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    US health care changes 2026-27 tracker: ACA, Medicaid, Medicare

    The enhanced ACA premium tax credits expired at the end of 2025, and as of October 2026 Congress had not restored them.[1][2] Paid Marketplace enrollment fell 13% to 19.2 million, and insurers have proposed a median 15% premium increase for 2027.[3][4] Medicaid work requirements must start by 1 January 2027, Medicare Open Enrollment runs from 15 October to 7 December 2026, and ACA Open Enrollment opens on 1 November.[5][6][7]

    Editor reviewedStrict sourcingUpdated DevelopingHealth and medicine, Tech policy

    What we know

    • The enhanced ACA premium tax credits expired on 31 December 2025[1]
    • Paid Marketplace enrollment fell from 22.1 million (2025) to 19.2 million (February 2026)[3]
    • Average premium payments after credits rose 58%, and average deductibles reached a record $3,786[14]
    • Insurers proposed a median 15% premium increase for 2027 across 276 filings[4]
    • HealthCare.gov Open Enrollment for 2027 runs 1 November 2026 to 15 January 2027[7]
    • Medicaid work requirements must generally start by 1 January 2027[5]
    • The Trustees estimate a $209.50 Part B premium for 2027; CMS has not yet announced it[22]
    • Negotiated prices for 15 more drugs, including Ozempic and Wegovy, take effect on 1 January 2027[10]

    What we don't know yet

    • Final 2027 Marketplace premiums in each state, which regulators can change from the proposed rates
    • Whether Congress will revisit the enhanced premium tax credits after the November 2026 midterm elections
    • The official 2027 Medicare Part B premium and deductible, which CMS usually announces in the autumn
    • How many people will lose Medicaid when work requirements start, and how many states will seek good-faith extensions to 2028
    • What prices CMS will announce by 30 November 2026 for the 15 third-cycle drugs
    • How litigation over the Marketplace integrity rules will be resolved
    Story status

    Story status

    State
    developing
    Started
    2025-07-04
    Timeline entries
    21
    Last entry

    Timeline data (JSON)

    This tracker follows the changes to US health coverage costs and rules in 2026 and 2027. It covers the ACA Marketplaces, Medicaid, Medicare and Medicare drug-price negotiation, starting from the 2025 reconciliation law, and it is updated as key dates pass.[8] Health coverage policy is politically contested, so positions are attributed to the parties and officials who hold them. This page is for information only. It is not financial, legal or medical advice; for decisions about your own coverage or care, talk to a licensed navigator, your state Medicaid agency or a clinician.

    Where things stand on 11 October 2026

    The enhanced ACA premium tax credits expired at the end of 2025.[1] People with incomes above 400% of the federal poverty level are again ineligible for premium tax credits.[9] As of early October 2026 Congress had not restored the enhanced credits. KFF said the remaining credits will shield most enrollees from 2027 increases, but higher-income enrollees will pay full premiums.[2]

    Paid (effectuated) Marketplace enrollment fell from 22.1 million in 2025 to 19.2 million in February 2026.[3] For 2027, insurers proposed a median premium increase of 15%.[4] HealthCare.gov Open Enrollment for 2027 coverage starts on 1 November 2026.[7]

    On Medicaid, states must generally start the new work requirement by 1 January 2027.[5] On Medicare, Open Enrollment runs from 15 October to 7 December 2026.[6] Negotiated prices for 15 more drugs take effect in January 2027.[10]

    ACA Marketplace

    The House passed a three-year extension of the enhanced credits on 8 January 2026, by 230-196.[11] The Senate had already rejected a Democratic extension and a Republican alternative in December 2025.[12] Republicans in Congress argued the credits were so generous that they let insurers charge more and encouraged improper enrollment.[13]

    Costs to enrollees rose in 2026. Average premium payments after credits rose 58%, from $113 to $178 a month.[14] Average deductibles rose to a record $3,786 as many people moved to bronze plans.[15] The administration attributes the enrollment drop to its anti-fraud efforts. KFF notes that the drop came as premium payments rose sharply.[16]

    In September 2026, CMS said it was cancelling about 315,000 unauthorized enrollments covering more than 760,000 people.[17] The White House announced $500 refunds for nearly 1 million unsubsidized enrollees in the 30 states that use the federal Marketplace.[18] See the ACA Marketplace explainer and the premiums debate.

