Lifestyle

Your Health Insurance Out-of-Pocket Maximum Is Going to $12,000 in 2027

By Mike Harper · June 4, 2026

If you buy health insurance through the Affordable Care Act marketplace — HealthCare.gov or your state’s equivalent exchange — a new federal rule will increase the maximum amount you can be required to pay out of pocket in a single year, starting with your 2027 coverage.

The Centers for Medicare and Medicaid Services finalized a rule this week raising the ACA marketplace out-of-pocket maximum from $10,600 in 2026 to $12,000 in 2027 — an increase of $1,400, representing one of the steeper single-year jumps since the ACA’s implementation. For bronze-tier plans, the out-of-pocket maximum can reach $15,600 annually.

The out-of-pocket maximum is the cap on what your insurer can require you to pay in a given year before your plan covers 100% of costs. Once you hit it — through deductibles, copays, and coinsurance — your plan pays everything else for the rest of the year. Raising that cap means more risk lands on you before the coverage floor kicks in.

The same rule eliminates a requirement that low-cost plans receive preferential placement on HealthCare.gov. Under the prior administration, the government required its marketplace website to display the most affordable available plans prominently — the equivalent of putting the generic brand at eye level. The new rule removes that requirement, meaning consumers browsing HealthCare.gov during open enrollment will need to sort more actively for the lowest-cost options rather than having them surfaced automatically.

For the approximately 21 million Americans who purchase coverage through ACA marketplaces — many of them self-employed, part-time workers, or people in the gap between employer coverage and Medicare eligibility — the combination of a higher cap and less prominent display of affordable plans creates a meaningful increase in financial exposure.

The KFF Health Insurance Marketplace Calculator estimates that a 55-year-old non-smoker earning $60,000 annually could face total premium-plus-out-of-pocket costs of up to $18,000 to $20,000 in 2027 under bronze-tier plans in high-cost markets, depending on location and family size. That figure exceeds 30% of pre-tax income for the household described — the standard threshold at which healthcare costs are considered financially burdensome.

The rule takes effect for plan year 2027. The open enrollment window during which Americans choose their 2027 coverage runs from November 1 through January 15, 2027. That is the first point at which you can act on this information directly — by comparing plans carefully, checking whether your current plan’s maximum changes, and considering whether upgrading from bronze to silver tier makes sense given the new cap.

Advocacy organizations including ACHI and the Center on Budget and Policy Priorities have published analyses warning that the rule will disproportionately affect middle-income households who earn too much to qualify for maximum ACA subsidies but too little to comfortably absorb a $12,000 out-of-pocket exposure. The rule was finalized without a public comment period, which CMS said was authorized under the interim final rule process given the timing of the regulatory calendar.

The $12,000 cap applies to individual coverage. Family out-of-pocket maximums will be higher.