A practical checklist for choosing 2027 coverage while there is still time to compare plans, costs, and care needs.
The start of health insurance open enrollment can feel like the beginning of a paperwork marathon. You may face unfamiliar plan names, changing premiums, new drug formularies, and several screens of insurance terminology, all while trying to predict what your family will need next year.
Preparation can make that decision more manageable. For most states using HealthCare.gov, open enrollment for 2027 coverage begins November 1, 2026, and runs through January 15, 2027. To start coverage January 1, enroll by December 15, 2026. Some state-operated Marketplaces have different schedules, so check your state’s official site.
Before November 1 arrives, I encourage consumers to take these seven steps to be a Prepared Patient:
1. Look back at how you used health care this year
List the appointments, prescriptions, tests, therapy visits, and hospital care your household needed in 2026. Note any new diagnoses or treatments planned for 2027. Include preventive care you postponed and any children or family members whose needs are changing.
This gives you a realistic starting point when a Marketplace comparison tool asks whether you expect low, moderate, or high medical use. No one can predict the year perfectly, but recent experience can guide better estimates.
2. Gather your income and household information
Marketplace financial help is generally based on your expected household income for the coverage year. Start with recent pay information and records of other income, then make adjustments for the year ahead. Consider anticipated changes in work, self-employment, retirement, family size, or dependent status.
Premium tax credits remain available for eligible households even though temporary enhanced federal tax credits ended after 2025. Eligibility and amounts depend on your circumstances. Estimate carefully, update the Marketplace when your situation changes, and remember that too much advance tax credit may need to be repaid at tax time.
3. Check your doctors and hospitals by exact plan name
Make a short list of the clinicians and facilities you use most: primary care, specialists, preferred hospital, behavioral health providers, and pharmacies. Once 2027 plans are available, search each plan’s directory. Then confirm directly with the practice and insurer if possible.
Do not assume a doctor who accepts an insurance company accepts every plan that company sells. Network changes can affect access to treatment and the price you pay.
4. List your prescriptions, including doses
Write down each medication, its strength, how often you take it, and where you fill it. Compare those details against the 2027 formulary, the plan’s list of covered drugs. Check drug tiers, pharmacy restrictions, prior authorization, and whether a prescription deductible applies.
A plan that looks affordable on premiums can become expensive if a single ongoing medication lands on a costly tier. If a drug appears to be excluded, ask about alternatives and exceptions before enrolling.
5. Set a budget for a normal year and an unexpected one
Compare the annual premium, deductible, copayments, coinsurance, and out-of-pocket maximum for each likely plan. Then estimate two scenarios: routine care and a major unplanned medical event. Include expenses that may fall outside the plan’s out-of-pocket limit, such as noncovered or out-of-network services.
The lowest monthly premium may cost more when you need care. Give extra attention to whether you could pay a large deductible early in the year. Ask whether a Health Savings Account could be useful and whether the plan is eligible.
6. Check savings before choosing a plan metal level
When you apply through the Marketplace, it can assess eligibility for premium tax credits and may direct eligible family members toward Medicaid or the Children’s Health Insurance Program. If you qualify for cost-sharing reductions, you generally must choose a Silver plan to receive the lower deductibles and copayments.
Compare Bronze, Silver, and Gold plans using your expected total yearly costs, rather than their labels alone. For some households, a Silver plan with cost-sharing reductions may be a better value than a lower-premium option.
7. Put the deadline and enrollment documents where you will see them
Create a simple folder with identification and household details, your expected income, medication list, provider list, and notices from your current insurer and Marketplace. Review any renewal letter carefully. If offered, automatic renewal may place you in a plan with changed premiums or benefits.
Set a reminder to compare plans when they become available, and another well before December 15 if you want coverage starting January 1. If the choices are confusing, ask a Marketplace-certified assister for free help. Finally, pay the first premium as instructed to start coverage.
You can complete several of these steps in one afternoon. Keep a single page listing your two or three leading plans and the unanswered questions you need to resolve. That page can be far more useful than trying to remember the differences among a dozen browser tabs.
In The Prepared Patient, I encourage readers to organize information before they must make decisions under pressure. Open enrollment provides a timely opportunity to put that advice to work.
Which part of choosing health coverage causes the most confusion in your household?
About the author Terry Adirim, MD, MPH, is a physician and the author of The Prepared Patient: Your Guide to Surviving the Health Care System (Johns Hopkins University Press, 2026).
Helpful resources: HealthCare.gov, 2027 Open Enrollment Dates and Deadlines | HealthCare.gov, Get Ready to Apply for Coverage | HealthCare.gov, How to Estimate Household Income | HealthCare.gov, Cost-Sharing Reductions | HealthCare.gov, Find Local Enrollment Assistance