Open enrollment for 2027 Affordable Care Act coverage began on Sunday on HealthCare.gov and state exchanges, the first season in which refugees, asylees and many other lawfully present immigrants are barred from federal premium subsidies. The change applies across all 50 states. Exchanges must now screen out applicants who qualified for financial help only a year ago.

The restriction comes from the tax and spending law President Donald Trump signed in July 2025. From January 2027 it limits premium tax credits to lawful permanent residents, certain Cuban and Haitian entrants, and migrants from Compact of Free Association nations. Refugees, people granted asylum and holders of temporary protected status no longer qualify for the credits.

The federal platform will accept sign-ups until January 15, 2027, after a federal court in June vacated a 2025 rule that would have shortened the window. The Centers for Medicare and Medicaid Services confirmed the traditional schedule over the summer. Covered California and New York's NY State of Health will accept applications until January 31.

The season is also the second since enhanced premium tax credits expired at the end of 2025. That expiry restored the subsidy cliff for households earning above 400 per cent of the federal poverty level. Analysts at KFF, the health policy research organisation, estimated that subsidised enrollees' average premium payments more than doubled in 2026 as a result.

Under the same 2025 law, enrollees who underestimated their income must now repay excess advance credits in full when they file 2026 tax returns.

Immigrant advocacy groups and federally funded navigator organisations said they expected confusion among families with mixed immigration statuses. Some households may contain members who remain eligible and others who do not. Consumers who want coverage to start on January 1 must choose a plan by December 15 on HealthCare.gov, though Covered California accepts such plans until December 31, and CMS typically publishes its first enrollment snapshot within weeks of the season opening.