US health insurance: 2027 out-of-pocket limit rises to $12,000; enrol by 15 December for 1 January cover

Within a year, the individual out-of-pocket limit on US health insurance Marketplace plans has risen from $10,600 to $12,000. That is the 2027 figure listed by HealthCare.gov.

HealthCare.gov, the US federal health insurance Marketplace platform, now carries the message "Enroll for 2027 now": open enrolment for 2027 plans began on 1 November. To be covered from 1 January, you must enrol in or change a plan on or before 15 December and pay your first month's premium. All dates, amounts and conditions below are as of November 2026.

Three dates that decide when cover starts

15 December is not the end of open enrolment. HealthCare.gov says that if you enrol in or change a plan between 16 December and 15 January, cover starts on 1 February, again once the first premium is paid. 15 January is the last day of open enrolment; after that, you need to qualify for a special enrolment period to enrol or change plans.

• 1 November: open enrolment for 2027 plans begins.
• 15 December: the last day to enrol in or change a plan for cover starting 1 January.
• 16 December to 15 January: those who enrol in this period are covered from 1 February; open enrolment ends on 15 January.

Missing the deadline is not necessarily the end of the road. Life changes such as marriage, having a baby, moving or losing existing cover can let you enrol through a special enrolment period between 16 January and 31 October. Medicaid and the Children's Health Insurance Program (CHIP) accept applications all year round.

What changed on the bill after the enhanced subsidies ended

The research organisation KFF says the enhanced premium tax credits ended at the end of 2025, and average out-of-pocket premium payments for enrollees rose by 58% in 2026. Most people can still receive a lower level of subsidy, but those with income at or above 400% of the federal poverty level (about $62,600 for a single person in 2026) lose subsidies entirely and face the full premium increase.

An analysis published by KFF on 8 July 2026 reviewed preliminary rate filings from 77 insurers in 16 states and Washington, DC. The median proposed premium increase for 2027 is 14%; most insurers requested between 10% and 20%, and 20 requested more than 20%. These are preliminary filings, not final approved rates.

The reasons insurers gave for the increases include: costs of medical services and drugs (including GLP-1 drugs) expected to rise by 10%; insurers expecting a worse risk pool, a factor KFF says pushed premiums up by about 4 percentage points in 2026 and is expected to add about another 4 percentage points in 2027; and recent changes to federal rules.

New federal rules: tighter checks, fewer options

The US Centers for Medicare & Medicaid Services (CMS) published the final 2027 Notice of Benefit and Payment Parameters on 15 May 2026, effective 20 July 2026. Changes that affect enrollees directly include:

• Standardised plan options are eliminated.
• From the 2027 plan year, individual-market bronze plans use adjusted de minimis actuarial value parameters.
• Routine adult dental can no longer be classed as an essential health benefit.
• For the 2027 plan year, the federal platform applies a "one-year" policy to people who have not filed and reconciled their taxes, denying them advance premium tax credits.
• The federal platform must verify at least 75% of new special enrolment period registrations; the special enrolment period for those at up to 150% of the federal poverty level stays eliminated after the 2026 plan year.
• Where the US Internal Revenue Service (IRS) has no relevant income data, exchanges are no longer required to accept self-attested income; where data show household income below 100% of the federal poverty level, additional verification is also required.

Comparing plans: premium, deductible and out-of-pocket limit side by side

Choosing a plan on the monthly premium alone is like buying a car on the monthly instalment alone. Look at the following three numbers together.

1. Premium: the amount you pay each month, whether or not you use care. It does not count towards the out-of-pocket limit.
2. Deductible: the amount you pay each year for certain covered services before the plan starts to pay; free preventive services are excluded.
3. Out-of-pocket maximum: the most you pay for covered services in a plan year. Once you reach it through deductibles, copayments and coinsurance for in-network care, the plan pays 100% of covered services. For 2027 Marketplace plans the limit is $12,000 for an individual and $24,000 for a family; for 2026 it was $10,600 and $21,200.

A rough calculation: a year's premiums plus the out-of-pocket maximum is broadly the worst-case cost of using covered, in-network services. But the limit has gaps: services the plan does not cover, out-of-network care and charges above the allowed amount do not count towards it. Before comparing, check whether the doctors you see regularly are in the network.

The self-employed and freelancers: estimate this year's income first

Without an employer arranging cover, a few points differ from those for employees when applying.

• Income for the year you enrol: HealthCare.gov asks you to estimate your net self-employment income for the year you are enrolling for, not the previous year's figure. Subsidy eligibility depends on income and household size, and some people may also qualify for Medicaid or CHIP.
• Income but no employees: a business with income but no employees counts as self-employed and can use the individual market. If you have at least one employee (not counting yourself, your spouse, family members or the owner), you may consider the Small Business Health Options Program (SHOP). Hiring independent contractors alone does not make you an employer.
• A spouse with job-based cover: if your spouse's job-based coverage covers the spouse and dependants, you generally do not qualify for the premium tax credit; married couples generally must file taxes jointly to receive the subsidy, with limited exceptions.

Whether self-employed people can deduct health insurance premiums from tax is a rule this article could not verify. Please check the latest IRS guidance or consult a licensed tax professional.

Before 15 December, compare the numbers side by side

To be covered from 1 January, you must enrol in or change a plan on or before 15 December and pay your first premium. Before then, compare the premium, deductible and out-of-pocket maximum side by side, and then decide. This article provides general information only and is not insurance or tax advice; for your personal circumstances, consult a licensed professional.

Prices and details correct as of November 2026

This article is general health information, not medical advice. For any health concern, consult a doctor or registered health professional.