Open enrollment for 2027 Marketplace coverage starts November 1, 2026, and most shoppers sort the plan list by monthly premium. The premium is the one number you pay every month whether or not you see a doctor, so it feels like the price. It is only the first of six numbers, and for anyone who uses health care in 2027 it is rarely the one that decides which plan costs less over the year. A plan with a $400 monthly premium and a $7,500 deductible can cost more than a plan with a $560 premium and a $2,500 deductible, or less, depending entirely on how much care you use.
This guide is for adults under 65 shopping on HealthCare.gov or a state Marketplace. It walks through the arithmetic with a worked 2027 example, shows how the official 2027 out-of-pocket limits and cost-sharing reductions change the answer, and lists what the math leaves out. For a comparison of the metal tiers alone, see Bronze vs Silver vs Gold ACA plans. Every dollar figure below is tied to the 2027 plan year unless it is labeled otherwise. To see which subsidy range you fall in, use the CoveredUSA screener.
Coverage Breakdown
Quick answer: how to compare health insurance plans for 2027
It depends on how much care you will use, and six numbers settle it. For 2027 plans, add twelve months of your net premium to your expected cost-sharing (deductible first, then coinsurance, stopping at the out-of-pocket maximum), then pick the lower total. Federal rules cap 2027 in-network out-of-pocket costs at $12,000 for one person and $24,000 for a family.
The six numbers that decide which 2027 plan is cheaper
Comparing 2027 health plans in the United States comes down to six numbers, and every plan on HealthCare.gov shows the first four on its plan summary. Pull them for each plan you are considering, write down your own estimate for the fifth, and check the sixth if your income is low enough to qualify. Then compute a total for each plan at three spending levels: a light year, a typical year, and a bad year. The plan with the lowest total at the level you think most likely is your answer, and the bad-year total tells you whether you could survive being wrong.
- Net monthly premium: the amount you pay after any premium tax credit, multiplied by 12 for the 2027 plan year.
- Deductible: what you pay for covered services before the plan starts to pay, except services the plan covers before the deductible, such as preventive care.
- Coinsurance and copays: your share after the deductible, such as 20% or 30%, plus flat copays for visits the plan prices that way.
- Out-of-pocket maximum: the most you pay in the plan year for covered in-network care, which cannot exceed $12,000 for one person or $24,000 for a family in 2027.
- Your expected covered care: a dollar estimate of the in-network care you and your household will use in 2027, built from last year's explanation-of-benefits statements plus anything planned.
- Your cost-sharing reduction level: if your household income is up to 250% of the federal poverty level, a Silver plan can carry a much lower deductible and out-of-pocket maximum than the same plan without the reduction.
Worked example: a lower-premium plan against a lower-deductible plan (2027)
Take two hypothetical 2027 plans for one adult. Plan A costs $400 a month after the subsidy ($4,800 for the year) with a $7,500 deductible, 30% coinsurance and a $9,200 out-of-pocket maximum. Plan B costs $560 a month ($6,720 for the year) with a $2,500 deductible, 20% coinsurance and a $7,000 out-of-pocket maximum. Plan B costs $1,920 more in premiums, so Plan A wins in any year where the care is cheap. The formula for each plan is the yearly premium plus the lesser of the out-of-pocket maximum and the deductible plus the coinsurance share of everything above it.
The break-even sits at $4,900 of covered in-network care in 2027. Below it, Plan A is cheaper by up to $1,920. Above it, Plan B is cheaper, by $2,130 at $8,000 of care and $2,280 at $15,000. Once both plans reach their out-of-pocket limits the gap shrinks to $280, because Plan A's $9,200 limit plus its $4,800 premium totals $14,000 and Plan B's $7,000 limit plus its $6,720 premium totals $13,720. The lesson is that the lower-deductible plan does not need a catastrophe to win: it needs a moderate year. Run your own numbers the same way for each plan on your list.
