Open enrollment for 2027 ACA Marketplace coverage began November 1, 2026 and runs through January 15, 2027, with December 15, 2026 as the deadline for coverage that starts January 1, 2027. The doctor question comes last for most shoppers, and it is the one that is hardest to undo: once your plan year starts, you generally cannot switch plans unless you qualify for a Special Enrollment Period. A provider directory is a plan's own list of doctors, hospitals and clinics, and directories are often wrong.
Adults under 65 who buy a plan on HealthCare.gov or a state Marketplace, or who pick an employer plan, can use the same verification routine and the same federal protections. This page covers the three-step check, why a doctor can be listed and still be out of network, and what the law says when a directory was wrong. For the definitions, see the in-network vs out-of-network glossary entry.
Coverage Breakdown
Direct answer: confirm your doctor three ways before 2027 enrollment
Yes. Before you enroll in 2027 coverage, search the plan's directory, call the insurer to confirm your doctor is in that exact network, then call the doctor's office and ask if it accepts that specific plan. Record the date, the person's name and a reference number. Insurers must answer network questions in writing within 1 business day.
The three-step check for ACA-compliant plans in 2027
HealthCare.gov and state Marketplaces sell ACA-compliant plans, and for 2027 coverage you can start comparing from November 1, 2026. HealthCare.gov lets you add your doctors, hospitals and other facilities during plan comparison and then shows whether each plan lists them in network. Treat that result as a shortlist, not a guarantee, and run the next three steps on the one or two plans you are seriously considering.
- Step 1, directory: open the insurer's own directory from the link in your Marketplace plan description. Select the exact plan and network name, not just the insurer name, then search your doctor by name and by the office address you actually visit. Check the last-updated date.
- Step 2, insurer call: use the member or sales number on the insurer's website. Ask 'Is Dr. [name], NPI [number if you have it], at [address] in network for [exact plan name] for 2027?' and ask them to send the answer in writing or by secure message. Note the date, the representative's name and the reference number.
- Step 3, office call: ask the front desk whether this doctor, at this location, is accepting new patients under the exact plan name. Ask whether the practice has a contract for that network or only for another plan from the same insurer. Also confirm the facilities where you would need care, such as the lab, imaging center and hospital.
- Then enroll, only after the answers match: if the directory, the insurer and the office disagree, trust the written insurer answer and keep looking. A plan that fails this check is not worth choosing on premium alone.
Why a listed doctor can still be out of network (ghost networks)
A ghost network is a provider directory that lists doctors who are not actually available to new patients under that plan. Common causes include doctors who left the network, retired or moved, practices that stopped accepting new patients, a doctor who works at several locations but contracts for only one, and listings under the wrong insurer network. Directories are built from data that insurers collect and update on their own schedule.
Network type matters for the stakes. HealthCare.gov explains that an HMO generally will not cover out-of-network care except in an emergency, while a PPO lets you see providers outside the network for an additional cost. A wrong directory entry on an HMO can therefore mean a bill for the full price of the visit, so verify most carefully if your plan is an HMO or EPO.
What the plan must do under federal law: 90-day updates and 1-business-day answers
Federal law at 42 U.S.C. 300gg-115, part of the No Surprises Act, sets directory rules for group health plans and for insurers in the group and individual markets, for plan years beginning on or after January 1, 2022. A plan must verify and update its directory listings at least once every 90 days, and it must have a procedure to remove providers it cannot verify. If you call to ask whether a provider is in network, the plan must respond in writing as soon as practicable and no later than 1 business day, and it must keep that response in your file for at least 2 years.
That written reply is the most useful document you can collect before enrolling in 2027 coverage. Ask for it by name: 'Please confirm in writing that this provider is in network for this plan.' Keep screenshots of the directory page with the date visible as well.
If the directory was wrong: your in-network cost-sharing protection
If you received care from an out-of-network provider because you relied on incorrect network information from the plan's directory, database or phone response, the plan cannot charge you more than in-network cost sharing for care it would have covered in network. The plan must also apply your deductible and out-of-pocket maximum as if the provider were in network. This protection, in 42 U.S.C. 300gg-115(b), is separate from the surprise-billing limits for emergencies.
