Start Here: 2027 at a Glance
For people living with HIV, a health plan is more than a monthly bill. It is refills, lab work, and appointments that keep care steady. Staying in care and on treatment is what helps most people reach and keep an undetectable viral load.[1] Here is what to know first for 2027:
Prices, drug lists, and doctor networks change every year. Some insurers are leaving the Marketplace entirely for 2027. See New for 2027.
Before comparing prices, confirm your medicine is on the plan's drug list and your HIV provider is in network. See HIV Medicines.
A cheap premium can cost more over a year if your medicine has high coinsurance. See the Checklist.
Your state's ADAP may help with premiums or drug costs, but only for certain plans. Ask before you enroll. See ADAP & Ryan White.
Key Dates for 2027 Coverage
In states that use HealthCare.gov, open enrollment runs November 1, 2026, through January 15, 2027. CMS confirmed this window in August 2026 after a court blocked a rule that would have shortened it.[2]
| Date | What it means |
|---|---|
| Nov 1, 2026 | Open enrollment begins. Compare your current plan with 2027 options. |
| Dec 15, 2026 | Enroll by this date for coverage starting January 1. |
| Jan 15, 2027 | Last day of open enrollment. Coverage starts February 1. |
Pay your first premium. Picking a plan does not start coverage. Confirm the insurer's payment deadline and that your payment went through.[3]
Live in a state with its own exchange? Some states run their own Marketplace and set their own deadlines, sometimes later than January 15. Use HealthCare.gov to find your state's exchange, and check its dates directly.
What's New for 2027
Premiums are up again
Average benchmark silver premiums are rising 13% for 2027: about 11% in HealthCare.gov states and 16% in states with their own exchanges. This follows a 26% jump from 2025 to 2026.[4] Most enrollees still get tax credits that lower the price they pay. Your price depends on your plan, county, household, and income.
The out-of-pocket limit is higher
The most a Marketplace plan can make you pay for covered in-network care in 2027 is $12,000 for one person or $24,000 for a family, up from $10,600 and $21,200 in 2026. Many plans set lower limits. Premiums do not count toward this limit.[5]
Some insurers are leaving
As of late October, 11 insurers announced they are leaving at least one state for 2027, and 7 are entering new states. Cigna is leaving the individual market in all 11 states where it sells.[4] If your insurer is leaving, you will need to pick a new plan. Check that your HIV provider and medicine are covered before you switch.
Changes for some immigrants
Starting in 2027, premium tax credits are limited to lawful permanent residents (green-card holders), Cuban and Haitian entrants, and people living in the U.S. under the Compact of Free Association. Refugees, asylees, and some others can still buy a plan but lose tax-credit help.[4] A certified Navigator can review your situation.
Other changes to know
- Tax-time repayment has no cap. If you got more tax-credit help in 2026 than you qualified for, you repay the full excess when you file in early 2027.[6]
- Medicaid work rules affect Marketplace help. People who lose Medicaid for not meeting the new work requirement cannot get Marketplace tax credits instead. See our Medicaid 2027 guide.
- Watch for enrollment fraud. In September 2026, HHS canceled about 760,000 enrollments it called “phantom.” Be wary of anyone promising a $0 plan or cash to enroll, and check your account to confirm your plan is really yours.[4]
- Some states add their own help. New Mexico, California, New Jersey, Rhode Island, and Virginia offer extra state subsidies for 2027.[4]
- Courts blocked some new rules. These include the shorter enrollment window and the expanded catastrophic plans. People who missed reconciling past tax credits won't lose 2027 help for that reason alone. You still need to file Form 8962 if tax credits were paid for you.[2][4]
Metal Tiers, Explained
Bronze, Silver, Gold, and Platinum describe how you and the plan share costs, not the quality of care. All Marketplace plans cover the same broad categories of essential benefits, but their drug lists, networks, and charges can differ.[7]
| Tier | What to check for HIV care |
|---|---|
| Bronze | Lowest premiums, highest costs when you use care. Check what your monthly medicine and lab visits would cost before the deductible is met. |
| Silver | The only tier with extra cost-sharing reductions for people with lower incomes, generally up to 250% FPL. If you qualify, start here.[8] |
| Gold | Higher premiums, lower costs when you use care. Often a good fit if you refill medicine monthly. Compare the real numbers, since Gold isn't always more expensive. |
| Platinum | Highest premiums, lowest costs when you use care. Not offered everywhere. |
Deductibles and out-of-pocket totals reset every January. If you switch plans mid-year, ask whether what you've already paid carries over. Don't assume it does.
Your HIV Medicines: Drug Lists & Tiers
Every plan has a formulary, a list of covered drugs sorted into tiers. Your medicine's tier, plus the deductible and plan rules, decides what you pay at the pharmacy.
A set dollar amount per refill, like $50.
A percentage of the drug's cost, like 30%. On expensive HIV medicines, this can add up fast.
What you pay before the plan starts sharing costs. Some plans have a separate drug deductible.
The plan must approve the drug before covering it. Ask your clinic to handle this early.
Questions to ask about each plan
- Is my exact HIV medicine and dose on the 2027 drug list? Which tier?
- Is it a copay or coinsurance? Does the deductible apply first?
- Do I have to use a specialty or mail-order pharmacy?
