Americans can begin enrolling in Affordable Care Act health plans on November 1, 2026, but higher insurance costs, reduced subsidies and new enrollment requirements could make coverage more difficult to afford.
Open enrollment for Affordable Care Act health insurance plans begins Sunday, November 1, 2026, across most of the United States. Millions of Americans can now select or renew coverage for 2027, although higher premiums, expired financial assistance and tighter enrollment rules are creating new challenges for consumers.
People using the federal HealthCare.gov marketplace have until December 15, 2026, to select coverage beginning January 1. Those who enroll between December 16 and January 15, 2027, can obtain coverage starting February 1, provided they pay their first premium.
This enrollment season follows significant changes to federal health insurance policy. The enhanced premium tax credits that helped millions afford coverage expired at the end of 2025, while new federal regulations have changed how some consumers and insurance brokers use the marketplace.
Health Insurance Premiums Rise Again
Health insurance costs are increasing for the second consecutive year, leaving many households facing difficult financial decisions. The increases are especially concerning for people who purchase their own insurance rather than receiving coverage through an employer.
An October 30 analysis by KFF found that average benchmark silver plan premiums are increasing by 13% nationally for 2027. That follows a 26% increase between 2025 and 2026, producing substantial increases over two years.
Benchmark silver plans are important because the federal government uses their prices to calculate premium tax credits. Actual costs vary according to location, age, income, household size and the insurance plan selected.
Although premiums are rising, federal financial assistance remains available to many qualifying households. The Centers for Medicare & Medicaid Services reported that more than 75% of consumers shopping through HealthCare.gov will have access to plans costing $50 or less per month after available tax credits.
Those lower-cost options will not be available to everyone. Families with incomes above 400% of the federal poverty level are particularly vulnerable because they no longer qualify for the expanded assistance that temporarily removed the previous income ceiling.
The enhanced tax credits were introduced in 2021 and later extended through 2025. Their expiration means some households must pay considerably more for identical or comparable insurance coverage.
Florida Enrollment Drops by 450,000
Florida provides an example of how changing insurance costs are affecting enrollment. More than 3.85 million residents enrolled in federal marketplace plans and paid their first premiums for 2026 coverage.
That was approximately 450,000 fewer people than the 4.3 million Floridians with active marketplace coverage in 2025. The decline represented roughly 10% of the state’s previous enrollment, according to reporting by the Florida Phoenix.
The figures do not establish that all 450,000 people became uninsured. Some may have obtained employer-sponsored coverage, purchased insurance outside the marketplace or qualified for other health programs.
Florida already had a substantial uninsured population before the enhanced subsidies expired. America’s Health Rankings estimated that 10.9% of state residents lacked health insurance in 2024.
Insurance regulators also expect another increase in Florida premiums. State insurance data indicate that average monthly health insurance premiums will rise approximately 10.4% in 2027 before accounting for financial assistance.
The actual amount consumers pay will depend on their eligibility for subsidies and their selected coverage. People who do not qualify for federal assistance will face the full premium increases.
Florida Residents Describe Financial Strain
For some residents, the loss of enhanced tax credits has made traditional marketplace insurance unaffordable. Catalina Jaramillo, a 43-year-old Miami-Dade County resident, described how rising premiums forced her to reconsider her coverage.
Jaramillo previously purchased an Affordable Care Act plan that helped pay for treatment after she was diagnosed with kidney disease. The insurance allowed her to receive specialist care and medication while managing her condition.
Her monthly premium increased from approximately $180 to more than $1,000 after she lost enhanced financial assistance in 2026. She told the Florida Phoenix that the higher payment was beyond her budget.
Jaramillo now receives care through Community Health of South Florida, a federally qualified health center. She said the arrangement costs approximately $180 monthly and provides access to important medical services.
However, the health center is not equivalent to comprehensive insurance coverage. Jaramillo expressed concern about medical bills after visiting an urgent care facility, illustrating the financial uncertainty faced by some uninsured patients.
