ACA Open Enrollment 2027: Higher Costs and How to Stay Covered

Health insurance is not the sexiest topic we cover. But it decides whether you can get your PrEP refilled, see someone about a weird bump, get birth control, start or continue hormones, manage a chronic condition, or go to therapy without a scary bill. In other words, it is deeply tied to your sexual health and your bodily autonomy.

Open enrollment for 2027 Affordable Care Act (ACA) Marketplace plans is happening right now, and this year comes with real changes: higher premiums, less financial help for many people, new rules for some immigrants, and new Medicaid work requirements arriving in most states in January. Here's what's going on, who it hits hardest, and how to protect your coverage.

What's Happening

On HealthCare.gov, open enrollment runs from November 1, 2026 to January 15, 2027. If you want coverage that starts January 1, the deadline is December 15, 2026. Some states run their own Marketplaces with different dates (several, like California, New Jersey and New York, run through January 31), so check your state's site.

Prices are climbing again. KFF reports the average benchmark silver premium is rising 13% for 2027, the second double-digit jump in a row. A big reason: the enhanced federal subsidies that made Marketplace plans cheaper expired at the end of 2025. According to the Peterson-KFF Health System Tracker, what enrollees actually paid after subsidies rose an average of 58% in 2026, and people earning more than 400% of the federal poverty level no longer qualify for any premium tax credit at all. Insurers say healthier people dropping coverage has made the remaining pool sicker and pricier.

The federal government frames the year differently. CMS says HealthCare.gov shoppers will see about 100 plan options on average and that most will find a plan for $50 a month or less. Both things can be true: many lower-income people still get significant help, while many others will pay noticeably more.

What's Still Protected

Some core protections are still standing. Marketplace plans can't deny you or charge you more for a pre-existing condition, including HIV. And in June 2025, the Supreme Court ruled 6-3 in Kennedy v. Braidwood that the ACA's requirement to cover recommended preventive services without cost-sharing is constitutional. KFF notes that means people with private insurance can keep getting PrEP, plus its related visits and lab work, without copays. KFF also flags a caveat: the ruling confirmed the HHS Secretary's authority over the expert panel that makes those recommendations, so future changes are possible.

Birth control coverage rests on a separate set of federal preventive care guidelines (HRSA's Women's Preventive Services Guidelines), and some employers can claim religious exemptions. If you use contraception, whatever your gender, check how any plan you're considering covers your specific method.

Who's Most Affected

• LGBTQ+ people. KFF survey data found LGBT+ adults are more likely than non-LGBT+ adults to be on Medicaid (21% vs. 16%) and more likely to have incomes under 200% of the poverty level (44% vs. 36%). Cuts to public coverage and subsidies land hard here, especially for trans people who rely on ongoing care.
• Some immigrants. Starting in 2027, premium tax credits are limited mainly to lawful permanent residents and a few other groups. KFF reports that refugees, asylees and survivors of trafficking can still buy Marketplace plans, but without subsidies.
• Medicaid expansion adults. The 2025 federal budget law requires most expansion adults to show 80 hours a month of work, school, volunteering or similar activities, with states required to start by January 1, 2027 (some already have). People who lose Medicaid only because of these rules also can't get Marketplace subsidies, per KFF.
• Disabled and chronically ill people, caregivers and pregnant people. Many are exempt from work requirements, but exemptions only help if your state knows about them. That paperwork burden often falls hardest on the people with the least time and energy to spare.

Exemptions listed in the law include people who are pregnant or postpartum, medically frail (including disabled people and people with serious or complex conditions), parents and caregivers of children 13 and under or of a disabled person, American Indian and Alaska Native people eligible for Indian Health Service care, former foster youth under 26, veterans with a total disability rating, and people in substance use treatment, among others.

What You Can Do

• Don't just auto-renew. Log in to HealthCare.gov or your state Marketplace, update your information and compare plans. Your current plan's price, network or drug list may have changed, and some insurers are leaving certain states.
• Estimate your income carefully. KFF notes the caps on paying back extra tax credits are gone, so a too-low guess could mean a bigger bill at tax time.
• Check your prescriptions and providers. Before you pick a plan, confirm it covers your PrEP, hormones, birth control, mental health care or other ongoing needs, and that your doctors are in network.
• Get free, certified help. HealthCare.gov's Find Local Help tool connects you with assisters by phone or in person, or call the Marketplace at 1-800-318-2596. LGBTQ+ folks can find affirming enrollment guidance through HRC's Get Insured resources, which link to Out2Enroll.
• Watch your Medicaid mail. Open every letter from your state, keep your address updated, and if you think you qualify for an exemption, ask for it in writing.
• Look for state help. A few states, including New Mexico, California, New Jersey, Rhode Island and Virginia, are using their own money to fill some of the lost subsidy gap.
• Be wary of look-alike plans. Short-term plans can look cheap but often skip key benefits and pre-existing conditions.
• Tell your lawmakers what this means for you. Find your U.S. Representative by ZIP code at house.gov, then call or email their office with your story. Personal stories move policy.

Money stress about health care is real and exhausting. If this is weighing on you, you don't have to sort it out alone: an enrollment assister, a local community health center, or a trusted friend can help you take it one step at a time.

The Takeaway

We believe health care, including sexual and reproductive health care, is a right, not a luxury. This year, staying covered takes a little more effort and attention, so give yourself the gift of 30 minutes before December 15 to shop, compare and ask for help. Then share this with someone you love who might not know their options have changed.

Empower Pleasure doesn't endorse candidates. Updated as of November 9, 2026. Facts can change quickly, so check the linked sources for the latest.

Sources

1. CMS (2026). Plan Year 2027 Marketplace Plans and Prices Fact Sheet
2. healthinsurance.org (2026). What are the deadlines for the ACA's open enrollment period?
3. KFF (2026). 9 Things to Watch for the 2027 ACA Open Enrollment Period
4. Peterson-KFF Health System Tracker (2026). How much and why ACA Marketplace premiums are going up in 2027
5. KFF (2025). Kennedy v. Braidwood: The Supreme Court Upheld ACA Preventive Services but That's Not the End of the Story
6. KFF (2025). A Closer Look at the Work Requirement Provisions in the 2025 Federal Budget Reconciliation Law
7. KFF (2026). An Early Look at Policy Decisions as States Get Ready to Implement Work Requirements
8. Center for Health Care Strategies (2026). A Summary of Federal Medicaid Work Requirements
9. KFF (2023). LGBT+ People's Health Status and Access to Care
10. Human Rights Campaign. Get Insured: Affordable Care Act Resources for the LGBTQ+ Community
11. HealthCare.gov. Find Assistance

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