Health Insurance FAQs: Straight Answers for 2027

Three big things. First, the enhanced premium tax credits that ran from 2021 through 2025 have expired, so many people will get smaller credits. Second, the 400% federal poverty level cutoff is back, which means households above it generally get no credit. Third, starting with tax year 2026, if you receive more advance credit than you qualify for, you have to repay all of it. On HealthCare.gov, open enrollment for 2027 runs November 1, 2026 through January 15, 2027, and you need to enroll by December 15 for coverage that starts January 1.

Many people are automatically moved into the same or a similar plan at the new year's price. That can be fine, but it can also mean a higher premium, a smaller tax credit, a discontinued plan, or a doctor or medication that's no longer covered. A quick review before December 15 is the safest move.

The Marketplace estimates a monthly discount, called the advance premium tax credit (APTC), from your projected 2027 household income and tax household size. It lowers your premium right away. At tax time, the advance credit is compared with your actual income on your federal return. If you earned less than you estimated, you may get more credit back. If you earned more, you'll owe the difference, and starting with tax year 2026, you repay the full amount because the old caps are gone. Credits generally stop above 400% of the federal poverty level. I'll help you set a realistic income estimate and update it if anything changes mid-year.

Tip: If your income varies (self-employed, seasonal, or more than one job), we'll talk about a careful approach to your estimate so you're less likely to owe money back at tax time.

CSRs lower what you pay when you use care: deductibles, copays, and out-of-pocket maximums. They're only available on Silver plans, and only for households in qualifying income ranges. When CSR applies, a Silver plan can feel like a higher-tier plan when you use care. I'll check whether you qualify and show you a true side-by-side of Bronze, Silver with CSR, and Gold.

Each carrier keeps its own provider directory, and networks change. I collect your list of doctors and clinics, then check them against each plan you're considering. If a favorite is out of network, I'll show you alternatives or estimate the real cost of going out of network so you can decide with confidence.

Good to know: HMO and EPO plans usually require you to stay in-network except in true emergencies. PPO plans are more flexible but can cost more. I'll match the network type to how you actually use care.

A formulary is a plan's list of covered drugs. Plans sort medications into tiers (generic, preferred brand, non-preferred, specialty), and each tier has its own copay or coinsurance. I compare your medication list with each plan's formulary, check for prior authorization or step-therapy rules, and estimate your monthly costs. If there's a lower-cost alternative, I'll flag it so you can talk about it with your doctor.

During open enrollment, or if you have a qualifying life event (QLE), like losing coverage, moving, getting married, or having a baby. For 2027 on HealthCare.gov, open enrollment runs November 1, 2026 through January 15, 2027. Enroll by December 15 for January 1 coverage, or between December 16 and January 15 for February 1 coverage. States with their own marketplace may use different dates. I'll keep track of the timing so your coverage starts when you expect it to.

Your premium is what you pay each month to keep your plan active. Out-of-pocket costs are copays, coinsurance, and what you pay before you reach your deductible and out-of-pocket maximum. I add up your doctors, prescriptions, and likely care to estimate your total yearly cost, not just the premium, because the cheapest plan per month isn't always the best value for the care you actually use.

Have ready: full legal names, dates of birth, Social Security numbers (if you have them), your address, email, and phone, plus income information for 2027 (W-2s, recent pay stubs, 1099s, Social Security statements, or a projection if you're self-employed). If you're not a U.S. citizen, have your immigration documents (for example, a green card, work permit, or naturalization record). I'll confirm exactly what you need before your appointment.

Yes. Your plan isn't active until the carrier receives your first premium. I'll walk you through that payment and confirm your start date so you're covered when you expect to be.

No. HealthSherpa is a secure online way to enroll with me as your broker, and you can use it on your own time. If you'd rather talk it through, book an appointment or call me and I'll handle the enrollment with you.

Tell me as soon as you can. I'll update your Marketplace application so your monthly tax credit adjusts. Because excess advance credits now have to be repaid in full, this matters more than ever. And if your income goes down, updating can lower your premium right away.

Yes, if you receive advance premium tax credits, you have to file a federal return to reconcile them. Most people do anyway. You'll get a Form 1095-A from the Marketplace, and I'll explain where its numbers go.

If you move to a new county or state, you'll usually need to pick a new plan. A move generally qualifies you for a special enrollment period. I'll help you compare networks and drug lists in your new area so your care moves with as little disruption as possible.

No. Licensed brokers are paid by the insurance carriers. You pay the same plan price you'd see on your own, and you get my guidance, a careful enrollment, and support all year.