Your main options, in order of who qualifies
| Source | Who it's for | Key facts for 2026–2027 |
|---|---|---|
| Employer plan | Workers and their families | About 154 million people under 65 are covered through work. Average family premium $26,993 in 2025, of which workers paid $6,850. |
| ACA Marketplace | People without affordable job coverage | 23.1 million signed up for 2026. Open enrollment for 2027: Nov. 1, 2026–Jan. 15, 2027 on HealthCare.gov. |
| Medicaid | Low-income adults and children | In expansion states, adults up to about 138% of the poverty level ($22,025 for one person in 2026). Ten states had not expanded. |
| COBRA | People leaving a job at an employer with 20+ workers | Keep the same plan for up to 18 months, at up to 102% of the full premium. |
| Medicare | People 65+ and some with disabilities | Open enrollment Oct. 15–Dec. 7. |
| Short-term plan | Temporary gaps only | Not required to cover pre-existing conditions or essential benefits. Federal rules are being rewritten. |
Source: KFF 2025 Employer Health Benefits Survey; CMS (Mar. 2026); healthinsurance.org (Aug. 2026); U.S. Department of Labor; Medicare.gov.
Employer coverage
If your employer offers a plan, it is usually the cheapest route because the employer pays most of the premium. In KFF's 2025 Employer Health Benefits Survey, the latest edition available in early October 2026, employers paid about three-quarters of the $26,993 average family premium. The average single deductible was $1,886, and 29% of covered workers were in high-deductible plans that work with a health savings account.
Compare the plans your employer offers on total cost, not just the paycheck deduction. Add the premium to what you would likely spend on deductibles and copays, and check whether your doctors are in network. Our guide to health insurance costs walks through the numbers.
If you leave your job, COBRA lets you keep the same plan if your employer has at least 20 workers. Coverage lasts up to 18 months after job loss or reduced hours, and up to 36 months after certain events such as divorce. The catch is cost: the plan can charge up to 102% of the total premium, including the share your employer used to pay. You have at least 60 days to elect it.
ACA Marketplace plans
Marketplace plans cannot turn you down or charge more because of a pre-existing condition, and they must cover essential health benefits. CMS reported 23.1 million sign-ups for 2026. Plan choices shifted sharply: Bronze rose to 40% of selections and Silver fell to 43%, while Gold rose to 17%.
Key dates for 2027 coverage
- HealthCare.gov states: November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage starting January 1.
- Earlier deadlines: Idaho closes December 15 and Rhode Island December 31.
- Later deadlines: Massachusetts January 23, Virginia January 29, and California, D.C., New Jersey and New York January 31.
A 2025 federal rule would have ended open enrollment earlier for 2027, but a federal court in Maryland vacated that part in June 2026, and CMS confirmed the January 15 date. The case was under appeal, so check your exchange's dates before you rely on them.
What changed with subsidies
The enhanced premium tax credits that capped costs for higher earners expired at the end of 2025. The House passed a three-year extension on January 8, 2026, by 230 to 196, but as of September 2026 Congress had not extended the credits. That means:
- No subsidy above 400% of the poverty level: $62,600 for one person and $128,600 for a family of four for 2026 coverage.
- For 2027, the expected contribution toward a benchmark silver plan runs from 2.15% to 10.22% of household income.
- From tax year 2026, the caps on repaying excess advance credits are gone. If your income comes in higher than you estimated, you may owe back the full excess.
- Insurers proposed a median 15% premium increase for 2027, according to KFF's review of 276 insurers. Unsubsidized buyers bear the full increase.
Plan rules are also changing for 2027. The out-of-pocket maximum rises to $12,000 for an individual and $24,000 for a family, from $10,600 and $21,200 in 2026. Separately, under the 2025 tax law, Bronze and catastrophic Marketplace plans have counted as HSA-eligible since January 2026.
Medicaid and CHIP
Medicaid covers low-income people at little or no cost, and it cannot refuse you or charge more because of a pre-existing condition. In states that expanded Medicaid, adults generally qualify up to about 138% of the poverty level, roughly $22,025 a year for one person or $45,540 for a family of four using 2026 figures. As of 2026, 10 states had not expanded.
New work requirements are coming. Under a CMS rule released June 1, 2026, certain adults ages 19 to 64 must show 80 hours a month of work, school, a work program or community service. States must start no later than January 1, 2027. Exemptions include people who are pregnant or postpartum, disabled or medically frail, American Indians and Alaska Natives, and parents or caregivers of young children or people with disabilities.
