Open enrollment for 2027 begins Oct. 15 for anyone on Medicare and Nov. 1 for those with Affordable Care Act health insurance plans. With rising costs and changing regulations, this open enrollment season promises to be challenging.

Even if you’re happy with your current insurance, it is important to review your plan each year and check for any changes to its network or coverage rates. To avoid costly mistakes, take time to review your options. Avoid plans that aren’t regulated by the Affordable Care Act and aren’t suited to those with preexisting or chronic conditions.

When comparing plans, look beyond monthly premium costs. A plan with lower monthly premiums might not save money in the long term if it has a high deductible and out-of-pocket maximum. Copays (a set amount per visit or procedure) may save money over coinsurance (a percentage of the cost).

Before you begin, review PHA’s information on choosing insurance plans during open enrollment for more tips:

• Open enrollment
• Choosing insurance plans
• Choosing Medicare Part D plans
• PHA’s Insurance Worksheet

Be ready for sticker shock

The loss of premium tax credits at the end of 2025 has already affected 2026 enrollment in the ACA. About 19.2 million people were enrolled in ACA marketplace coverage in February 2026, a 13% drop from 2025, according to Health and Human Services Department data reported by the Center on Budget and Policy Priorities.

Active enrollment in ACA plans dropped in every state except New Mexico, which implemented its own state-funded supplemental subsidies to entirely replace the lost federal tax credits.

Prices are expected to continue rising. Insurance companies’ median proposed premium for 2027 ACA plans increased by 15% compared to 2026 plans, according to analysis from KFF.

Medicaid expansion’s most significant structural overhaul in years takes effect Jan. 1, 2027, and includes new work requirements. Review PHA’s Medicaid work requirements resource page to learn more and find the specific changes to your state’s Medicaid program.

Beware of non-ACA-regulated plans

Consumers looking for marketplace coverage frequently encountered aggressive and misleading marketing products that fail to provide protection from steep healthcare costs, according to a May 2026 secret shopper study by researchers at Georgetown University’s Center on Health Insurance Reforms.

Study authors warned that agents and brokers capitalized on health system upheaval and intense affordability challenges, reeling in consumers with promises of affordable and comprehensive coverage through short-term limited-duration insurance and fixed indemnity products as an alternative to the marketplace. PHA is a member of the Partnership to Protect Coverage coalition, which is supported by/connected with the Center on Health Insurance Reforms.

To guarantee a plan is fully ACA-regulated, purchase coverage directly through official government portals. Use the federal HealthCare.gov portal or your state’s official marketplace exchange. Here are other ways to avoid plans without consumer protections:

• Never buy a plan from an unsolicited phone call, text or a random social media advertisement.
• If the application asks for your medical history, prescriptions or preexisting conditions, it isn’t an ACA plan. Official ACA plans must accept everyone regardless of health status.
• ACA plans are legally banned from setting dollar limits on essential care.
• ACA plans won’t have waiting periods that refuse to pay for any care related to your rare disease for the first six to 12 months of the policy.

Remember that the ACA market may include private insurance plans, but the difference is that people can get federal assistance on ACA premiums if they make under 400% of the federal poverty level.

If you are struggling to afford premium costs, apply for help from the Patient Advocate Foundation’s TotalAssist fund for pulmonary hypertension. PH patients with any insurance type, including ACA plans, are eligible to apply. TotalAssist helps cover eligible out-of-pocket healthcare costs, including:

• Medication, copays, coinsurance and deductibles
• Health insurance premiums
• Office visit charges the day of treatment
• Administration charges related to treatment