2027 Open Enrollment: What People with Arthritis Need to Know  

Sept. 14, 2026 

Health insurance coverage can change from year to year, even if you keep the same plan. Your costs may change, and so can your doctors, medications and services your plan covers.  

In 2027, rules are changing for Medicare, Medicaid  and the Health Insurance Marketplace. 

If you live with arthritis, take time to review your coverage for 2027. Make sure your plan still works for the care you need.  

Medicaid: New Rules Begin in 2027 

You can usually apply for Medicaid at any time. However, some important Medicaid eligibility rules will change starting in 2027. 

Work and Community Engagement Requirements 

• Beginning January 1, 2027, some adults ages 19 to 64 may need to meet new work or community engagement requirements to qualify for or keep Medicaid coverage. Some states may implement these requirements earlier. 

  • If the requirement applies to you, you will generally need to meet a monthly requirement through qualifying work, community service, job training or education. Most qualifying activities must total at least 80 hours per month; enrollment in an educational program at least half-time can also satisfy the requirement. 

    Source: CMS Medicaid Community Engagement IFR 

• Other approved community engagement activities 
• These activities must be completed each month to remain eligible for Medicaid if you are subject to the requirement. 
• Not everyone has to meet this requirement. Exemptions include certain caregivers, pregnant and postpartum people, and some people with serious health conditions or disabilities. 
• Having arthritis does not automatically mean you are exempt. But if arthritis or another health condition makes it hard for you to meet the requirement, check with your state Medicaid program about whether an exemption applies.  

More frequent Medicaid renewals 

• Many adults covered through Medicaid expansion will also have their eligibility checked every six months instead of once a year beginning in 2027.  
• What you can do: Keep your address, phone number and other information up to date with your state Medicaid office. Open notices you receive from your state and respond quickly if they ask for information.  

Marketplace Coverage: Review your plan even if it renews automatically  

For states that use HealthCare.gov, open enrollment runs Nov. 1, 2026, through Jan. 15, 2027. Enroll or change plans by Dec. 15, 2026, for coverage beginning Jan. 1, 2027. State-based Marketplaces may have different deadlines, so it’s important to know whether your state uses its own exchange platform or the federal platform. Find your state’s program.  

Some Marketplace rules are still being decided in court. Several changes that were planned for 2027 are currently on hold while litigation continues. Because the rules could change before or during Open Enrollment, check HealthCare.gov or your state Marketplace for the latest information. And regardless of what happens in court, recheck to see whether your arthritis doctors, drugs and costs are covered. 

Other key points to consider include: 

• Maximum Out-of-Pocket Costs: the maximum cost for covered services will be $12,000 for an individual and $24,000 for a family plan in 2027. 
• Review your plan even when it automatically renews: If you already have Marketplace coverage, you may be automatically re-enrolled if you don’t choose a new plan. But don’t assume your current plan is still your best choice. 
• Before renewing, check: 
• Is your rheumatologist still in network? 
• Are your medications still covered? 
• Did your deductible and co-pays/coinsurance change? 
• Are there new prior authorization or step therapy requirements? 
• Is your preferred pharmacy or infusion center still covered? 
• Financial help has changed 
• Starting in 2026, people with incomes above 400% of the Federal Poverty Level (about $63,840 for one person / $132,000 for a family of four ) generally no longer qualify for federal ACA premium tax credit subsidies to lower their monthly health insurance bills. 
• There's also a new repayment rule: if you receive more premium tax credit than you qualify for, you may have to pay back the full amount when you file your taxes. 

What you can do: Keep your income and household information up to date when you apply, renew or have a life change during the year. This can help you avoid unexpected costs at tax time. If you receive financial assistance, update your Marketplace application each year with your expected income and household information. Even if you are automatically re-enrolled, reviewing your information and plan can help ensure you receive the correct financial assistance and avoid unexpected costs at tax time. 

Source: HealthCare.gov — Automatic re-enrollment 

• More paperwork: Marketplace enrollees may need to verify and update information about their income, immigration status and other eligibility details each year. Failure to provide required information could result in the loss of coverage or financial assistance. 
• Be careful with low-cost plans outside the Marketplace: As Marketplace premiums increase, you may see lower-cost health plans advertised outside the Marketplace, such as short-term health plans or fixed indemnity plans. While these plans may cost less, they often provide limited coverage and may not cover pre-existing conditions, prescription drugs, preventive care or other important health services. Review the benefits carefully before enrolling to make sure the plan meets your needs. 

Remember: a low monthly premium may not mean lower costs overall. 

Medicare: Prescription drug costs are changing 

Medicare open enrollment runs from Oct. 15 through Dec. 7, 2026, for coverage beginning Jan. 1, 2027. This is about a month shorter than in previous years. 

If you have a Medicare Advantage plan or Medicare Part D prescription drug coverage, review your plan every year. Your medications, pharmacies, doctors and costs can change. 

For 2027: 

• The standard Part D deductible increases to $700 from $615. 
• The annual out-of-pocket limit for covered Part D drugs increases to $2,400 from $2,100. After you reach that limit, you pay no additional cost-sharing (copay/coinsurance) for covered Part D drugs for the rest of the plan year. 

You can spread your Medicare drug costs across the year. 

• The Medicare Prescription Payment Plan (MPPP) lets people with Part D coverage spread out prescription costs across the year in monthly payments instead of having to pay a large amount at the pharmacy all at once. This could be a great benefit for people with high out-of-pocket prescription drug costs, but you must opt-in. Your health plan will have more information, or you can consult your State Health Insurance Assistance Program (SHIP) for personalized guidance.  
• MPPP can make costs easier to budget, but it does not reduce the total amount you owe.  
• If you used the MPPP in 2026, you’ll be automatically re-enrolled unless you switch drug plans. So, if you choose a new plan, you must re-enroll for the payment plan.  

Prior authorization is becoming more transparent and more electronic. 

• Starting in 2027, many Medicare Advantage, Medicaid and CHIP plans, as well as plans on the federal Exchanges, must begin using new electronic tools to provide more information and clearer timelines for prior authorization of many medical services and items. Prescription drugs are excluded from this particular final rule.
• This does not mean prior authorization is going away. It is intended to make requests and decisions easier for patients and healthcare providers to track. 
• For people with arthritis, this may affect services such as imaging, physical therapy and some procedures or treatments. 
• Patients can access information about their prior authorization status and details and authorize their previous health plan (up to five years) to share prior authorization information with their current health plan to ensure better continuity as they change health plans. Check your health plan for more information.  

Before you choose a plan, check these 5 points: 

1. Your doctors: Are your rheumatologists, specialists and other providers in-network? 
2. Your medications: Are all your prescriptions covered? What will you pay? 
3. Prior authorization: Does the plan require approval before you can get certain medications, tests or treatments? 
4. Your arthritis care: Are your infusion center, specialty pharmacy, physical or occupational therapy and other services covered? 
5. Your total costs: Look beyond the monthly premium. Compare the deductibles, copays, coinsurance and the most you could have to pay out of pocket. 

A plan that worked for you last year may not be the choice for next year. 

Need help with Medicare? Your State Health Insurance Assistance Program (SHIP) offers free, personalized Medicare counseling.  

Need help choosing or enrolling in a Marketplace plan? HealthCare.gov can connect you with a trained enrollment assister.  

For arthritis information, questions and support, call the Arthritis Foundation Helpline at 800-283-7800.