To use it, act quickly and keep records. Save the directory screenshot or the written insurer reply that listed the provider. File an appeal with the plan, attaching that proof and asking that the claim be reprocessed at in-network rates. If the plan will not comply, you can submit a complaint to the CMS No Surprises Help Desk at 1-800-985-3059 or through cms.gov, and you can also contact your state department of insurance. Related billing terms are explained in the balance billing glossary entry.
Alternatives if your doctor turns out not to be in network
When the check fails before you enroll, you still have options, and the cheapest time to use them is during open enrollment, which runs through January 15, 2027. Compare these routes before you pick a plan.
- Switch to another plan: use the HealthCare.gov doctor search to find plans that list your doctor, then repeat the three-step check on them. A PPO or POS plan may allow out-of-network visits at a higher price if you must keep the doctor.
- Choose an in-network doctor of the same kind: ask the insurer for the names of in-network providers in your specialty near you, and ask your current doctor for a referral.
- Ask the practice about joining the network: some doctors will start the contracting process if several patients ask, though that rarely finishes in time for a January 1 start.
- Ask about continuity of care if you are mid-treatment: federal rules let some continuing care patients keep in-network cost sharing for a transition period when a provider leaves the network. Ask the plan whether you qualify before you assume you do not.
- File a complaint when the directory was wrong: report ghost network problems to your state department of insurance and to CMS at 1-800-985-3059, which also helps other enrollees.
How to enroll once your doctor is confirmed (2027 coverage)
Open enrollment for 2027 coverage runs November 1, 2026 to January 15, 2027. Per HealthCare.gov, you must enroll or change plans by December 15, 2026 and pay your first premium for coverage to start January 1, 2027; enrolling December 16 through January 15 starts coverage February 1, 2027. Confirm those dates on HealthCare.gov before you rely on them, because deadline rules can change. Start your application at HealthCare.gov, or at your state Marketplace if your state runs its own.
Frequently Asked Questions
How do I check if my doctor takes my insurance before I enroll in 2027 coverage?
Use three checks. First, search the insurer's directory for the exact plan and network. Second, call the insurer and ask for written confirmation, which federal law requires within 1 business day. Third, call the doctor's office and ask if it accepts that exact plan name. On HealthCare.gov you can also add your doctors during 2027 plan comparison to see which plans list them.
What is a ghost network?
A ghost network is a health plan directory that lists doctors who are not really available under that plan, for example because they left the network, retired, moved or are not taking new patients. Ghost listings make a plan look larger than it is. Verify any doctor you need by phone with both the insurer and the office before enrolling.
Is the HealthCare.gov doctor search enough to confirm my doctor is in network?
No. The HealthCare.gov plan comparison tool shows whether each plan lists your doctors, hospitals and facilities in network, which is a useful shortlist. The data comes from insurers and can be out of date, so confirm with the insurer and the doctor's office before you pick a plan. Do this before the 2027 enrollment deadlines.
How often must insurers update their provider directories?
Under 42 U.S.C. 300gg-115, a plan must verify and update its directory listings at least every 90 days and must have a process to remove providers it cannot verify. The rule applies to group health plans and to insurers in the group and individual markets for plan years beginning on or after January 1, 2022.
What happens if I see a doctor the directory said was in network and it was wrong?
If you relied on incorrect network information from the plan's directory, database or phone response, the plan cannot charge more than in-network cost sharing for care it would have covered in network. Your payments must count toward your in-network deductible and out-of-pocket maximum. Appeal to the plan with your proof, then contact your state insurance department if needed.
Does the in-network protection apply if I only looked at the directory myself and never called?
The federal protection covers reliance on incorrect information from the plan's directory or database, as well as phone answers. Even so, a dated screenshot of the listing is essential proof, and a written reply from the insurer is stronger. Capture the page showing the provider, plan name and date before you book care.
Who do I contact if a plan will not fix a wrong directory claim?
Start with the plan's appeal process, then file a complaint with your state department of insurance. For federal surprise billing and directory protections you can also call the CMS No Surprises Help Desk at 1-800-985-3059 or submit a complaint at cms.gov. Include your screenshot, call log and written insurer confirmation with the complaint.
What if my doctor leaves the network after I enroll?
Ask the plan about continuity of care. Federal rules allow some continuing care patients, such as people in an active course of treatment, to keep in-network cost sharing for a transition period after a provider leaves. Notify the plan quickly and ask for the decision in writing.
