Obamacare 2027 changes: what is different this year

• 15%median proposed 2027 premium increase across 276 ACA insurers, per KFF
• $12,000maximum out-of-pocket limit for one person in 2027, up from $10,600
• 10.22%top share of income you are expected to pay for the benchmark plan in 2027

The 2027 changes at a glance

1. Premiums are going up for the second year in a row

KFF reviewed rate filings from 276 insurers in all 50 states and DC and found a median proposed increase of about 15 percent for 2027. Last year's median finalized increase was 20 percent, so this is the second straight year of double-digit hikes.

Insurers point to two main causes. Medical and drug costs are rising about 10 percent a year, above the recent 8 percent norm. And the end of the enhanced tax credits pushed healthier people out of the market, which insurers say adds about 4 percentage points to 2027 rates. Final prices appear when open enrollment starts November 1.

If you get a subsidy, a rising benchmark price raises your credit too, which cushions most of the increase. If you pay full price, you feel all of it.

2. The subsidy cliff is still here

The enhanced premium tax credits that ran from 2021 through 2025 expired on January 1, 2026. Congress has debated extending them, but as of late September 2026 no extension has become law. So for 2027 the original ACA rules apply. Premium tax credits stop at 400 percent of the poverty line, which is $63,840 for one person and $132,000 for a family of four for 2027 coverage.

Below the line, the IRS sets your expected contribution for the benchmark silver plan at 2.15 to 10.22 percent of income for 2027, up from a top rate of 9.96 percent in 2026. Above the line, you get nothing. I explain the math, and the legal ways to stay under it, in my guide to the 2027 subsidy cliff.

3. No more cap on paying credits back

This is the change I worry about most for my clients. Your tax credit is paid monthly based on your income estimate, then reconciled on your tax return. Until 2025, if you underestimated, the amount you had to repay was capped for most households. The IRS confirms that the 2025 tax law removed those limits for tax years beginning after December 31, 2025. Starting with 2026 coverage, you repay the full excess.

For self employed people and commission earners, this is serious. Cross 400 percent of the poverty line by surprise and you could owe back a full year of credits. Estimate carefully, and update the marketplace during the year if your income changes.

4. Bronze and catastrophic plans now work with an HSA

Starting January 1, 2026, bronze and catastrophic plans count as HSA compatible even if they do not meet the usual high deductible plan rules, according to Treasury and IRS guidance. That continues for 2027, and the IRS raised the 2027 HSA contribution limits to $4,500 for self-only coverage and $9,000 for family coverage, plus $1,000 more if you are 55 or older.

For a healthy household paying full price, a bronze plan plus an HSA can be a strong pair. You save pre-tax money for medical bills, and the contribution lowers the income the marketplace counts, which can help near the cliff.

5. The out-of-pocket maximum rises to $12,000

CMS set the 2027 maximum out-of-pocket limit at $12,000 for one person and $24,000 for a family, up from $10,600 and $21,200 in 2026, about a 13 percent jump. Not every plan will go to the limit, but many bronze plans will be close to it. Compare the maximum, not just the deductible.

6. Some insurers are leaving

Cigna is exiting the ACA individual market for 2027 in all 11 states where it sells, affecting about 369,000 members, including Florida, Texas, Georgia, North Carolina and Colorado. Baylor Scott and White Health Plan is also leaving the Texas individual market, affecting about 100,000 enrollees. If your insurer leaves, you are usually moved automatically to a similar plan from another company, which may not include your doctors. Read what to do when your carrier leaves.

7. Fewer immigrants qualify for help

Under the 2025 reconciliation law, starting January 1, 2027, marketplace tax credits are limited to citizens, lawful permanent residents, certain Cuban and Haitian entrants and people from the Compact of Free Association nations, per KFF. Refugees, asylees, people with Temporary Protected Status and people on work visas can still buy a plan, but at full price.

What did not change

Pre-existing conditions are still covered. Open enrollment on HealthCare.gov still runs November 1, 2026 to January 15, 2027, with December 15 as the date for a January 1 start. Silver loading continues, so gold plans can cost less than silver in many areas. And some states are adding their own help. Virginia launches Virginia Premium Savings for 2027 for incomes from 138 to 250 percent of the poverty line.

What I'd do now

Open your renewal notice when it arrives, and do not let auto renewal decide for you. If your income is low enough that the credit covers most of the premium, you may be fine picking the cheapest plan with your doctors on HealthCare.gov yourself. If you are near or above the cliff, self employed, or losing your carrier, that is where a second set of eyes pays off. I'm Carson Hornish, an independent broker licensed in 31 states, and my help is free. Here is how that works.

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