The 2027 out-of-pocket limits and cost-sharing reductions change the math
For 2027 plans, CMS set the maximum annual limitation on cost sharing at $12,000 for self-only coverage and $24,000 for other-than-self-only coverage, up about 13.2% from the 2026 limits of $10,600 and $21,200. Each person on a family plan still has the $12,000 individual limit. The limit covers in-network essential health benefits only, so premiums, out-of-network care and services the plan does not cover never count toward it, according to HealthCare.gov. Many plans set their own maximum below the ceiling, which is why the out-of-pocket maximum is a number to compare and not a constant.
Cost-sharing reductions change the comparison for lower incomes. For 2027, CMS set reduced out-of-pocket limits of $4,000 for household income from 100% up to 150% of the federal poverty level, $4,000 for income above 150% up to 200%, and $9,600 for income above 200% up to 250%, with family limits of $8,000, $8,000 and $19,200. The reductions apply only to Silver plans, per HealthCare.gov. The 250% line for 2027 coverage is $39,900 for one person, measured against the 2026 poverty guidelines. A person at that income can find a Silver plan whose real deductible beats a Gold plan with a larger premium.
Your premium tax credit sets the premium number in 2027
The premium in the six-number formula is the net premium, meaning what remains after the premium tax credit. For 2027 coverage, sold from November 1, 2026, the credit is available at household incomes from 100% to 400% of the 2026 poverty guidelines: $15,960 to $63,840 for one person and $33,000 to $132,000 for a family of four. The expected contribution runs from 2.15% to 10.22% of income. The enhanced credits that ended on December 31, 2025 were not extended, so above 400% of poverty there is no credit. The credit is pegged to the benchmark Silver plan, so a Bronze or Gold plan costs the benchmark premium difference rather than a fixed share of income.
Estimate your 2027 income carefully. For tax year 2026 and later there is no repayment cap, according to the IRS: if advance payments of the credit exceed the credit you qualify for, you repay the full difference on Form 8962 at any income. Starting with 2027 coverage the credit is also limited to citizens, green card holders, Cuban and Haitian entrants, and citizens of Micronesia, the Marshall Islands and Palau (P.L. 119-21, section 71301). If your income is below 138% of poverty ($22,025 for one person under the 2026 guidelines) in a state that expanded Medicaid, you likely qualify for Medicaid, not a Marketplace plan.
What the six numbers leave out: networks, covered services and the plan year
Networks decide whether the arithmetic applies at all. The out-of-pocket maximum counts in-network care only, so a plan that excludes your surgeon, your hospital or your therapist can cost far more than the totals suggest. Search each plan's provider directory for the specific doctors and facilities you use, and confirm the plan's covered-services list for anything you expect to need. HealthCare.gov lets you add providers before you compare, and the insurer's own directory is worth a phone call because directories lag behind contracts.
The plan year also matters. Deductibles and out-of-pocket maximums reset every January 1, so a large bill in December and another in January are two separate deductibles. Preventive care that the plan covers before the deductible, such as annual checkups, costs nothing toward your total under every Marketplace plan, so leave it out of the expected-care estimate. Copay-based plans need a small adjustment: add the flat copays you expect to the coinsurance estimate, and remember that some plans charge copays before the deductible for primary care visits.
How to compare plans on HealthCare.gov and when to enroll for 2027
Enrollment for 2027 coverage opens on November 1, 2026 and ends January 15, 2027 on HealthCare.gov, which lists December 15, 2026 as the last day to enroll or change plans for coverage that starts January 1, 2027. Confirm those dates on the HealthCare.gov dates page before relying on them, because the December 15 deadline has been disputed in court, and state-run Marketplaces set their own deadlines. After open enrollment closes you need a Special Enrollment Period, such as losing other coverage, to sign up. Medicaid and CHIP have no enrollment window and accept applications year-round.
- Update your HealthCare.gov application with your best estimate of 2027 household income so the subsidy shown is the one you will actually get.
- Add your doctors and facilities, then filter for the metal tiers you want to compare.
- Open each plan's summary and record the net premium, deductible, coinsurance or copays and out-of-pocket maximum.
