Guides / Health insurance

By NorseHorse. Updated October 16, 2026. General information, not tax or insurance advice; confirm your situation with the Marketplace, your state Medicaid agency or a tax professional.

Open enrollment for 2027 Marketplace coverage starts November 1. Enroll by December 15 for coverage that starts January 1; enrollment ends January 15. The extra premium help of 2021 through 2025 is gone, so for 2027 the premium tax credit stops at 400 percent of the federal poverty level, and any advance credit you get beyond what you qualify for has to be paid back in full when you file.

Open enrollment dates for 2027 coverage

These are the HealthCare.gov dates:

• November 1: open enrollment starts.
• December 15: last day to enroll or change plans for coverage starting January 1.
• December 16 to January 15: enroll in this window and coverage starts February 1.
• January 15: open enrollment ends.

If your state runs its own Marketplace, check its site for its dates. Outside open enrollment you need a Special Enrollment Period, which comes with life events such as moving, losing other coverage, getting married or having a baby. You can apply for Medicaid and CHIP any time of year.

The premium tax credit for 2027

The premium tax credit lowers your monthly premium for a Marketplace plan. In general you qualify if your household income is at least 100 percent and no more than 400 percent of the federal poverty level for your family size. For tax years 2021 through 2025, Congress temporarily removed the 400 percent ceiling. That expansion has ended, and the table the IRS published for 2027 stops at 400 percent.

The Marketplace uses the previous year's poverty figures to set the next year's savings, so 2027 plans use the 2026 amounts: $15,960 for one person and $33,000 for a family of four (higher in Alaska and Hawaii). Four times those is $63,840 for one person and $132,000 for a family of four. Earn a dollar over that and the credit is zero.

The credit each month is the lesser of your plan's premium or the cost of your benchmark plan (the second-lowest-cost silver plan that applies to you) minus your expected contribution. Your expected contribution is a percentage of your household income, set for 2027 by Rev. Proc. 2026-26:

Plan prices and exact 2027 savings aren't out yet: HealthCare.gov shows them starting November 1. Congress could still change the credit, so check what the Marketplace shows when you apply rather than relying on any estimate made before then.

A worked example

You're single and expect $55,000 of wages and tips in 2027. That's about 345 percent of $15,960, so you're expected to pay 10.22 percent of your income, or about $5,621 a year ($468 a month), toward the benchmark plan. If the benchmark plan in your area costs $700 a month, your credit is about $232 a month. If you expect $65,000 instead, you're over 400 percent and get no credit at all, whatever the plan costs.

Why tipped income makes this risky

Your credit is based on the income you estimate for the year you want coverage, not last year's. Advance payments are settled on your tax return, and for tax years after 2025 there is no repayment cap: if you took more than you qualified for, you repay the full difference, which reduces your refund or adds to what you owe. Update your Marketplace application as soon as your income changes. If you log each shift's tips in Cashout, your running total gives you something real to base the estimate on (see tip tracking).

Medicaid depends on your state

In states that expanded Medicaid, you qualify if your household income is below 133 percent of the poverty level, which works out to 138 percent because of how it's calculated. A few states use a different limit. In a state that hasn't expanded, if your income is below the poverty level and you don't qualify under your state's other rules, you won't qualify for Medicaid or for Marketplace savings. Apply anyway: each state has its own options.

2027 adds work requirements for many adults in the Medicaid expansion group. Under the Medicaid community engagement rule, states have to start them no later than January 1, 2027, and some may start earlier. A state can ask HHS for a temporary good faith exemption to start later, but any exemption ends no later than December 31, 2028. They apply to adults 19 to 64 in the expansion group, in the 40 states and D.C. that expanded. You meet them with at least 80 hours a month of work, community service, a work program or half-time school, or with monthly income of at least the federal minimum wage times 80 hours. At today's $7.25 federal minimum, that's $580 a month. There are exceptions, including parents and caretakers of a child 13 or under, people who are medically frail, and pregnant people. Your state Medicaid agency will say how it checks. If you're found ineligible for Medicaid only because you didn't meet the requirement, the law also bars the premium tax credit for those months, so you can't switch to a subsidized Marketplace plan instead.

Coverage from your job if you work 30 or more hours

The ACA's employer rules apply to an applicable large employer: one that averaged at least 50 full-time employees, counting full-time equivalents, in the prior year. A full-time employee averages at least 30 hours of service a week, or 130 hours a month. A large employer that doesn't offer affordable coverage with minimum value to at least 95 percent of its full-time employees and their dependents may owe the IRS a payment, but only if at least one full-time employee gets a premium tax credit. The law doesn't stop an employer from covering part-time staff too.

This matters for your own credit. If your job offers coverage that is affordable and meets minimum standards, you won't qualify for a premium tax credit if you buy a Marketplace plan instead. For plan years starting in 2027, the affordability line is 10.22 percent of household income, measured against your share of the premium for the lowest-cost plan your employer offers. If your hours swing around 30, ask HR how they count them. For pay and hours rules, see tipped minimum wage by state.

The self-employed health insurance deduction

If you had a net profit on Schedule C, you can deduct premiums for medical, dental, vision and qualified long-term care insurance for yourself, your spouse and your dependents, plus a child under 27 at year end. For a sole proprietor, the policy can be in your own name or the business's name.

• You can't take it for any month you were eligible for a subsidized plan from an employer, including your spouse's employer.
• It's limited by your net profit from the business: Form 7206 takes the smaller of your premiums or the figure based on that profit.
• It goes on Schedule 1 (Form 1040) (line 17 on the 2025 form), so it lowers income tax, but you can't subtract it when you figure self-employment tax.
• If you also get the premium tax credit, the two are figured together. Publication 974 explains how.

Common questions

When is the deadline to sign up for 2027 health insurance?

On HealthCare.gov, December 15 for coverage starting January 1, and January 15 to get any 2027 plan during open enrollment. State-run Marketplaces publish their own dates.

Did the enhanced ACA subsidies get extended for 2027?

Not as of the IRS's 2027 figures. The temporary expansion covered 2021 through 2025, and the 2027 table tops out at 400 percent of the poverty level. If Congress acts later, the Marketplace will show the new amounts when you apply.

Can I get Marketplace help if my restaurant offers insurance?

Only if the job's coverage isn't affordable or doesn't meet minimum standards. If it passes both tests, you may still be able to buy a Marketplace plan, but without the credit.

I'm a 1099 driver. Can I deduct my Marketplace premiums?

Generally yes, through the self-employed health insurance deduction, for months you weren't eligible for an employer plan and up to the limit set by your net profit. See W-2 vs 1099 for the other ways the two kinds of work differ, and the retirement savings guide for the other benefit you have to set up yourself.

Track it all with Cashout. Shifts, tips, unpaid breaks, taxes, and mileage, logged in seconds. iPhone · Android