If your renewal notice already has you bracing for what November 1 might bring, this one’s for you.
Open enrollment for 2027 health plans starts November 1, and this year it lands differently than most. The extra subsidies that kept marketplace premiums manageable expired at the end of 2025, and a lot of us already felt that hit once, in 2026. Now the marketplace is shifting again, insurers are leaving in more than twenty states, and the choices you make between November 1 and January 15 carry more weight than they used to.
You do not need to read a hundred pages of policy language to get this right. You need the handful of things that actually move your costs and your coverage, especially if gender-affirming care or physical therapy is part of what you’re paying for.
What’s actually changing for 2027
Premiums are going up again. The median proposed increase nationally is around 15 percent, though it ranges from under 7 percent in some states to close to 30 percent in others. Texas runs on the federal marketplace at healthcare.gov, so if your current insurer is one of the many exiting a market this year, your plan could end automatically at the close of 2026, whether you were paying attention or not.
The out-of-pocket maximum is rising too, to $12,000 for an individual, up from $10,600 this year. That number is the real ceiling on what a bad year could cost you, not the premium you see first.
If your insurer is leaving, auto-renewal will pick something for you. That something is not guaranteed to resemble what you have now. This is the year to actually log in and compare, not the year to let the system default you into whatever’s closest.
Mark your real deadlines
Open enrollment runs November 1, 2026 through January 15, 2027, for most of the country, Texas included. Enroll by December 15 and your new plan starts January 1. Enroll any time after that, through January 15, and your coverage starts February 1 instead.
That six-week gap matters if you’re mid-treatment for anything, gender-affirming care, physical therapy, ongoing medication. A coverage start date you didn’t plan for can mean a real gap in care, so this is worth doing early rather than on January 14.
Where gender-affirming care coverage stands right now
We’ve written before about the court ruling that restored essential-health-benefit protections for gender-affirming care, and that ruling is still holding as of this fall. No appeal has been filed. For 2027 plans, that matters in a very specific way: when gender-affirming care counts as an essential health benefit, your spending on it counts toward your deductible and your out-of-pocket maximum, with no lifetime dollar cap.
What that ruling does not do is create coverage where none exists. Texas has never required insurers to cover gender-affirming care, and this year’s plan comparison is still the moment to check, not assume. Pull up a plan’s Summary of Benefits and Coverage before you enroll and search it for “gender dysphoria” or “gender-affirming.” That document has to spell out exclusions in plain language, and it is usually a more honest answer than a phone call.
Physical therapy isn’t up for debate
Unlike gender-affirming care, physical therapy sits in a category the ACA has protected since the law passed. Rehabilitative and habilitative services are one of the ten essential health benefits every ACA-compliant plan has to include, on the marketplace or off it. Visit limits can vary by state and by plan, but no insurer can strip physical therapy out of your coverage entirely. That is one thing you do not have to verify twice this year.
How to actually pick a plan this year
Compare total likely cost, not just the premium on the page. A lower monthly payment attached to a high deductible can cost you more over a year than a plan with a higher premium and better cost-sharing, especially if you know you’ll be using physical therapy or ongoing gender-affirming care regularly.
Before you buy anything, check what your HSA or FSA already covers. We’ve written before about how much further those dollars go than people assume, physical therapy is already a qualified expense in almost every case, and a lot of gender-affirming gear qualifies too with one extra letter from your provider.
Call with a specific question, not a general one. “Does my plan cover gender-affirming care” gets you a vague answer. “Does spending on gender-affirming hormone therapy count toward my deductible and out-of-pocket maximum this year” gets you something you can actually act on.
Final Thoughts
None of this is a reason to panic, and it is not a reason to skip open enrollment either. The system got more complicated this year, not less navigable. You deserve a plan that actually reflects how you use care, not whatever you had last year by default.
Want help thinking through how a plan’s coverage will actually work with your physical therapy or your recovery? Book a free 15-minute consult with our physical therapy team.
