Picking a health plan is one of the few purchases where the sticker price tells you almost nothing. A plan with a low monthly premium can cost far more over a year than one with a higher premium, and you usually find out only when a bill arrives. Add subsidies, metal tiers, four network types and a market where several insurers are packing up after 2026, and it is no surprise that a KFF survey found 51% of insured adults have trouble understanding at least some part of their coverage.
This guide takes the decision in order: when to shop and what has changed, whether you qualify for financial help, how to estimate what a plan will really cost, how to match a metal tier and network type to your household, and how to check the two things people skip most, the doctor directory and the drug list. If you want to see how the major carriers compare first, start with our roundup of the best health insurance companies of 2026, then come back here to pick the actual plan.
Step 1: Know your dates and what has changed
If you are reading this in the fall of 2026, you are shopping for 2027 coverage. Open enrollment on HealthCare.gov runs from November 1, 2026 through January 15, 2027. Enroll by December 15 for coverage starting January 1; enroll between December 16 and January 15 and it starts February 1. A 2025 federal rule tried to end open enrollment on December 15, but a court vacated it in June 2026 and CMS confirmed in August that enrollment runs through January 15. The official calendar is at HealthCare.gov.
State-run exchanges set their own deadlines: Idaho closes on December 15, Rhode Island on December 31, and California, New Jersey, New York and Washington DC on January 31, so check yours. Also note that the year-round special enrollment period for people under 150% of the poverty level was suspended in August 2025, so a low income no longer lets you sign up in any month you like.
Do not let your plan auto-renew without looking
This is the year to open the renewal letter. Cigna is leaving the individual ACA market in all 11 of its states on December 31, 2026, affecting about 369,000 members. Molina is shrinking from 14 states to 6 for 2027, Ambetter is leaving Delaware and New Hampshire, and regional carriers such as Baylor Scott and White in Texas and CareSource in Indiana, Ohio and West Virginia are also pulling out. If your carrier is on that list, you will be moved to a different plan or left without one unless you actively choose, so treat this open enrollment as a fresh purchase.
Step 2: Find out whether you qualify for help
The single biggest factor in what you pay is the premium tax credit, and the rules got tougher in 2026. The enhanced credits passed during the pandemic expired on December 31, 2025. The House passed a three-year extension in January 2026, but the Senate had already rejected one, and as of this writing nothing has been enacted. That means the original ACA rules apply:
- You qualify if your household income is between 100% and 400% of the federal poverty level (FPL). Above 400% you get nothing. This is the “subsidy cliff,” and it is back.
- Your expected contribution toward the benchmark plan runs from 2.10% of income at or below 133% FPL up to 9.96% of income between 300% and 400% FPL, per IRS Revenue Procedure 2025-25. The credit covers the rest of the benchmark premium.
- For 2027 coverage, the 2026 poverty guidelines apply: $15,960 for a single person and $33,000 for a family of four, so the cliff sits at $63,840 and $132,000 respectively. (2026 coverage used the 2025 figures of $15,650 and $32,150.)
- If your income is under 250% FPL, you also qualify for cost-sharing reductions that shrink your deductible and copays, but only on a Silver plan.
The credit is real money: 87% of 2026 marketplace enrollees received one, though the average net premium jumped from $113 to $178 a month once the enhanced credits ended. One warning: starting with the 2026 tax year there is no cap on how much excess advance credit you must repay if you underestimate your income, so estimate carefully and update the marketplace when your income changes. Our explainer on ACA subsidies and premium tax credits has the details.
A worked example
Say you are single and expect to earn $52,000 in 2027. Divide that by the $15,960 poverty level and you are at about 326% FPL, which puts you in the 300% to 400% band with an expected contribution of 9.96% of income. That works out to $5,179 a year, or roughly $432 a month, toward the second-lowest-cost Silver plan in your county. If that benchmark plan costs $650 a month (a made-up figure for illustration; your county will differ), your credit would be about $218 a month, and you can apply it to any metal tier, not just Silver. Now change one number: at $64,000 of income you are just over the $63,840 cliff and the credit disappears entirely. That is why it pays to know exactly where your income lands before you shop.
Step 3: Estimate your total yearly cost, not your premium
Your real cost is the premium plus what you pay when you use care, which depends on three more figures:
- Deductible: what you pay before the plan starts sharing costs for most services. The average 2026 marketplace deductible is $3,786, up $1,027 in a single year, according to KFF. Pick a deductible you could actually pay next month if you had to.
- Copays and coinsurance: the flat fees or percentages you pay for visits, prescriptions and procedures.
- Out-of-pocket maximum: the ceiling on what you pay for in-network covered care in a year. The federal limit is $10,600 for an individual and $21,200 for a family in 2026, rising to $12,000 and $24,000 in 2027 under the 2027 payment notice. Many plans set lower limits, and some Bronze plans may go higher from 2027.
