23.1MPeople enrolled in Marketplace plans for 2026
$26,993Average family premium for employer coverage
Nov 1Start of open enrollment for 2027 coverage
$12,0002027 out-of-pocket maximum for an individual
Key takeaway: Most Americans under 65 get health insurance through work; others buy a Marketplace (Obamacare) plan, qualify for Medicaid or continue a former employer’s plan through COBRA. Open enrollment for 2027 Marketplace plans runs from November 1, 2026 to January 15, 2027 in most states. Because the enhanced subsidies expired after 2025, many people will pay more in 2027, so compare plans carefully.
How we put this guide together: We used CMS enrollment data, the KFF 2025 Employer Health Benefits Survey, KFF Marketplace analyses, IRS and CMS cost limits, NCQA plan ratings and guidance from HealthCare.gov and the Department of Labor. Rules and figures were checked in October 2026. Health insurance rules change often, so confirm details at HealthCare.gov or your state marketplace. See our advertiser disclosure.

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Where people get health insurance

SourceWho it’s forKey facts
Employer planWorkers and their familiesAbout 154 million people under 65; employers pay about 75% of family premiums on average
ACA MarketplacePeople without affordable job-based cover23.1 million enrolled for 2026; subsidies based on income
Medicaid / CHIPLower-income adults and childrenIncome limits vary by state; 10 states haven’t expanded
COBRAPeople leaving a job with group coverUsually 18 months; up to 102% of the full premium
MedicarePeople 65+ and some with disabilitiesSee our Medicare guide

Sources: KFF 2025 Employer Health Benefits Survey; CMS (March 2026); U.S. Department of Labor; healthinsurance.org.

What’s changing for 2027

  • Open enrollment: November 1, 2026 to January 15, 2027 on HealthCare.gov. Enroll by December 15 for cover starting January 1. Some state marketplaces have different deadlines.
  • Smaller subsidies: the enhanced premium tax credits expired at the end of 2025. There’s again no subsidy above 400% of the poverty level ($62,600 for a single person for 2026 cover).
  • Higher prices: insurers’ proposed 2027 increases had a median of about 15%, according to KFF’s review of 276 insurers.
  • Higher out-of-pocket limits: $12,000 for an individual and $24,000 for a family, up from $10,600 and $21,200.
  • Fewer insurers in some areas: Aetna left the Marketplace after 2025 and Cigna is leaving after 2026.

See our guides to the Marketplace and subsidies for details.

Key terms to understand

  • Premium: what you pay each month for the plan.
  • Deductible: what you pay for covered care before the plan starts sharing costs. The average single deductible for employer plans was $1,886 in 2025.
  • Copay and coinsurance: your share after the deductible, either a flat fee or a percentage.
  • Out-of-pocket maximum: the most you pay in a year for covered in-network care.
  • Network: the doctors and hospitals the plan contracts with. HMOs and EPOs generally don’t cover out-of-network care; see HMO vs. PPO.

ACA-compliant plans must cover essential health benefits, can’t charge more for pre-existing conditions, and must cover many preventive services without cost-sharing when you use in-network providers.

How to choose a plan

  1. Check your doctors and prescriptions are covered in the plan’s network and drug list.
  2. Compare total yearly cost: premiums plus the deductible and likely copays, not just the monthly price. Our cost guide shows typical figures.
  3. Look at plan quality: NCQA rates health plans on a 0–5 scale; 18 plans earned 5 stars in 2026.
  4. Consider an HSA-eligible plan if you’re healthy and can save, for the tax benefits.

Our guide to the best health insurance companies compares the major insurers.

All Health insurance guides

Best Health Insurance Companies: Quality Ratings, Availability and How to ChooseMajor insurers compared on Marketplace presence, NCQA ratings and plan types.The ACA Health Insurance Marketplace: How It Works and How to Enroll for 2027How the ACA Marketplace works, 2027 deadlines, metal tiers and special enrollment.Health Insurance Subsidies in 2027: Who Qualifies and How Much You GetPremium tax credits and cost-sharing reductions after the enhanced subsidies ended.How Much Does Health Insurance Cost? Premiums, Deductibles and Out-of-Pocket LimitsEmployer and Marketplace premiums, deductibles, out-of-pocket limits and HSAs.HMO vs. PPO (and EPO and POS): How Health Plan Networks DifferHMO, PPO, EPO and POS plans compared, and how to choose a network.Health Insurance for the Self-Employed: Options, Costs and Tax BreaksOptions for freelancers and the self-employed, plus the tax deduction.Health Insurance for Small Businesses: Group Plans, QSEHRAs and ICHRAs ComparedGroup plans, QSEHRAs, ICHRAs and the SHOP Marketplace for small employers.COBRA Health Insurance: How It Works, What It Costs and When to Choose Something ElseHow COBRA works, what it costs and cheaper alternatives after a job loss.Short-Term Health Insurance: What It Covers, the Rules and the RisksWhat short-term plans cover, what they leave out and the current rules.Medicaid vs. Marketplace Health Insurance: Which Can You Get and How Do They Compare?Medicaid eligibility, 2027 work requirements and how it compares with Marketplace cover.

Frequently asked questions

When is open enrollment for 2027 health insurance?

On HealthCare.gov, November 1, 2026 to January 15, 2027. Enroll by December 15 for cover starting January 1. Some state marketplaces have different dates.

Is health insurance required?

There’s no federal penalty for being uninsured, but a few states, including California, Massachusetts, New Jersey, Rhode Island and Washington, D.C., have their own mandates.

What is the cheapest way to get health insurance?

For most people, an employer plan or, if your income qualifies, Medicaid or a subsidized Marketplace plan. Compare total yearly costs, not just premiums.

Can I be denied health insurance for a pre-existing condition?

Not for ACA-compliant plans, Medicaid or CHIP. Short-term plans can deny or exclude pre-existing conditions.

What happens if I miss open enrollment?

You can only enroll in a Marketplace plan outside open enrollment if you have a qualifying life event, such as losing other cover, moving, marriage or a new baby.

Sources

Insurance prices, discounts and rules change often and vary by state. Figures were checked in October 2026; confirm details with the insurer or your state insurance department.