Prepare for 2027 Insurance Changes

• The extra premium help is gone. The larger tax credits from 2021 to 2025 ended, and Congress hasn't brought them back. In 2027, people who qualify for premium help, generally those earning between 100% and 400% of the poverty level, pay at most 10.22% of their income for the benchmark plan, and there's no help above 400%.
• Premiums are likely to rise again. Insurers have asked for a median increase of about 15% for 2027, after about 20% for 2026. Final prices come out around November 1.
• The most you can pay out of pocket for covered, in-network care in 2027 is $12,000 for one person and $24,000 for a family. Care outside your plan's network can cost more.
• Many lawfully present immigrants lose premium tax credits on January 1, 2027, including refugees, people with asylum and people with Temporary Protected Status. Green card holders can still get them.
• Plans still renew on their own in 2027, premium help included. Automatic renewal with premium help ends for 2028, and staying put may cost you more even now. Compare plans this year.

What to do: Update your income on your application, compare plans instead of letting yours renew, and check whether a bronze plan with an HSA or a different metal level costs less overall.

• Work requirements start by January 1, 2027 for adults 19 to 64 who got Medicaid through expansion. You'll need about 80 hours a month of work, volunteering, job training or at least half-time school, or earnings of about 80 times the federal minimum wage. Some states started in 2026.
• Many people are exempt, including people who are pregnant or recently gave birth, people with disabilities or who are medically frail, parents or caregivers of children under 14, American Indians and Alaska Natives, and former foster youth.
• Expansion adults renew every 6 months instead of once a year.
• Medicaid covers less time before you apply. Starting January 1, 2027, it can pay bills from 1 month before you apply if you're an expansion adult, or 2 months for others, down from 3. Apply quickly after a hospital stay.

What to do: Keep your address up to date with your state, answer every notice by the date it gives, which can be as soon as 10 days, and keep proof of your hours or exemption. Our Medicaid work requirements FAQ has more.

• The most you'll pay for Part D drugs in 2027 is $2,400, up from $2,100. The standard deductible rises to $700.
• Negotiated prices for 15 more drugs start January 1, including Ozempic, Rybelsus and Wegovy, Trelegy Ellipta, Xtandi, Ibrance, Linzess, Vraylar, Otezla and Janumet.
• The Part B premium is projected at about $209.50 a month, up from $202.90. The official number usually comes out in the fall.
• In six states (AZ, NJ, OH, OK, TX and WA), Original Medicare now reviews some services, such as skin substitutes and nerve stimulator implants, before paying for them. Your provider can ask for approval first or have the claim reviewed after you get the care.

What to do: Read your Annual Notice of Change, then compare plans in the Medicare Plan Finder between October 15 and December 7, checking that your drugs and doctors are covered.

• HSA limits for 2027 are $4,500 for one person and $9,000 for a family, plus $1,000 more if you're 55 or older.
• An HSA-eligible plan needs a deductible of at least $1,750 for one person or $3,500 for a family. Starting in 2026, bronze and catastrophic plans you buy yourself (on the Marketplace or directly from an insurer) count as HSA-eligible whatever their deductible. A bronze-level plan through a job still has to meet the deductible above.
• The 2027 FSA limit isn't out yet. For 2026 it's $3,400, and plans can let you carry over up to $680.
• Job-based coverage keeps you from Marketplace help if it pays at least 60% of typical costs and covers hospital stays and doctor visits (called minimum value), and your share for the cheapest self-only plan is at most 10.22% of household income. For your family, the same test uses the cost of family coverage. If the plan fails either test, you or your family may qualify for Marketplace help instead.

What to do: Spend down your 2026 FSA or check your plan's carry-over rules, and set your 2027 HSA contributions to the new limits.

• Since January 2026, Medicare Advantage, Medicaid and HealthCare.gov plans have had to give a specific reason for every prior authorization denial. That reason is a starting point for your appeal.
• By January 1, 2027, those plans must let you check the status of a prior authorization online, and move your records when you switch plans. Drugs aren't included yet.
• Many insurers have promised that when you switch plans in the middle of treatment, the new plan will honor your old approvals for 90 days. It's a voluntary pledge, so ask your plan.

What to do: Before January 1, get prior authorizations for ongoing treatment renewed or documented. If you're switching plans, ask the new plan how it handles approvals you already have.