Here's what's changing, how it affects you, and how to keep your patients and your payments.
What is changing in the ACA marketplace for 2027?
Extra premium help has ended. The larger premium tax credits people got in past years expired and were not renewed. Many patients will pay more, and people earning more than 4 times the poverty level may get no help at all.
Some insurers are leaving. Centene (Ambetter) is leaving the Delaware and New Hampshire marketplaces for 2027, while expanding to new counties elsewhere.
Tighter broker rules. CMS now wants insurance brokers to record sales calls, to stop people being signed up for plans without their knowledge.
How this affects your practice
- Patients may switch to cheaper plans with high deductibles and smaller networks, which may not include you.
- Some patients will drop coverage and become self-pay.
- Higher deductibles mean bigger patient bills, and more unpaid balances.
- In Delaware and New Hampshire, Ambetter patients must find a new plan.
What to do now: 6 simple steps
How to turn this into an opportunity
Be easy to find.
Patients shopping for plans are also shopping for doctors. Update your Google Business Profile and website with the plans you accept.
Keep patients with clear prices.
Upfront self-pay prices keep patients who drop coverage coming back.
Join growing networks.
Insurers expanding into new areas need doctors. Centene, for example, is adding 40 counties in 2027.
Key dates
| Date | What happens |
|---|---|
| November 1, 2026 | Open enrollment starts |
| Varies by state | Enrollment deadline (check HealthCare.gov or your state exchange) |
| January 1, 2027 | New plans start. Check insurance at every visit. |
The bottom line
Tell patients to check your network before they pick a plan, verify insurance in January, and collect payment up front.
Frequently asked questions
When is ACA open enrollment for 2027?
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It starts November 1, 2026. Deadlines vary by state, so patients should check HealthCare.gov or their state's marketplace website.
Why are ACA premiums going up in 2027?
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The extra premium tax credits that lowered costs in recent years expired and were not renewed, so many people will get less help paying their premiums.
How can my practice help marketplace patients?
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Share the list of plans you accept, remind patients to check networks before choosing, and point them to free enrollment help.
What if a patient drops coverage?
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Offer a clear self-pay price list and payment plans, and remind them they may qualify for coverage during special enrollment or through Medicaid.
Feeling overwhelmed? HealthRescue Partners can help
If you're not sure how these changes will affect your patients or collections, HealthRescue Partners can help. We can:
- Explain the 2027 marketplace changes in plain terms
- Give you ready-made patient notices for open enrollment
- Help you set up a simple plan for collecting higher deductibles
Sources
- KFF Health News Morning Briefing: Centene exits two ACA marketplacesOct 21, 2026
- CMS urges marketplace insurers to have brokers record consumer callsBecker's Payer Issues, Oct 2026
- Senate fails to extend enhanced ACA subsidiesHealth Affairs Forefront
- HealthCare.govOfficial marketplace
This article is general information, not legal or billing advice.