Reported by NPR Health
Christine Meehan, a hair stylist in Upper Chichester, Pa., has purchased health insurance through Pennie , the ACA marketplace for Pennsylvania. She's pictured here in October 2025. ACA open enrollment runs from Nov. 1 through Jan. 15 in most states. Tassanee Vejpongsa/AP hide caption
Consumers who buy Affordable Care Act health insurance are going to see changes both big and small as open enrollment for 2027 coverage kicks off. These include premium increases, possible additional identity checks, potential delays in working with a broker, and new limits on which immigrants can get subsidies.
Open enrollment starts Nov. 1 in most states . Idaho, Connecticut, and Massachusetts started earlier, and some states have been allowing "window shopping" to check premium rates.
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A continued decline in overall enrollment is expected, mainly because of the expiration of enhanced subsidies at the end of 2025. Policy experts say the end of those subsidies led millions to drop or lose coverage through the first few months of this year.
But the Trump administration sees victory in the falling enrollment, crediting its various efforts to reduce fraud, including the August cancellation of policies covering 760,000 enrollees suspected to be improperly signed up. A small number of those enrollees have regained coverage .
One of the biggest changes for people shopping for their 2027 coverage will be increased scrutiny of both consumers and agents. The requirements are aimed at thwarting fraud or improper enrollments. For consumers, it could slow the enrollment process.
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The new rules , outlined by the Centers for Medicare & Medicaid Services, affect only consumers using agents or brokers to help them enroll through the federal marketplace, which serves 29 states. They do not apply to state-based exchanges, which have their own rules and have in most cases been more successful at preventing fraudulent sign-ups.
For starters, all consumers using an agent in the federal marketplace will need to get a one-time confirmation code or link to authorize a specific agent to enroll them or make changes on their behalf. It…