2027 ACA Premiums: What Should Therapists Tell Clients Now?

Reviewed by: Matthew Sexton, LCSW

Therapists whose clients buy their own Marketplace insurance can tell those clients, before open enrollment, that the Pennsylvania Insurance Department approved 2027 individual-market rates that rise an average of 15.97%, and that enrollment for 2027 coverage on HealthCare.gov opens November 1. The step is to point clients to HealthCare.gov or Pennie to compare plans before December 15, which HealthCare.gov lists as the last day to enroll in or change plans for coverage starting January 1; open enrollment there ends January 15; clients in Pennsylvania use Pennie, Pennsylvania’s marketplace. The dates come from HealthCare.gov, run by CMS, and the Pennsylvania figure from the Pennsylvania Insurance Department, all checked October 4, 2026. They show the 2027 enrollment calendar and Pennsylvania’s approved individual-market average. They do not prove how many therapy clients hold Marketplace plans or whether any plan for next year covers a given clinician.

Key takeaways

• Enrollment for 2027 Marketplace coverage starts November 1, per HealthCare.gov.
• December 15 is the cutoff for coverage that starts January 1, per HealthCare.gov.
• Pennsylvania’s approved 2027 individual-market rates rise 15.97% on average, per the Pennsylvania Insurance Department.
• Losing coverage can open a Special Enrollment Period, per HealthCare.gov.

What Dates Should Clients Know for 2027 Coverage?

The calendar has four fixed points. HealthCare.gov says people can apply for 2027 coverage or update an application starting November 1, and the glossary defines the yearly Open Enrollment Period as November 1 through January 15, noting that job-based plans may run different periods. Coverage starts January 1 only for people who enroll or change plans by December 15 and pay their first premium. Anyone who enrolls or changes plans December 16 through January 15 gets coverage starting February 1, again after the first payment. After January 15, federal open enrollment is closed, and a plan change requires a Special Enrollment Period.

How Much Are 2027 Premiums Rising?

Pennsylvania has an official figure; the national picture comes from reporting. The Pennsylvania Insurance Department says people who buy their own coverage will see an average increase of 15.97% in the individual market for 2027, down from the 17.14% insurers requested, and that increases will vary significantly based on plan type, region, and individual circumstances. State regulators, per WHYY, cite the loss of pandemic-era enhanced premium tax credits among the cost drivers. Nationally, CNBC reports that many consumers insured at work or through the Marketplace may see premium increases next year and lists the expiration of enhanced subsidies among the factors experts named. No official CMS national average for next year was found.

What Happens If a Client Loses Qualifying Coverage?

A lapse need not mean waiting a full year, because federal rules carve out exceptions. HealthCare.gov says a household may qualify for a Special Enrollment Period if someone lost qualifying coverage in the past 60 days or expects to lose it in the next 60 days. Medicaid and CHIP accept applications any time of year. In Pennsylvania, Pennie tells people losing coverage to apply at least a week before current coverage ends. Whether a client qualifies for any of these is a question for the marketplace, not the therapist; the clinician’s part is knowing the options exist and naming the official site.

Does the Broker Moratorium Stop Clients From Enrolling?

The rule pauses registration for certain agents and brokers. An HHS and CMS interim final rule, effective September 22, 2026, says agents and brokers without a Plan Year 2026 Exchange agreement cannot complete registration with the federally-facilitated Exchanges for Plan Year 2027 until February 1, 2027. The rule says the pause runs until February 1, 2027 unless CMS lifts it earlier, extends it further, or otherwise modifies it. To be assured consideration, comments are due November 21, 2026. The sources checked here do not say it blocks consumers from enrolling or affects state exchanges such as Pennie.

What Can a Clinician Do Without Giving Billing Advice?

The useful move is informational, not financial. A clinician can share the official dates and name HealthCare.gov or Pennie as the place to compare plans. Plan choice, cost and coverage of mental health services belong to the client and the plan; no source here says whether any plan for next year covers a given clinician. Couch Commons is a directory where clients can find clinicians. MWS has also explained what the No Surprises Act covers in mental health.

What the Evidence Does Not Show

No source here shows what share of any caseload is on Marketplace plans, or that clients will stop therapy because of next year’s premiums. The subsidy status comes from WHYY and CNBC, not from a primary government statement, and no official CMS national average for next year was found.

Takeaway

The dates are fixed and official: November 1 to open, December 15 for January 1 coverage, January 15 to close on HealthCare.gov. A short conversation before December 15, pointing clients to the official marketplace, is the step a clinician can take without giving billing advice.

Frequently asked questions

When does open enrollment for 2027 Marketplace coverage start and end?

HealthCare.gov says people can apply for 2027 coverage starting November 1, and federal open enrollment ends January 15. December 15 is the last day to pick a plan for coverage that starts January 1 (HealthCare.gov).

What happens if a client picks a plan after December 15?

HealthCare.gov says people who enroll or change plans December 16 through January 15 get coverage starting February 1, after paying the first premium (HealthCare.gov).

Can a client who loses coverage outside open enrollment still get a plan?

Possibly. HealthCare.gov says losing qualifying coverage in the past 60 days, or expecting to lose it in the next 60 days, may qualify a household for a Special Enrollment Period (HealthCare.gov). Medicaid and CHIP accept applications any time of year (HealthCare.gov).

Does the new broker moratorium stop clients from enrolling?

The rule pauses registration with the federally-facilitated Exchanges for agents and brokers without a Plan Year 2026 agreement until February 1, 2027, unless CMS lifts it earlier, extends it further, or otherwise modifies it (Federal Register). The sources checked here do not say it blocks consumers from enrolling or affects state exchanges such as Pennie.

This article is general information for clinicians, not legal, billing or clinical advice.

Sources

All checked October 4, 2026.

• HealthCare.gov (CMS), “When can you get health insurance?”: https://www.healthcare.gov/quick-guide/dates-and-deadlines/
• HealthCare.gov (CMS), “Open Enrollment Period” glossary: https://www.healthcare.gov/glossary/open-enrollment-period/
• HealthCare.gov (CMS), “Getting health coverage outside Open Enrollment”: https://www.healthcare.gov/coverage-outside-open-enrollment/special-enrollment-period/
• Federal Register, CMS-9872-IFC, published September 23, 2026: https://www.govinfo.gov/content/pkg/FR-2026-09-23/pdf/2026-19493.pdf
• Pennsylvania Insurance Department, 2027 ACA rates release, September 18, 2026: https://www.pa.gov/agencies/insurance/newsroom/pennsylvania-releases-aca-2027-health-insurance-rates
• WHYY, Pennsylvania 2027 Pennie premiums, September 21, 2026: https://whyy.org/articles/pennsylvania-health-insurance-premium-increase-pennie/
• CNBC, 2027 health insurance premiums, October 2, 2026: https://www.cnbc.com/2026/10/02/health-insurance-premiums-2027-inflation-aca-obamacare.html
• Pennie, Pennsylvania’s official marketplace: https://pennie.com/