- Compute yearly totals at a light, typical and bad level of care, then choose the plan you can afford in the bad case and that wins in the typical case.
Alternatives if you would rather not run the comparison yourself
Running this comparison for several plans and several spending levels takes real time, and getting it wrong can cost thousands of dollars, so help is a reasonable choice. Several free or low-cost options exist for adults under 65, and each can be found through an official starting point. A person who does this work all day will also know the local networks and which insurers in your county have narrow provider lists. Whichever route you take, ask the helper to show you the yearly total for each plan at the spending levels above, not just the premium.
- Marketplace Navigators and certified application counselors: free, impartial help found at localhelp.healthcare.gov.
- Licensed agents and brokers: can compare plans and enroll you through HealthCare.gov or a direct enrollment site; ask how they are paid and whether they show every insurer in your county.
- Medicaid or CHIP: if your household income is low enough, coverage with no premium may be available; check your state agency or the CoveredUSA screener first.
- Employer coverage: if your job offers a plan, compare its employee premium and deductible using the same six numbers before turning to the Marketplace.
- Catastrophic plans: available to people under 30 or with a hardship or affordability exemption, with low premiums and very high deductibles, and no premium tax credit.
Frequently Asked Questions
What numbers should I compare between health insurance plans?
Compare six numbers for 2027: the net monthly premium times 12, the deductible, the coinsurance or copays, the out-of-pocket maximum, your own estimate of covered in-network care, and whether you qualify for a Silver cost-sharing reduction. Add the premium total to your expected cost-sharing for each plan, stopping at the out-of-pocket maximum, then compare the totals.
Is the plan with the lowest monthly premium the cheapest?
Only in a light year. In the worked 2027 example on this page, the plan with the $400 premium wins below $4,900 of covered care, and the $560 plan wins above it, by $2,130 at $8,000 of care. The break-even depends on your expected care, so the lowest premium is cheapest only if you use little care in the plan year.
What is the difference between a deductible and an out-of-pocket maximum?
The deductible is what you pay for covered services before the plan starts sharing costs. The out-of-pocket maximum is the most you pay in the plan year for covered in-network care, including the deductible, copays and coinsurance. For 2027 plans it cannot exceed $12,000 for one person or $24,000 for a family. Premiums never count toward it.
Do premiums count toward the out-of-pocket maximum?
No. HealthCare.gov says the out-of-pocket maximum does not include monthly premiums, out-of-network care, services your plan does not cover, or charges above the allowed amount. That is why the formula adds twelve months of premium on top of your cost-sharing instead of treating the maximum as your total cost for the year.
Do cost-sharing reductions change which plan is cheaper?
Yes, for Silver plans. For 2027, the reduced out-of-pocket limits are $4,000 for income up to 200% of the federal poverty level and $9,600 for income above 200% up to 250%, per CMS. Silver with a reduction can beat Gold and Bronze on total cost. The reduction applies only to Silver, and you must enroll in Silver to receive it.
How do I estimate how much care I will use next year?
Start with last year's explanation-of-benefits statements and your insurer's claims history, which show the allowed amounts for visits, tests and procedures you used. Add anything planned, such as a scheduled surgery, pregnancy or recurring therapy. Then test each plan at a light, typical and bad level so one wrong guess does not decide the whole choice.
When can I enroll in a 2027 Marketplace plan?
HealthCare.gov opens enrollment for 2027 coverage on November 1, 2026 and closes it January 15, 2027, and lists December 15, 2026 as the last day to enroll for January 1 coverage. Check the HealthCare.gov dates page before relying on the December 15 date, because it has been disputed in court. After the window closes you need a Special Enrollment Period.
Can someone help me run this comparison for free?
Yes. Marketplace Navigators and certified application counselors give free, impartial help, and you can find one at localhelp.healthcare.gov. Licensed agents and brokers also compare plans and enroll you; ask how they are paid and whether they show every insurer sold in your county. Bring last year's claims so the helper can estimate your expected care.
