Open enrollment for Affordable Care Act health insurance marketplaces began November 1 in most states, running through January 15 for coverage starting in 2027.

Insurers have raised premiums significantly. Benchmark silver plan rates increased by an average of 13 percent, following a 26 percent jump the prior year. Median gross premium proposals reached 15 percent, driven by rising medical costs, hospital consolidation, and effects from the expiration of enhanced premium tax credits at the end of 2025.

The end of those temporary subsidies has already reduced enrollment. Marketplace plan selections fell by 1.2 million during the previous open enrollment period. Individual market enrollment dropped 18 percent from June 2025 to June 2026, signaling further attrition as healthier individuals exit and risk pools worsen.

Out-of-pocket costs have risen for many. Average net premiums paid by consumers increased 58 percent to $178 per month in 2026. Deductibles climbed 37 percent to a record $3,786 on average, as more enrollees shifted to higher-deductible bronze plans.

Additional policy changes include new eligibility restrictions for certain immigrants and stricter enrollment verification. Some carriers have exited markets while others entered, altering options in various states.

The federal government noted that many subsidized enrollees can still find low-cost plans after credits. However, those above 400 percent of the federal poverty level face the full cost without assistance.

Consumers are advised to compare plans directly on HealthCare.gov or state exchanges to assess personal impacts.