The Federal Poverty Level (FPL) household income guidelines for calendar year 2027
The Open Enrollment Period (OEP) deadlines for every state, including exceptions/special cases
The official ACA Exchange/Marketplaces to use to shop for & enroll in healthcare coverage
The 2027 Advance Premium Tax Credit (APTC) household income table for calculating subsidy eligibility
Ways to legally keep your Modified Adjusted Gross Income (MAGI) below the 400% FPL subsidy eligibility cut-off threshold, and...
A reminder that starting this year, there's no longer any caps on what portion of those subsidies you might have to pay back if your actual MAGI ends up being higher than you anticipated.
The Federal Poverty Level (FPL) household income guidelines for calendar year 2027
The Open Enrollment Period (OEP) deadlines for every state, including exceptions/special cases
The official ACA Exchange/Marketplaces to use to shop for & enroll in healthcare coverage
The 2027 Advance Premium Tax Credit (APTC) household income table for calculating subsidy eligibility
Ways to legally keep your Modified Adjusted Gross Income (MAGI) below the 400% FPL subsidy eligibility cut-off threshold, and...
A reminder that starting this year, there's no longer any caps on what portion of those subsidies you might have to pay back if your actual MAGI ends up being higher than you anticipated.
(sigh) Welp. Welcome to TrumpCare 2.0: The subsidies have been gutted, anyone earning more than 4x the federal poverty level is completely S.O.L., nearly anyone who isn't a U.S. citizen has been thrown under the bus, and there's more ugliness yet to come.
Even with all of this, however, the ACA isn't quite dead yet: It still offers affordable coverage to many people (if far less affordable than it was a year ago), it still offers a lot of vitally important patient protections, and it's still the only viable option for millions of Americans who are self-employed or who work for small businesses which don't offer decent health coverage on their behalf.
So, with that in mind, it's time once again to update my annual ACA Open Enrollment Period (OEP) Guide for 2027. As I noted last year, most of the Open Enrollment tips I give every year remain good advice, even if they kind of feel like slapping a Band-Aid® on a gaping gunshot wound this year.
ACA exchange enrollment has dropped by more than 26% in North Carolina since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Technically speaking, the year over year drop was as high as 27% in January due to an oddly sharp effectuated enrollment drop in January 2025...but over the first two months of 2026 this averages out to a hair over 200,000 North Carolinians losing coverage in just the first two months of the year:
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by 22% in Wyoming since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 11% vs. OEP 2025...and the drop-off grew to 16% year over year as of January and 22% as of February. That's nearly 10,000 Wyomingites who have lost ACA healthcare coverage in just the first two months of the year. While this may sound like a pretty small number, it's huge when you consider that Wyoming only has around 590,000 residents total.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by over 15% in Wisconsin since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were down 7% vs. OEP 2025...but effectuated enrollment was 11% lower year over year in January, rising to 15.6% lower as of February.
That's over 45,000 Wisconsinites who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by 13% in West Virginia since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Interestingly, while plan signups during the 2026 Open Enrollment Period were down nearly 17% vs. OEP 2025, effectuated enrollment as of February was actually only down 13%...it was down nearly 20% year over year in January, but actually increased slightly between January and February, which I believe makes West Virginia one of the only states to see that happen this year. Huh.
We'll have to see what develops over the rest of the year, of course, but this is especially unusual given that West Virginia has by far the highest unsubsidized premiums in the country this year (and will next year as well, as you'll see if you read further).
ACA exchange enrollment has dropped by a whopping 25% in Missouri since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down over 12% vs. OEP 2025...but effectuated enrollment in was 18% year over year as of January and 25% lower in February. That's over 86,000 Missourians who have lost their individual market healthcare coverage.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
ACA exchange enrollment has dropped by more than 26% in Mississippi since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were already down 7.3% vs. OEP 2025...but effectuated enrollment was 16.9% lower year over year in January and 26.4% lower as of February.
That's over 68,000 Mississippians who already lost coverage in just the first two months of the year...a number which has almost certainly continued to get worse since then.
ACA exchange enrollment has dropped by 20% in Kansas since Congressional Republicans allowed the enhanced federal subsidies to expire at the end of last year.
Initial signups during Open Enrollment were only down 3.6% vs. OEP 2025...but effectuated enrollment was 9.3% lower year over year in January, rising to 20% lower as of February.
That's over 36,000 Kansans who already lost coverage in just the first two months of the year...a number which has likely continued to climb since then.
Here's what this looks like visually, with both 2025 and 2019 (the last pre-COVID year, which didn't include the enhanced subsidies) included for comparison:
