Affordable Care Act open enrolment for 2027 has begun in most US states, with consumers facing higher premiums, tighter identity checks, fewer brokers and new restrictions on subsidy eligibility for some immigrants.
The sign-up period runs from 1 November to 15 January in most states. Idaho, Connecticut and Massachusetts opened earlier, while some state exchanges have already allowed customers to compare indicative prices.
Overall enrolment is expected to fall after enhanced subsidies expired at the end of 2025. Policy experts say millions lost or abandoned cover during the first months of this year as support became less generous.
The Trump administration has presented the decline as evidence that its efforts to tackle fraud are working. In August, it cancelled policies covering 760,000 people suspected of having been improperly enrolled, although a small number have since regained cover.
Stricter checks for consumers using brokers
Customers using an agent or broker through the federal marketplace, which serves 29 states, will face additional safeguards. The rules do not apply to state-run exchanges, which have their own arrangements.
Every consumer using an agent on the federal exchange must obtain a one-time confirmation code or link before authorising that agent to enrol them or make changes to their policy. The confirmation may arrive by text message, email or automated telephone call.
People whose contact details are out of date will first have to contact the federal marketplace themselves or submit an online application to update them.
Applicants classed as “high-risk” must also prove their identity before authorising an agent. The category includes first-time applicants, existing customers moving to another state, people changing broker and those with monthly premiums of $30 or less.
Identity checks may be carried out through an approved third party such as Experian. Those who fail may have to contact its help desk or apply independently through a Healthcare.gov account, uploading documents including a driving licence, passport or immigration papers.
Joshua Brooker, who runs an insurance agency in Pennsylvania, said the groups appeared to have been selected because of the risk of impersonation or unauthorised applications. He said low-cost plans could also be targeted because customers might not receive a bill, with some rogue agents paying the premium themselves while collecting commission.
Mr Brooker said he feared as many as one in five consumers could face additional identity checks and abandon the process rather than obtain cover.
Stacey Pogue, a senior research fellow at Georgetown University’s Center on Health Insurance Reforms, said legitimate applicants could struggle if they lacked a credit file, had moved home or changed their name.
She said the measures could be a suitable response to fraudulent enrolments but might also create additional obstacles for consumers.
Fewer brokers available during open enrolment
The Centers for Medicare & Medicaid Services has also imposed a moratorium on brokers who are new to selling Affordable Care Act cover. Agents not registered with the federal marketplace in 2026 cannot help with 2027 enrolments until at least February, after the main sign-up period has ended.
The agency said newly registered agents were responsible for a disproportionate share of significant compliance concerns in 2026. It has also removed hundreds of agents and brokers it described as non-compliant.
Jason Fine, who runs a brokerage in Florida, said he had reported cases in which rogue agents switched his clients’ cover without permission. He said the long-term aims of the changes made sense, but questioned whether officials understood the short-term disruption.
Mr Fine had planned to recruit up to 10 agents to a core team of about five. He said recruiters had warned that it would be difficult to find people who had been registered in 2026 and remained available.
He said the restrictions could unintentionally favour large call centres, which could afford to retain teams of 25 or 40 people throughout the year.
Groups representing insurance agents have challenged the moratorium in court. The National Association of Benefits and Insurance Professionals said it unfairly affected 19,000 agents who might want to sell ACA plans, while Health Agents for America has sought a temporary restraining order.
Stacey Pogue advised consumers who depend on brokers to arrange appointments early, warning that the reduced number of agents could mean their availability would fill quickly.
Premiums and subsidies remain under pressure
Most people buying ACA cover will still receive a subsidy, but it will be less generous than before the enhanced support expired. Premiums are expected to rise by about 15 per cent, following an increase of 26 per cent last year.
The support is linked to the cost of the benchmark plan in each area, helping to offset some premium rises. Louise Norris, a health policy analyst, said affordability would remain broadly similar for people who had managed to pay for cover during the current year, although costs would still be difficult for many households.
Subsidies are income-based and end for households earning more than four times the federal poverty rate. For the current open-enrolment period, that threshold is $63,840 for a single person, $86,560 for a couple and $109,280 for a family of three.
Anne Petry, who helps customers buy health insurance in Illinois, said affordability was likely to be the biggest challenge, adding: “There definitely will come a breaking point for people.”
Insurance agents are urging customers not to allow policies to renew automatically. Premiums, deductibles and other costs can change even when the plan remains the same, while some insurers, including Cigna, have withdrawn from part or all of their existing coverage areas.
The maximum amount consumers must pay towards deductibles, co-payments and coinsurance before remaining in-network costs are covered will also rise in 2027. It will increase from $10,600 to $12,000 for an individual and from $21,200 to $24,000 for a family.
Lower out-of-pocket limits apply to households earning up to 2.5 times the federal poverty level.
Some immigrants lose access to subsidies
Legislation passed last year also removes subsidy eligibility from many lawfully present immigrants, including people on temporary H-1B work visas, refugees, asylum seekers, people with temporary protected status and those with pending green-card applications.
Green-card holders, certain Cuban and Haitian immigrants, and citizens of Micronesia, the Marshall Islands and Palau remain eligible for ACA subsidies.
