Open enrollment is underway as Americans prepare to choose health insurance coverage for 2027. Most Americans under age 65 obtain coverage through employer-sponsored plans, with approximately 166 million people enrolled in such arrangements. An additional 19.2 million Americans were enrolled through Affordable Care Act marketplace plans for 2026, according to Department of Health and Human Services data from June. These marketplace participants typically include self-employed individuals, gig workers, early retirees, small business owners, and others without employer-based coverage.
For those using the federal ACA marketplace, open enrollment runs from November 1, 2026, through January 15, 2027. Coverage begins January 1, 2027, for enrollees who sign up by December 15, with February 1 coverage start dates for those enrolling between December 16 and January 15. Some states operate their own marketplaces with different enrollment periods—Idaho’s begins October 15 and Connecticut’s begins October 23, for example. Consumers are advised to navigate directly to healthcare.gov rather than using search engines, as research from Georgetown University found that online searches may direct consumers to products with fewer regulatory protections.
When selecting a plan, financial advisor Carolyn McClanahan recommends consumers consider two key questions about their healthcare needs and financial circumstances. The first involves determining the appropriate plan type—HMO, PPO, EPO, or POS—each offering different balances between cost, flexibility, and provider access. PPO plans offer greater flexibility but carry higher premiums, while HMO plans provide lower costs with more restrictions. Between these extremes are EPO and POS plans with varying levels of coverage and choice.
Beyond comparing premiums, consumers should understand cost-sharing differences including deductibles, co-insurance, and out-of-pocket maximums. Experts recommend verifying that preferred doctors and prescription medications are covered under a specific plan by consulting provider directories and formularies. Health savings accounts, which offer tax-free contributions, tax-deferred growth, and tax-free withdrawals for medical expenses, may provide additional financial advantages depending on plan selection.
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