ACA Open Enrollment 2027: Check Your Prescriptions Before You Pick a Plan

Premiums and out-of-pocket limits both rise for 2027, and insurers are leaving some states. A cheap premium can hide an expensive pharmacy bill. Here is how to compare.

The Short Answer

Open enrollment for 2027 Affordable Care Act (ACA) Marketplace plans started November 1, 2026. On HealthCare.gov, you must enroll by December 15 for coverage that starts January 1. Open enrollment ends January 15, and coverage from a later sign-up starts February 1. These dates come from HealthCare.gov. State-run Marketplaces can set different dates.

Do not choose a plan by the premium alone this year. The plan with the lowest premium may not cover your medicine, or it may charge you the full price until you meet a high deductible. If you take a medicine every month, your prescription list should decide your plan.

Four Changes Make 2027 Different

Most people who buy Marketplace coverage get a premium tax credit, so their own increase may be smaller than the headline number. However, people above 400% of the federal poverty level pay the full premium. That limit is $63,840 for one person, $86,560 for a couple, and $109,280 for a family of three. Alaska and Hawaii have higher limits.

The insurer exits matter for your medicines. KFF reports that Cigna will leave the individual market in all 11 states where it sells plans. If your insurer leaves, the Marketplace may assign you to a new plan. That plan can use a different drug list, a different pharmacy network, and a different set of doctors.

Why the Lowest Premium Can Cost You More

Three parts of a plan decide your pharmacy bill. Check all three for each medicine that you take.

The Formulary

A formulary is the plan's list of covered drugs. A plan can leave your medicine off the list. If that happens, you usually pay the full price, and the cost does not count toward your deductible or your out-of-pocket limit.

The Tier

Plans sort covered drugs into tiers. A low tier may mean a $10 copay. A high tier may mean that you pay a percentage of the price. For a brand-name drug with a high list price, a percentage can mean hundreds of dollars a month.

The Deductible

Some plans cover generic drugs before you meet the deductible. Other plans apply the deductible to every drug. On the second kind of plan, you pay the full negotiated price until you reach the deductible. Bronze plans often have the highest deductibles, so read the drug section of the plan summary closely.

Check Your Prescriptions in Seven Steps

1. Make your list. Write the name, strength, and monthly quantity of every medicine.
2. Find out what you pay now. Check your last pharmacy receipts for each drug.
3. Enter your drugs in the plan search. HealthCare.gov and most state Marketplaces let you add your prescriptions when you compare plans.
4. Open the formulary for your top two plans. Confirm the tier for each drug. Plan tools can lag behind, so check the insurer's own list.
5. Look for limits. Find any notes for prior authorization (PA), step therapy (ST), or quantity limits (QL).
6. Check your pharmacy. Confirm that your pharmacy is in the network. Ask if a preferred pharmacy costs less.
7. Add up the full year. Multiply the premium by 12. Add your expected drug costs and your usual doctor visits.

Call the insurer before you enroll if a drug matters to your health. Ask the representative to confirm the tier and any limits for your exact strength. Write down the date and the name of the person.

Three Rules Can Catch You by Surprise

Do Not Let Your Plan Renew Automatically

KFF Health News warns against automatic renewal this year. Premiums and benefits can change, even when the plan keeps its name. A plan that fit you in 2026 may now cost more or cover less.

Plan for Tax Credit Repayment

No caps apply to repayment of extra premium tax credits, starting with the 2026 tax year, according to KFF. Those returns come due in 2027. If your income ends up higher than you estimated, you may owe back the full extra amount at tax time. Update your income estimate on your Marketplace application when it changes. For questions about your own return, contact the IRS or a free Volunteer Income Tax Assistance site.

Expect an Extra Step With an Agent

If you use an agent on the federal Marketplace, you must approve that agent with a one-time code or link. Some people must also confirm their identity through a third party. A moratorium blocks new agents from the federal Marketplace until February 2027, so book help early. Free local help is available through the search tool at HealthCare.gov.

Silver Plans Can Lower Your Drug Costs

If your income is up to 2.5 times the federal poverty level, look at silver plans first. At that income, silver plans come with lower deductibles and lower out-of-pocket limits. For most people, only silver plans offer these extra savings. A bronze plan may show a lower premium but cost you much more at the pharmacy.

Your state may offer more help. KFF reports that New Mexico, California, New Jersey, Rhode Island, and Virginia offer or plan state subsidies for 2027. Check your state's Marketplace for the current rules.

What to Do if No Plan Covers Your Medicine

• Ask about an exception. Marketplace plans must offer a way to request coverage for a drug that is not on the formulary. Your prescriber supplies the medical reason.
• Ask your prescriber about a covered alternative. Another drug in the same class may treat your condition at a lower tier. Do not change your medicine on your own.
• Check the manufacturer. Many drug makers run savings cards and patient assistance programs for brand-name medicines.
• Compare cash prices. Search your medicine on RxGator. A discount price can beat your plan's price for a generic. However, that purchase usually does not count toward your deductible.

Frequently Asked Questions

Can I enroll after January 15?

Only with a Special Enrollment Period. You generally need a qualifying life event, such as a move, a new child, or the loss of other coverage.

Is the deadline the same in every state?

No. State-run Marketplaces set their own schedules. California, for example, keeps enrollment open until January 31. Check your state's Marketplace site.

How do I avoid fake enrollment sites?

Start at HealthCare.gov or your state's official Marketplace. Be careful with ads that promise a $0 plan for everyone. New rules ban false claims that coverage is always free.

Does my pharmacy purchase count if I use a discount card?

Usually not. A discount card purchase happens outside your insurance, so it does not count toward your deductible or out-of-pocket limit.

Why did my drug cost more after I changed plans?

Your new plan may place the drug on a higher tier, or it may apply a new deductible. Your deductible also starts over each January, so your first fills of the year often cost the most. Check both points before you switch.

Can I use a 90-day supply on a Marketplace plan?

Many plans allow it, and some charge less through a mail-order pharmacy. Compare the 90-day plan price with the 90-day cash price before you choose.

The Bottom Line

The deadline to remember is December 15 for coverage on January 1. Before that date, check every medicine against the formulary, the tier, and the deductible of each plan that you consider. Then use RxGator to compare those plan prices with the prices that you can get without insurance.