- If I use a manufacturer copay card, does that help count toward my deductible and out-of-pocket limit? Rules vary by plan and state.[9]
If your medicine isn't covered, you can ask for a formulary exception based on medical need, and appeal a denial. An approval doesn't guarantee a lower tier or copay.[10]
Every HIV medicine on the top tier? If a plan puts nearly all HIV drugs on its most expensive tier, ask a Navigator or your state insurance department to look at it. Compare other plans before you enroll.
Tax Credits & Income Limits
A premium tax credit lowers your monthly premium. For 2027, the general income range is 100% to 400% of the federal poverty level (FPL). The extra “enhanced” credits that removed the 400% cap ended after 2025, and no extension has been enacted.[6][4]
| One-person household, 2027 coverage | Yearly income |
|---|---|
| 100% FPL | $15,960 |
| 400% FPL | $63,840 |
These use the 2026 poverty guideline. Larger households have higher limits. Being in this range doesn't guarantee a credit: your tax household, immigration status, and access to other coverage also matter.[11]
Report income changes during the year. Because there is no longer a cap on repaying excess tax credits, updating your Marketplace account when your income changes can help you avoid a large tax bill.[6]
Income below 100% FPL? In states that expanded Medicaid, you may qualify for Medicaid instead. In states that didn't, some adults fall into a “coverage gap.” Ask for a full screening anyway, because disability, pregnancy, parenting, and other pathways have their own rules.
ADAP & Ryan White Can Help
The Ryan White HIV/AIDS Program is the payer of last resort for people living with HIV. Each state's ADAP (AIDS Drug Assistance Program) can help eligible people with HIV medicines, and many ADAPs also help with insurance premiums, copays, or deductibles.[12]
What ADAP covers depends on your state. Some pay premiums only for certain plans or tiers. Others, like Florida's, help with medicines and copays but do not pay premiums. Ask your ADAP or case manager before choosing a plan, so your choice fits the help available to you.
In Florida? Our Florida Marketplace Guide covers Florida's 2027 plans, Florida ADAP, and the state's coverage gap in detail.
Protections That Still Apply
- Marketplace plans cannot deny you, cancel you, or charge more because of HIV or any other pre-existing condition.[13]
- Every plan must cover the 10 essential health benefits, including prescription drugs, lab services, mental health care, and hospital care.[7]
- The question isn't whether HIV care is covered, but how: which drugs, which providers, and what you pay.
- If you don't act during open enrollment, you may be automatically renewed into the same or a similar plan. Review it first. A plan that cost $0 this year may not next year.[14]
Your Plan-Shopping Checklist
Your HIV medicine and dose, other prescriptions, your HIV provider, specialists, lab, and pharmacy.
Use your expected 2027 household income, not last year's.
Rule out any plan that doesn't cover your HIV medicine or your HIV provider.
Monthly premium × 12, plus expected medicine, lab, and visit costs. Compare that total.
Confirm which plans your ADAP supports and what help you'd get.
Keep your confirmation number, plan summary, and proof of your first payment.
Free help: HealthCare.gov's call center is open 24/7 at 1-800-318-2596 (TTY 1-855-889-4325).[15] Find a certified Navigator at localhelp.healthcare.gov. Your HIV case manager can also review plans with you.
Use the checklist with your case manager or Navigator.
References & Sources
- HIV.gov. “HIV Care Continuum.” hiv.gov — HIV care continuum ↩
- CMS. Statement on City of Columbus v. Kennedy and the 2027 open enrollment period. August 4, 2026. cms.gov — August 4, 2026 statement (PDF) ↩
- HealthCare.gov. “Keep or Change Your Plan.” Enrollment deadlines, start dates, and renewal steps. healthcare.gov/keep-or-change-plan ↩
- KFF. “9 Things to Watch for the 2027 ACA Open Enrollment Period.” October 30, 2026. kff.org — 2027 open enrollment ↩
- HealthCare.gov. “Out-of-Pocket Maximum/Limit.” 2026 and 2027 Marketplace limits. healthcare.gov — out-of-pocket maximum ↩
- IRS. “Questions and Answers on the Premium Tax Credit.” Income range and repayment rules for tax years after 2025. irs.gov — premium tax credit Q&A ↩
- HealthCare.gov. “Health Plan Categories: Bronze, Silver, Gold & Platinum” and “What Marketplace Health Insurance Plans Cover.” healthcare.gov — plan categories ↩
- HealthCare.gov. “Cost-Sharing Reductions.” healthcare.gov — cost-sharing reductions ↩
- HIV+Hepatitis Policy Institute. “Request for Prompt Enforcement of Prescription Drug Copay Assistance Court Ruling.” hivhep.org — copay assistance ↩
- KFF. “How Can I Find Out If a Health Plan Covers the Prescription Drugs That I Take?” kff.org — prescription drug coverage FAQ ↩
- HealthCare.gov. “Federal Poverty Level (FPL).” 2026 guidelines used for 2027 coverage. healthcare.gov — federal poverty level ↩
- HRSA Ryan White HIV/AIDS Program. “Part B: AIDS Drug Assistance Program (ADAP).” ryanwhite.hrsa.gov — ADAP ↩
- HealthCare.gov. “Pre-Existing Conditions.” healthcare.gov — pre-existing conditions ↩
- HealthCare.gov. “Automatically Re-Enrolled in a Marketplace Plan.” healthcare.gov — automatic re-enrollment ↩
- HealthCare.gov. “Contact Us.” Marketplace Call Center. healthcare.gov/contact-us ↩