    Medicaid

    The 2025 reconciliation law, signed on 4 July 2025, changes Medicaid eligibility, renewals and financing.[8] CBO estimated the law will increase the number of uninsured people by 10 million in 2034.[19] CMS issued its interim final rule on work requirements on 1 June 2026.[5] Six-month eligibility renewals for expansion adults apply to renewals scheduled from 1 January 2027.[20] Details are in the Medicaid changes explainer.

    Medicare and drug prices

    The standard Part B premium is $202.90 a month in 2026.[21] The Trustees estimate $209.50 for 2027, but the official figure has not been announced.[22] The Part D out-of-pocket cap rises to $2,400 in 2027.[23] CMS’s final offers on the third set of negotiated drugs were due by 30 September 2026, and prices must be announced by 30 November 2026.[24] See the Medicare 2027 explainer and medicare-drug-price-negotiation.

    Key dates ahead

    • 15 October to 7 December 2026: Medicare Open Enrollment.[6]
    • 1 November 2026: HealthCare.gov Open Enrollment opens, and 2027 income and savings figures go up.[7][25]
    • By 30 November 2026: CMS announces third-cycle negotiated drug prices.[24]
    • 15 December 2026: last day to pick a HealthCare.gov plan that starts on 1 January.[7]
    • 1 January 2027: Medicaid work requirements generally start, and second-cycle drug prices take effect.[5][10]

    Timeline

    21 confirmed

    1. confirmed

      Medicare Open Enrollment set to open on 15 October[6]

      Medicare Open Enrollment runs to 7 December 2026, and ACA Open Enrollment starts on 1 November.

    2. confirmed

      Enhanced credits still expired heading into 2027[2]

    3. confirmed

      Deadline for CMS final offers on third-cycle drugs[24]

    4. confirmed

      CMS projects lower 2027 Medicare Advantage premiums[35][36]

    5. confirmed

      CMS cancels coverage for 760,000 in anti-fraud action[17][34]

    6. confirmed

      White House announces $500 Marketplace refunds[18]

      The refunds go to nearly 1 million unsubsidized enrollees in 30 federal-Marketplace states.

    7. confirmed

      Insurers propose median 15% premium rise for 2027[4][33]

    8. confirmed

      CMS ends Part D premium stabilization demonstration[32]

    9. confirmed

      Paid Marketplace enrollment down 13%[3]

    10. confirmed

      Medicare Trustees project 2027 Part B premium of $209.50[22][31]

      The Part A trust fund is projected to be depleted in 2033.

    11. confirmed

      CMS issues Medicaid work requirement rule[5][30]

    12. confirmed

      KFF reports record deductibles and 23.1 million sign-ups[29][15][14]

    13. confirmed

      Part D out-of-pocket cap set at $2,400 for 2027[23]

    14. confirmed

      All third-cycle drugmakers agree to negotiate[28]

    15. confirmed

      CMS picks 15 drugs for third negotiation cycle[27]

      The list includes Part B drugs for the first time. Prices take effect in 2028.

    16. confirmed

      House passes three-year credit extension, 230-196[11]

      Seventeen Republicans join Democrats. The Senate has not passed it.

    17. confirmed

      First Medicare negotiated drug prices take effect[26]

      Prices for 10 Part D drugs, including Eliquis and Jardiance, apply from this date.

    18. confirmed

      Enhanced ACA premium tax credits expire[1][9]

    19. confirmed

      Senate rejects rival health cost bills[12]

      A Democratic three-year credit extension and a Republican health-account bill each get 51 votes, short of 60.

