Health Savings Account (HSA). An HSA lets you set aside money before taxes for certain healthcare expenses. Learn about HSA-eligible plans and review IRS Publication 502, the list of qualified medical expenses.

Do I qualify for Marketplace financial help?

Check what help is available to you

Complete or update your Marketplace application to find out whether financial help may be available. The amount can depend on your expected household income, household size and access to other health coverage.

A premium tax credit lowers the monthly premium you pay. If you qualify, you can use it with a Bronze, Silver, Gold or Platinum plan.

Reminder: Premium tax credits cannot be used with a Catastrophic plan.

Extra savings called cost-sharing reductions lower the deductible, copays, coinsurance and out-of-pocket maximum for people who qualify. You must choose a Silver plan to receive these savings.

Update your income and household information, read your eligibility notice and send any requested documents by the deadline. Then compare the monthly premium you would pay after financial help. Check whether you may qualify for savings.

If your income or household changes during the year, update your Marketplace application. The change may affect the financial help available to you.

After enrollment

Make sure your enrollment is complete

After you choose a plan, look for an enrollment confirmation and check the date your coverage starts. Pay your first premium directly to the insurance company by its deadline. Your coverage may not begin until the first premium is paid.

Make sure any automatic payment uses the correct plan and amount. When your insurance card arrives, check it and give the new information to your doctors and pharmacy. Send any documents the Marketplace requests.

Do not cancel your current coverage until you have confirmed when your new coverage starts. This can help you avoid a gap in coverage.

Keep your coverage active

If your plan charges a monthly premium, pay it on time. Know how much you owe, when it is due, and how you will pay for it. If you miss a payment or receive a notice, contact the insurance company right away. Ask what you need to do to keep your coverage.

If your plan denies care or a medication

Read the denial notice. It should explain why the request was denied, how to appeal, and the deadline. Your healthcare provider may also be able to send information to support the request.

Read PAF’s Appeals Guide for general information and next steps.

Get help

I need help paying for care

Charitable patient assistance programs, like Patient Advocate Foundation’s TotalAssist, provide grants to eligible people with serious or chronic conditions. Depending on the fund, help may be available for:

• Medication copays
• Coinsurance
• Deductibles
• Health insurance premiums and
• Certain treatment-related costs

Check the fund for your condition to learn what it covers and whether you may qualify.

I need help with something else

Health insurance can be confusing. You do not have to figure it out alone. Use our health insurance and open enrollment resources to learn more.

A note about this information

This page provides general education to help you review and compare Medicare plans. It does not recommend a specific plan. Plan choices, costs, coverage, networks, financial help and eligibility can vary. Review the official plan and documents or contact Medicare or a Medicare Advantage plan if you have questions.