Another Florida resident, commercial pilot Dave Waalewyn of Leesburg, encountered similar financial pressure after losing employer-sponsored health insurance. He initially purchased a private policy costing approximately $800 monthly through an insurance broker.
The policy involved medical underwriting, meaning the insurer could consider his medical history when determining coverage. After questions arose about information from previous medical testing, Waalewyn decided against keeping the plan.
He subsequently purchased marketplace insurance costing approximately $1,500 monthly, equivalent to $18,000 annually before deductibles and copayments. Waalewyn later obtained another job that would provide employer-sponsored insurance beginning in December.
His experience illustrates the difference between ACA-compliant insurance and some alternative private policies. Marketplace plans cannot deny coverage because of preexisting medical conditions, while certain plans sold outside the marketplace do not provide the same protections.
New Federal Rules Affect Insurance Brokers
The Trump administration has introduced additional safeguards intended to prevent fraudulent marketplace enrollments. Federal officials say unauthorized insurance applications and improper broker activity have contributed to unnecessary government spending and consumer problems.
On September 22, CMS reported that approximately 315,000 marketplace enrollments covering more than 760,000 individuals had been canceled after investigations confirmed they were unauthorized. The agency estimated that the cancellations could recover approximately $2.2 billion in advance premium tax credit payments.
The administration also announced a temporary moratorium on registering certain new insurance agents and brokers for the 2027 marketplace. The restriction applies to individuals without active federal marketplace agreements for 2026 and is scheduled to continue through February 1, 2027, unless modified.
Existing qualified brokers can continue helping consumers, although additional verification requirements may affect their work. Federal officials say these measures are intended to protect consumers from unauthorized enrollment and misuse of personal information.
Critics of tighter marketplace rules have raised concerns about additional administrative obstacles for people who already find insurance applications confusing. The practical effects will depend on implementation and whether eligible consumers can complete enrollment successfully.
Enrollment Assistance Faces Funding Cuts
Consumers seeking help with their applications can turn to certified marketplace navigators, who explain insurance options and enrollment requirements. These services are especially important for people unfamiliar with subsidies, deductibles and provider networks.
Florida Covering Kids and Families coordinates federally supported enrollment assistance across the state. Its director, Xonjenese Jacobs, says navigators are preparing to help residents understand available plans and make informed choices.
The organization received approximately $1.379 million in federal funding for the current year. That amount is roughly 90% below the $13.79 million it received in 2024, although it is similar to its funding during the previous year.
Despite the reduction, the organization has agreements with five additional navigator groups to provide assistance throughout Florida. Staff members can help consumers compare coverage and identify potential financial assistance.
Navigators may also direct uninsured residents toward community health centers and charitable clinics when marketplace plans remain unaffordable. These facilities can provide important medical services, although they do not replace comprehensive health insurance.
What Consumers Should Check Before Enrolling
Health policy experts recommend comparing more than monthly premiums when selecting a plan. Deductibles, prescription drug coverage, copayments, hospital networks and maximum out-of-pocket expenses can significantly affect total costs.
Bronze plans generally have lower monthly premiums but higher costs when patients need medical treatment. Gold and platinum plans typically charge more each month while covering a larger share of eligible medical expenses.
Consumers should also confirm that their doctors, specialists and preferred hospitals participate in a plan’s provider network. A cheaper policy may ultimately become expensive if necessary treatment requires out-of-network care.
People receiving premium tax credits should carefully estimate their expected household income for 2027. Federal changes have eliminated previous repayment limits for excess advance premium tax credits beginning with the 2026 tax year, increasing the potential financial consequences of inaccurate income estimates.
Those who experience changes in employment, income or household size should update their marketplace applications promptly. Correct information can help prevent unexpected tax bills and ensure that available assistance is calculated properly.
Consumers who miss the January 15 enrollment deadline generally need a qualifying life event to obtain marketplace coverage before the next enrollment period. Losing qualifying health insurance, getting married or having a child may provide access to a special enrollment period.
Medicaid and the Children’s Health Insurance Program operate under different enrollment rules. Eligible individuals and families can generally apply f
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