    20. confirmed

      CMS sets 2026 Medicare Part B premium at $202.90[21]

    21. confirmed

      2025 reconciliation law signed[8][19]

      Public Law 119-21 changes Medicaid, the ACA Marketplaces and Medicare drug negotiation. CBO estimates 10 million more uninsured by 2034.

    Health & medicine

    Medicare Drug Price Negotiation Program

    How Medicare negotiates drug prices: the 10 drugs priced from 2026, 15 from 2027 including Ozempic, the 2028 list with first Part B drugs, and what is next.

    Developing in Health

    Questions readers ask

    Did the enhanced ACA subsidies expire?

    Yes. The enhanced premium tax credits expired on 31 December 2025. The House passed a three-year extension in January 2026, but as of October 2026 the credits had not been restored.[1][11][2]

    When is open enrollment for 2027?

    Medicare Open Enrollment runs from 15 October to 7 December 2026. On HealthCare.gov, ACA Open Enrollment runs from 1 November 2026 to 15 January 2027, and enrolling by 15 December gives coverage from 1 January.[6][7]

    How much are ACA premiums going up in 2027?

    Insurers proposed a median 15% increase across 276 filings, after a median finalized increase of 20% for 2026. The filings are preliminary and can change.[4][37]

    When do Medicaid work requirements start?

    States must generally implement them by 1 January 2027, though some states started earlier and HHS can grant good-faith exemptions up to 31 December 2028.[5][38][39]

    What will the Medicare Part B premium be in 2027?

    CMS has not announced it yet. The 2026 Medicare Trustees Report estimated $209.50 a month, up from $202.90 in 2026.[22]

    Sources

    · 39 claims from 18 publishers

    Each numbered claim is a statement we checked against the sources listed with it. Tap a number in the text to see its sources in place.

    1. [1]

      The enhanced ACA premium tax credits, created by the American Rescue Plan in 2021 and extended through 2025 by the Inflation Reduction Act, expired on 31 December 2025. confirmedas of 2026-10-06

    2. [2]

      As of early October 2026 the enhanced credits had not been restored; KFF said remaining tax credits will shield most enrollees from 2027 premium increases, but higher-income enrollees no longer eligible for help would pay full costs. confirmedas of 2026-10-06

    3. [3]

      Federal data released on 26 June 2026 showed effectuated (paid) Marketplace enrollment fell 13%, from a high of 22.1 million in 2025 to 19.2 million in February 2026. confirmedas of 2026-06-29

    4. [4]

      Across 276 Marketplace insurers in all 50 states and DC, the median proposed premium increase for 2027 is 15%, the second consecutive year of double-digit increases; for 2026 the median proposed change was 18% and the median finalized change 20%. confirmedas of 2026-08-03

    5. [5]

      CMS issued an interim final rule on 1 June 2026 implementing the requirement of 80 hours a month of qualifying activity; states must generally implement it by 1 January 2027. confirmedas of 2026-06-01

    6. [6]

      Medicare Open Enrollment for 2027 coverage runs from 15 October to 7 December 2026, and people who keep their current coverage generally do not need to re-enroll. confirmedas of 2026-09-28

    7. [7]

      On HealthCare.gov, Open Enrollment for 2027 coverage starts 1 November 2026; enrolling by 15 December gives coverage from 1 January, and Open Enrollment ends 15 January, with coverage from 1 February for later sign-ups. confirmedas of 2026-10-11

    8. [8]

      The 2025 budget reconciliation law (H.R. 1, formerly called the "One Big Beautiful Bill Act") became Public Law 119-21 when President Trump signed it on 4 July 2025. confirmedas of 2025-07-04

    9. [9]

      Under the enhanced credits, people with incomes above 400% of the federal poverty level paid no more than 8.5% of income for a benchmark silver plan; since the credits expired, people above 400% of poverty are not eligible for premium tax credits and pay the full premium. confirmedas of 2026-10-02

    10. [10]

