If you buy your own health insurance through the Affordable Care Act Marketplace, the plan that renews automatically on January 1 is probably not the plan you would choose if you shopped. For 2026, KFF estimated that the amount Marketplace insurers charge rose 26% on average, with benchmark silver premiums up about 30% in states that use HealthCare.gov. For 2027, insurers are asking for another round of double-digit increases. This guide is written for self-employed women, freelancers, and single-income households, including single mothers and women between jobs or not yet eligible for Medicare, who rely on the Marketplace for coverage. It is general education, not advice about your specific plan.

What Actually Happened to Premiums

Two separate things drove the 2026 price shock, and they matter differently depending on your income.

Insurers raised their prices. KFF’s October 2025 analysis put the average increase in what insurers charge at 26% for 2026. Benchmark silver premiums, the second-lowest-cost silver plan that subsidies are pegged to, rose an average of 30% in HealthCare.gov states and 17% in states running their own marketplaces.

The enhanced subsidies expired. The larger premium tax credits in place from 2021 through 2025 ended on December 31, 2025. KFF estimated that subsidized enrollees’ annual premium payments would more than double on average, rising 114%, from $888 in 2025 to $1,904 in 2026. The House passed a three-year extension in January 2026, but as of KFF’s August 2026 analysis the enhanced credits had not been restored.

For 2027, prices are climbing again. In its August 2026 review of 276 insurers’ filings across all 50 states and DC, KFF found a median proposed increase of 15%. Insurers cited rising hospital, physician, and prescription drug costs, and a sicker risk pool as healthier people dropped coverage after the subsidies shrank. Proposed rates can change before they are finalized, so the prices you see when window shopping opens are the ones that count.

The Subsidy Cliff Is Back

With the enhanced credits gone, the pre-2021 rules apply again, including a hard income cutoff. A household with income above 400% of the federal poverty level gets no premium tax credit at all. There is no phase-out: one dollar over the line can cost the entire subsidy.

For 2027 coverage, the calculation uses the 2026 poverty guidelines. For a one-person household, 400% of poverty is $63,840 of modified adjusted gross income. For a single mother, the threshold is higher because household size counts.

This is where self-employed women are most exposed. A freelancer’s income is an estimate made in November for a year that has not happened yet. A strong fourth quarter can push actual income over the cliff after the subsidy has already been paid.

That risk grew for 2026. Under the One Big Beautiful Bill Act, the caps that used to limit how much excess advance premium tax credit you had to repay at tax time were eliminated for tax years beginning after December 31, 2025. If your 2026 income comes in higher than you projected, you repay the full difference on your 2026 return. The IRS explains how the credit is reconciled on its premium tax credit eligibility page.

Why Auto-Renewal Can Cost You

If you do nothing during open enrollment, HealthCare.gov generally re-enrolls you in your current plan, or a similar one if yours is discontinued, and recalculates your subsidy. Three things can go wrong:

  • Your plan’s price can rise faster than your subsidy. Your tax credit is tied to the benchmark silver plan in your area, not to your plan. If your plan’s premium rises more than the benchmark, you pay the whole gap.
  • The benchmark can change. If a new, cheaper silver plan enters your market, the benchmark drops and your subsidy shrinks, even if your own plan’s price barely moves.
  • Networks and drug lists change every year. A renewed plan may no longer include your doctors or cover your prescriptions at the same tier.

The only way to know is to compare the renewal notice against the other plans available to you.

What to Re-Shop This Fall

For 2027 coverage, open enrollment on HealthCare.gov runs from November 1, 2026, through January 15, 2027. Enroll or switch by December 15 for coverage that starts January 1. A federal rule that would have ended open enrollment on December 15 was blocked in court. States that run their own marketplaces set their own deadlines, so check yours.

1. Update your income estimate carefully. Use last year’s Schedule C, this year’s year-to-date profit, and known contracts. Update the Marketplace mid-year if your income changes, which reduces the risk of a large repayment.

2. Know your distance from the cliff. If your projected income is near 400% of poverty, contributions that lower modified adjusted gross income can matter. For self-employed women, these can include traditional IRA, SEP IRA, or solo 401(k) contributions, HSA contributions, and the self-employed health insurance deduction. Run the numbers with a tax professional before year-end.

3. Compare metal levels, not just prices. A bronze plan costs less each month but carries a much higher deductible. Starting in 2026, bronze and catastrophic plans count as HSA-compatible under IRS Notice 2026-5, so a bronze enrollee can contribute to a health savings account ($4,400 for self-only coverage in 2026). That pairing can suit a healthy freelancer with savings. If your income is below 250% of poverty, a silver plan may carry cost-sharing reductions that lower your deductible, a benefit bronze plans do not have.

4. Price out your actual care. Add your expected premiums, your deductible, and the cost of your regular prescriptions and visits. The cheapest premium is not the cheapest plan if you are managing a chronic condition.

5. Check doctors and drugs in every plan you consider, using the plan’s current provider directory and formulary for 2027.

6. If you are over the cliff, compare off-Marketplace plans too. Without a subsidy, the same ACA-compliant plans may be sold directly by insurers or through brokers, and prices can be identical or slightly different. Stay with ACA-compliant coverage: short-term plans can exclude pre-existing conditions.

A Budget Line That Needs a Buffer

For single-income households, health insurance is now one of the least predictable fixed costs in the budget. Build the 2027 premium into your monthly plan at the real price, not last year’s, and if you are self-employed, set aside a portion of any income above your Marketplace estimate in a separate savings account so a tax-time repayment does not become debt.

Before November 1, pull up your current plan’s details, your income estimate, and your prescription list. When window shopping opens, compare at least three plans across two metal levels, and make an active choice by December 15 rather than letting the renewal make it for you.