Open Enrollment 2027: Compare Two Health Plans on Total Yearly Cost

Open enrollment for 2027 Marketplace coverage starts Nov. 1 on HealthCare.gov and is already under way in Massachusetts, and the plan with the lowest monthly premium is not always the one that costs the least over a full year.

The 2027 dates

HealthCare.gov lists open enrollment for 2027 coverage as Nov. 1, 2026, through Jan. 15, 2027. Shoppers who enroll by Dec. 15 get coverage starting Jan. 1; those who enroll after that, through Jan. 15, get coverage starting Feb. 1. Healthinsurance.org and Medical Daily report the same schedule for states that use HealthCare.gov.

Massachusetts runs its own exchange, the Massachusetts Health Connector, and opened earlier. Its open enrollment began Oct. 23, 2026, and runs through Jan. 23, 2027, according to the Healey administration and the Connector. Residents must choose a plan and make the first premium payment by Dec. 23, 2026, for coverage starting Jan. 1, or by Jan. 23 for coverage starting Feb. 1.

The federal dates nearly changed. A rule the Centers for Medicare & Medicaid Services finalized in June 2025 would have required every exchange to end open enrollment by Dec. 31 starting with 2027 coverage, which would have closed the HealthCare.gov window on Dec. 15. A federal judge in Maryland vacated that provision in June 2026, and CMS confirmed the traditional schedule in August, according to healthinsurance.org and Medical Daily. Healthinsurance.org notes that the government has appealed, so later years could still change.

Four numbers on every plan

Every Marketplace plan page shows the same building blocks. HealthCare.gov defines them this way:

• Premium: the monthly bill, paid whether or not any care is used.
• Deductible: the amount paid for covered services before the plan starts to pay. All Marketplace plans cover certain preventive benefits in full even before the deductible is met.
• Copayments and coinsurance: a copayment is a fixed amount, such as $20 for a visit; coinsurance is a percentage of the cost, such as 20%, owed after the deductible.
• Out-of-pocket maximum: the most a member pays for covered, in-network services in a plan year. For 2027 Marketplace plans the limit is $12,000 for an individual and $24,000 for a family, up from $10,600 and $21,200 in 2026, according to HealthCare.gov and the benefits firm The Horton Group.

Two details matter for any estimate. Premiums do not count toward the out-of-pocket maximum, and neither do out-of-network care, services the plan does not cover or charges above the plan’s allowed amount. HealthCare.gov’s own coinsurance example shows how the pieces combine: with a $3,000 deductible, 20% coinsurance and $12,000 in allowed costs, the member pays the first $3,000 plus $1,800 in coinsurance, $4,800 in total.

Why the premium alone misleads

Marketplace plans come in metal levels. On average, Bronze plans pay about 60% of covered costs, Silver about 70%, Gold about 80% and Platinum about 90%, according to HealthCare.gov and Maine’s state exchange, CoverME.gov. Bronze plans carry high deductibles, while Gold and Platinum carry low ones. Shoppers who qualify for cost-sharing reductions, which lower deductibles, copays and coinsurance, receive them only on Silver plans, both sites say.

HealthCare.gov advises comparing total yearly health spending rather than the premium alone. The tradeoff is simple to state: a lower premium buys a larger share of the bill when care is used. In a year with little care, the cheaper premium usually wins. In a year with surgery, a birth or a chronic condition, the plan with the lower combination of premiums and out-of-pocket maximum can come out ahead even though its monthly bill is higher.

How to estimate a year of care

The best starting point is last year. Claims histories and explanation-of-benefits statements show what was actually billed and allowed; a list of regular prescriptions, specialist visits, therapy sessions and any planned procedures fills in the rest. From there, three scenarios cover most of the range:

• A light year: preventive care and a few visits.
• An expected year: the usual prescriptions and visits, plus one unplanned problem.
• A bad year: enough care to reach the out-of-pocket maximum. For any plan, the worst case for covered in-network care is 12 months of premiums plus that maximum.

Network checks belong in the same exercise, because out-of-network care sits outside the cap. In Massachusetts, the Connector’s PlanFinder tool checks whether specific doctors and hospitals are in a plan’s network; elsewhere, each plan’s provider directory is the place to confirm. The calculator below handles the core arithmetic for one person: it applies the deductible, then coinsurance, caps the result at the out-of-pocket maximum and adds a year of premiums. It does not model copays that sit outside the deductible, separate drug deductibles or family coverage, so its results are estimates.

Prices are rising again

Insurers proposed a median premium increase of 15% for 2027 across 276 Marketplace insurers, the second straight year of double-digit requests, according to an analysis by KFF and the Peterson Center on Healthcare; Medical Daily reported the same figures. The enhanced premium tax credits that had lowered costs for many enrollees expired at the end of 2025, KFF said. Final rates vary by state and insurer, which makes shopping more useful than renewing by default.

In Massachusetts, the Connector says members who do not choose a plan will be automatically enrolled in the lowest-cost plan at their current level in their area, and it lists carrier and plan changes for 2027 in some counties. Renewal notices are worth reading closely this year.

The Paxton-Digital Take

The premium is the only cost on a plan page that is certain; everything else depends on health, which no one can schedule. That is why a single comparison point misleads. Running two plans at three spending levels turns the choice into a range, and the crossover, the level of spending at which the higher-premium plan becomes the cheaper one, often arrives sooner than shoppers expect when deductibles differ by several thousand dollars. With premiums rising and the enhanced tax credits gone, households paying more of the bill themselves have more riding on that arithmetic. The calculator below is a planning aid, not advice. Final choices should be checked against the plan documents on HealthCare.gov or the Massachusetts Health Connector; the state says the Connector offers free in-person enrollment help at 50 locations in 29 languages.

What it means for you

• Mark the Jan. 1 deadline: Dec. 15 on HealthCare.gov, or Dec. 23, 2026, with first payment, at the Massachusetts Health Connector.
• Gather last year’s claims, prescriptions and planned care before comparing plans.
• Compare at least two plans at a light, expected and bad year; the bad-year cost is 12 months of premiums plus the out-of-pocket maximum.
• Check that doctors, hospitals and prescriptions are covered in network, since out-of-network care does not count toward the cap.
• In Massachusetts, review renewal notices: members who take no action may be moved into the lowest-cost plan at their level.