      In the second cycle Medicare reached agreement on all 15 selected Part D drugs, including Ozempic and Wegovy; the prices take effect on 1 January 2027, and CMS estimated they would have saved about $8.5 billion (about 36% lower net spending) had they applied in 2024. confirmedas of 2026-01-27

    11. [11]

      On 8 January 2026 the House passed a three-year extension of the enhanced premium tax credits by 230-196, with 17 Republicans joining Democrats, and sent it to the Senate. confirmedas of 2026-01-12

    12. [12]

      On 11 December 2025 the Senate rejected both a Democratic-led three-year extension of the enhanced credits and a Republican-backed bill offering health spending account deposits; each failed 51-48, short of the 60 votes needed. confirmedas of 2025-12-11

    13. [13]

      Republicans in Congress argued the enhanced credits were so generous that they let insurers charge more and encouraged improper or fraudulent enrollment; House Speaker Mike Johnson called the House-passed extension "a really bad policy". confirmedas of 2026-10-06

    14. [14]

      Average monthly Marketplace premium payments after tax credits rose 58% in 2026, from $113 to $178. confirmedas of 2026-05-19

    15. [15]

      Average Marketplace deductibles rose 37% ($1,027 per person) to a record $3,786 in 2026, largely because many enrollees moved from silver plans to high-deductible bronze plans. confirmedas of 2026-05-19

    16. [16]

      The Trump administration attributes the 2026 enrollment drop to its anti-fraud efforts, while KFF notes the loss coincided with steep increases in premium payments. confirmedas of 2026-06-29

    17. [17]

      On 22 September 2026 CMS said it was cancelling about 315,000 unauthorized federal Marketplace enrollments covering more than 760,000 people, expecting to recover about $2.2 billion in subsidies. confirmedas of 2026-09-22

    18. [18]

      The White House announced on 10 September 2026 one-time $500 refunds for nearly 1 million unsubsidized enrollees in the 30 states using the federal Marketplace, describing them as returning excess user fees; the Treasury began sending payments to more than 950,000 people around the start of October. confirmedas of 2026-10-02

    19. [19]

      CBO estimated the 2025 reconciliation law will cut federal health spending by over $1 trillion and increase the number of uninsured people in 2034 by 10 million (7.5 million from Medicaid changes, 2.1 million from ACA Marketplace changes). confirmedas of 2025-08-22· forecast

    20. [20]

      The law requires states to redetermine eligibility every six months for Medicaid expansion adults, for renewals scheduled from the first quarter beginning after 31 December 2026 (that is, from 1 January 2027). confirmedas of 2025-08-22

    21. [21]

      CMS announced on 14 November 2025 that the standard Medicare Part B premium is $202.90 a month in 2026, up $17.90 from $185.00 in 2025, and the Part B deductible is $283. confirmedas of 2025-11-14

      • 2026 Medicare Parts A & B Premiums and Deductibles · U.S. Centers for Medicare & Medicaid Services · 2025-11-14 · Opening: "On November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums" (retrieved 2026-10-11)
    22. [22]

      The 2026 Medicare Trustees Report (9 June 2026) estimated the 2027 Part B premium at $209.50 a month; Part B financing rates had been set only through 31 December 2026, so CMS has yet to announce the actual 2027 premium. confirmedas of 2026-06-09· forecast

    23. [23]

      Under the standard Part D benefit, the annual out-of-pocket threshold rises from $2,100 in 2026 to $2,400 in 2027, and the maximum deductible from $615 to $700. confirmedas of 2026-04-06

    24. [24]

      For the third cycle, CMS's final written offers were due by 30 September 2026, drug companies must accept or reject them by 31 October 2026, the negotiation period ends on 1 November 2026, and CMS must publish negotiated prices by 30 November 2026. confirmedas of 2026-03-11

    25. [25]

      HealthCare.gov says 2027 income levels and savings estimates will be posted on 1 November 2026 and suggests using 2026 amounts for a rough estimate before then. confirmedas of 2026-10-11