The easiest way to run the math is to let HealthCare.gov’s plan comparison tool do it. Tell it whether you expect low, medium or high use of care and it shows an estimated total yearly cost for each plan, not just the premium. Then sanity-check two scenarios of your own: a healthy year with a couple of doctor visits, and a bad year in which you hit the out-of-pocket maximum. The right plan is the one whose worst case you could survive and whose typical case you can afford every month.
Step 4: Pick a metal tier
Metal tiers describe how costs are split between you and the insurer, and nothing else. HealthCare.gov puts it plainly: the tier has nothing to do with quality of care. A Bronze plan covers the same essential benefits as a Platinum plan; it just leaves more of the bill to you.
| Tier | Plan pays / you pay (average) | Premium | Usually best for |
|---|---|---|---|
| Bronze | 60% / 40% | Lowest | Healthy people who can cover a large deductible; HSA savers |
| Silver | 70% / 30% (73% to 94% with cost-sharing reductions) | Moderate | Anyone under 250% FPL, and shoppers who want a middle ground |
| Gold | 80% / 20% | Higher | People with regular prescriptions, chronic conditions or a planned procedure |
| Platinum | 90% / 10% | Highest | Heavy users of care who want predictable costs; not offered everywhere |
Three tier-specific rules matter this season:
- Silver is the only tier with cost-sharing reductions. If your income is under 250% FPL and you buy Bronze to save on premiums, you leave a much richer plan on the table. Silver’s share of enrollment fell from 57% to 43% in 2026 as Bronze rose to 40%, and some of those Bronze buyers would have done better in Silver.
- Every Bronze and Catastrophic marketplace plan is HSA-eligible from 2026. You can put up to $4,400 (individual) or $8,750 (family) into a health savings account, plus $1,000 if you are 55 or older, and deduct it.
- From 2027, some Bronze plans can carry an out-of-pocket maximum up to 130% of the standard limit, meaning up to $15,600 for an individual and $31,200 for a family. Read the limit on any Bronze plan you consider.
Catastrophic plans are limited to people under 30 or with a hardship or affordability exemption, and you cannot use a premium tax credit on one. For a deeper dive, see our guide to Bronze, Silver, Gold and Platinum tiers.
Step 5: Choose a network type you can live with
The letters after a plan name tell you how much freedom you have in choosing doctors. HMO and EPO plans cover nothing outside their network except emergencies, and HMOs usually require a primary care physician and referrals to see specialists. PPO and POS plans cost more but let you see out-of-network providers at a higher cost.
On the individual market, narrow networks are now the norm. Kaiser Permanente is a fully integrated HMO in its eight states plus DC, Molina sells narrow-network HMOs, and Oscar has moved from EPOs to HMO designs with referral requirements in Florida and other states for 2026, according to broker reports. Blue Cross Blue Shield plans are among the few places you will still find a PPO in many states, and they tend to cost more for that flexibility. If your doctors span several health systems or you split time between two states, that may be worth it; if everyone you see is in one system, an HMO can be a bargain. Our comparison of HMO, PPO, EPO and POS plans goes deeper.
Step 6: Check the doctor directory and the drug list
This is where most avoidable mistakes happen. The KFF consumer survey found 58% of insured adults had a problem with their insurance in the past year, and 18% had a claim denied. Many of those problems trace back to out-of-network care or a drug missing from the plan’s formulary. Before you enroll:
- Enter every doctor and prescription your household uses into HealthCare.gov’s comparison tool, which filters plans by both. State exchanges have similar tools.
- Call your most important providers and ask whether they accept the specific plan, not just the insurer. A doctor who takes an insurer’s employer plans may not take its marketplace HMO.
- Open the formulary and look up your medications by tier. A drug in a high tier or subject to prior authorization can cost far more than you assume.
- If someone in the household has ongoing treatment, confirm the hospital and specialists are in network too.
Step 7: Compare quality and service, then enroll
Once you have a short list of plans that fit your budget and network needs, use quality data to break ties. Every marketplace plan carries a star rating from 1 to 5 on HealthCare.gov, and NCQA publishes its own ratings by plan. J.D. Power’s 2026 member study found only 30% of commercial members consider their plan a trusted partner, with big differences by region; that study covers mostly employer plan members, so treat it as a rough guide to a carrier’s service culture rather than a verdict on its ACA plans. Perks such as $0 virtual visits can tip a close decision, but never let them override cost or network.
When you enroll, report your income honestly and update your application if your income or household changes. And do not coast next fall: under a 2025 rule, auto-renewal can no longer move you from a Bronze plan into a cost-sharing-reduction Silver plan even when you qualify, so the best plan for you may never be selected unless you select it. Our list of common health insurance mistakes covers the other traps.
Bottom line
Choosing a health plan comes down to a handful of decisions made in the right order: confirm your enrollment window, find out whether you qualify for a premium tax credit and cost-sharing reductions, estimate your total yearly cost under a good year and a bad one, then pick the metal tier and network type that fit how your household actually uses care. Verify your doctors and prescriptions before you click enroll. This year the one non-negotiable is to review your renewal, because a carrier that served you well in 2026 may not exist in your county in 2027.
For a starting point on which insurers are worth a look, see our independent ranking of the best health insurance companies of 2026.