Short-term health plans
Short-term plans cost less because they do not have to follow ACA protections, such as covering pre-existing conditions or essential health benefits. A 2024 federal rule limited them to an initial term of three months and four months in total. In August 2025, federal regulators said they would not prioritize enforcing that rule while they rewrite it, and they told a court they planned to propose a longer maximum length in summer 2026. As of September 2026, the four-month limit remained under that enforcement pause, and state rules vary. Treat short-term plans as a stopgap. A claim related to an existing condition may not be paid.
Large health insurers: what's changed
The insurer matters for network, service and plan quality, and the lineup in the individual market has shifted. These figures describe each company's Marketplace footprint and NCQA quality ratings.
| Insurer | Marketplace states, 2026 | Notes |
|---|---|---|
| UnitedHealthcare | 30 | Expected to shrink its ACA enrollment by about one-third in 2026 |
| Centene (Ambetter) | 29 | Largest individual-market insurer in 2024, with 18% of enrollees |
| Oscar Health | 20 | Sold plans in 20 states for 2026 |
| Elevance Health (Anthem, Wellpoint) | 18 | Marketplace plans listed under Elevance (Wellpoint) by KFF |
| Molina Healthcare | 14 | Sold plans in 14 states for 2026 |
| Kaiser Permanente | 10 | Nine of the 18 five-star plans in NCQA's 2026 ratings were Kaiser plans |
| Cigna | 11 (leaving) | Exiting the ACA individual market after 2026; 369,000 members affected |
| Aetna (CVS Health) | 0 | Left at the end of 2025; about 1 million members in 17 states had to switch |
Source: KFF, insurer participation in the ACA Marketplaces (June 2026); Becker's Payer Issues (May 2026); Healthcare Dive on NCQA 2026 ratings (Sept. 2026).
KFF counted an average of 9.0 insurers per state in 2026, down from a record 9.6 in 2025. The number of counties with a single insurer rose from 93 to 165. If your insurer is leaving, you will need to pick a new plan during open enrollment.
Quality ratings
NCQA rates plans from 0 to 5 stars on clinical quality and member experience. In its 2026 ratings, released in September, 18 plans earned 5 stars, up from 11, and all 18 were nonprofits. Five-star commercial plans included BCBS Massachusetts, Harvard Pilgrim, Independent Health, two Capital District Physicians' plans in New York, Kaiser Mid-Atlantic, Kaiser Northern California and two UPMC plans. Among publicly traded insurers, CVS/Aetna had the highest average at about 4 stars, and Cigna trailed. Ratings apply to specific regional plans, so look up the plan you are considering, not just the brand.
How to choose a plan
- Start with eligibility. Check employer coverage first, then Medicaid, then the Marketplace.
- Estimate your income carefully. With the repayment caps gone, a low estimate can mean a large tax bill.
- Check networks. Confirm your doctors, hospitals and prescriptions are covered before you enroll.
- Compare total yearly cost. Add 12 months of premiums to your likely out-of-pocket spending, and know the plan's out-of-pocket maximum.
- Look up the plan's NCQA rating. Ratings vary by region even within the same company.
Dental and vision coverage are usually separate; see our guides to dental insurance and health coverage. If you are turning 65, read our Medicare plans guide.
Frequently asked questions
When is open enrollment for 2027 health insurance?
On HealthCare.gov it runs from November 1, 2026 to January 15, 2027. Enroll by December 15 for coverage starting January 1. Some state exchanges have different dates, such as Idaho (December 15) and California, New York, New Jersey and D.C. (January 31).
Were the enhanced ACA subsidies extended?
Not as of September 2026. They expired at the end of 2025. The House passed a three-year extension in January 2026, but it did not become law. Subsidies again stop above 400% of the federal poverty level.
Is a short-term health plan a good substitute for ACA coverage?
Generally no. Short-term plans don't have to cover pre-existing conditions or essential health benefits. They can fill a brief gap, but claims tied to existing conditions may be denied.
Which insurers left the ACA Marketplace?
Aetna (CVS Health) left at the end of 2025, affecting about 1 million people in 17 states. Cigna is leaving after 2026, affecting 369,000 members in 11 states, and Baylor Scott & White Health Plan is also leaving in Texas.
How do I qualify for Medicaid?
In states that expanded Medicaid, adults generally qualify with income up to about 138% of the poverty level, roughly $22,025 for one person in 2026. Eligibility rules vary by state, and new work requirements start by January 1, 2027 for certain adults.
How much does COBRA cost?
Up to 102% of the full premium, including the part your employer used to pay. For a family plan averaging $26,993 a year in 2025, that could be over $2,200 a month.