    26. [26]

      Medicare's negotiated prices for the first 10 Part D drugs, including Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and Fiasp/NovoLog, took effect on 1 January 2026. confirmedas of 2026-03-11

    27. [27]

      On 27 January 2026 CMS selected 15 drugs for the third cycle, including the first Part B drugs, with prices effective 1 January 2028; the list is Anoro Ellipta, Biktarvy, Botox, Cimzia, Cosentyx, Entyvio, Erleada, Kisqali, Lenvima, Orencia, Rexulti, Trulicity, Verzenio, Xeljanz and Xolair, and Tradjenta was picked for renegotiation. confirmedas of 2026-01-27

    28. [28]

      Under the Negotiation Program CMS directly negotiates prices of certain high-expenditure, single-source drugs without generic or biosimilar competition; on 13 March 2026 it announced that the manufacturers of all 15 third-cycle drugs, and of the drug selected for renegotiation, chose to participate. confirmedas of 2026-03-13

    29. [29]

      CMS reported 23.1 million Marketplace sign-ups (new selections and automatic re-enrollments) during the 2026 Open Enrollment Period, down about 1.2 million (5%) from 2025; KFF called it the sharpest single-year drop since the Marketplaces launched. confirmedas of 2026-03-30

    30. [30]

      The requirement applies to non-pregnant adults aged 19 to 64 in the Medicaid expansion group or certain section 1115 demonstrations who are not on Medicare; 43 states and DC must implement it, and US territories are not covered. confirmedas of 2026-06-01

    31. [31]

      The Medicare Hospital Insurance (Part A) trust fund is projected to be depleted in the second quarter of 2033, one quarter earlier than in the previous report, after which income would cover 89% of scheduled benefits. confirmedas of 2026-06-09· forecast

    32. [32]

      CMS is ending the voluntary Part D Premium Stabilization Demonstration at the end of 2026; the 2027 base beneficiary premium is $41.33. confirmedas of 2026-07-28

    33. [33]

      In 2027 rate filings the median assumed growth in the underlying cost of medical care and prescription drugs (medical trend) is 10%, above the 8% average of recent years. confirmedas of 2026-08-03

    34. [34]

      CMS issued an interim final rule pausing new registration for the 2027 plan year for agents and brokers without an active 2026 Exchange agreement, and is requiring brokers to re-verify identity and to get electronic consumer authorization. confirmedas of 2026-09-22

    35. [35]

      CMS projects the weighted average monthly Medicare Advantage premium will fall from $14.37 in 2026 to $12.00 in 2027 (16.5%), with about 34 million enrollees, roughly 47.4% of Medicare. confirmedas of 2026-09-28· forecast

    36. [36]

      CMS projects the average total monthly premium for stand-alone Part D drug plans will rise from $35.09 in 2026 to $36 in 2027. confirmedas of 2026-09-28· forecast

    37. [37]

      Proposed 2027 changes range from -1% to 54%; 63% fall between 10% and 25%, 51 insurers asked for more than 25%, and the filings are preliminary. confirmedas of 2026-08-03

    38. [38]

      Nebraska and Montana had already implemented Medicaid work requirements by mid-2026, and most states must send outreach notices in September 2026 ahead of a 1 January 2027 start. confirmedas of 2026-07-24

    39. [39]

      HHS may exempt a state making a good-faith effort to comply, but any such exemption must expire by 31 December 2028. confirmedas of 2025-07-04

    Revision history (1)
    1. Page created.

    Created Oct 11, 2026. Last reviewed by an editor on Oct 11, 2026. Next scheduled review: Nov 2, 2026.

    Cite this page

    "US health care changes 2026-27 tracker: ACA, Medicaid, Medicare." ContentLora, updated Oct 11, 2026. https://contentlora.com/events/us-health-care-changes-2026-tracker

    Spotted an error? Suggest a correction or emailcorrections@contentlora.com.

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