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ACA Changes 2027: What They Mean If You're Pregnant

Are you pregnant or planning a baby, and do you buy your own health insurance? Start with the good news. Every 2027 plan on HealthCare.gov or your state's marketplace still has to cover your pregnancy, your delivery, and your newborn.

What's changing is how much you might pay. Some families will get less help with their monthly bill. And the most you can be charged for care in one year is going up. This guide explains each change in plain words, and what to do about it before December 15, 2026.

The short version

  • Less help with your monthly bill. If your household makes more than about $86,560 a year (2 people) or $109,280 (3 people), you won't get help paying your monthly bill in 2027. Log in and check your 2027 price before you renew.

  • A higher yearly limit on what you pay. The most a plan can charge you for in-network care in a year goes up to $12,000, from $10,600. Many people hit this limit the year they have a baby. Compare plans by this limit, not only by the monthly price.

  • More low-cost, high-deductible plans. Cheap plans can make you pay thousands before they cover anything. Check the deductible before you pick a plan.

  • Paying back extra help at tax time. Since 2026, if you got more help than you qualified for, you pay all of it back. There's no limit anymore. Update your income on HealthCare.gov when it changes, like during unpaid leave.

  • A new baby can mean more help. A bigger family can get more help with the monthly bill. Add your baby on HealthCare.gov within 60 days of the birth.

Deadline: Pick a plan by December 15, 2026 to be covered on January 1, 2027.

What's changing in 2027, and when

  • What: Less help with monthly bills for some families, a higher yearly limit on what you pay, new rules for low-cost plans, and fewer look-alike plans to compare.

  • Who it affects: People who buy their own plan on HealthCare.gov or a state marketplace. It doesn't apply to insurance you get through a job.

  • When: January 1, 2027, when 2027 plans start.

  • Open enrollment: November 1, 2026 to January 15, 2027.

  • Deadline for January 1 coverage: December 15, 2026.

  • Source: HealthCare.gov dates and deadlines and CMS 2027 final rule fact sheet

Less help with your monthly bill

Your premium is what you pay each month to keep your plan. Many people get help from the government to pay it. That help is called the premium tax credit.

From 2021 through 2025, Congress let more people get this help, says the IRS. That extra help has ended.

Now, help generally goes to households that make between 100% and 400% of the federal poverty level. That's a yearly income guideline set by the government. For 2027 plans, 400% works out to about $86,560 a year for 2 people and $109,280 for 3 people. If your household makes more than that, you may get no help at all.

Prices are going up, too. Insurers asked for a median 15% price increase for 2027, according to the Peterson-KFF Health System Tracker. That means half asked for more and half asked for less. Your price depends on your state and your plan.

What stays the same for pregnancy

Your plan still has to cover pregnancy and childbirth, says HealthCare.gov. Pregnancy and newborn care is a required benefit on every marketplace plan. A plan also can't turn you down or charge you more because you're pregnant.

The 2027 rule doesn't change any of this. And having a baby still gives you 60 days to sign up for a plan or switch plans.

Having a baby can lower your monthly bill

The income limit for help goes up with each person in your household. So once your baby is born, your family may qualify for more help at the same income.

Update your application as soon as you can after the birth. HealthCare.gov says adding a household member could mean more savings than you're getting now. The IRS also lists a birth as a change to report.

Why reporting changes matters more now: Most people get their help in advance. It's paid straight to the insurer each month, based on the income you expect. If you end up getting more than you qualified for, you pay it back when you file taxes. The IRS says "there is no repayment cap for tax years after 2025." So you pay back the full amount, however large. Tell HealthCare.gov when your income changes, like when you take unpaid leave or go back to work.

The most you can pay in out of pocket maximums on ACA plans is going up

Every plan has an out-of-pocket maximum. That's the most you pay in a year for covered, in-network care. Once you reach it, your plan pays for the rest of your covered, in-network care that year.

For 2027, that limit is $12,000 for one person and $24,000 for a family. In 2026 it was $10,600 and $21,200, according to CMS guidance.

What this means in a pregnancy year:

  • You may reach the limit. Prenatal visits, delivery, and newborn care add up fast.

  • Your plan's limit may be lower. $12,000 is the most any plan can set. Check your own plan's number.

  • Timing matters. If your baby is born late in the year, your costs may land in two plan years. That can mean paying toward two deductibles.

Cheap plans can cost more in a pregnancy year

Some 2027 changes make low-cost plans easier to get. A low monthly price looks good. But in a year with a baby, you'll likely use a lot of care, and these plans make you pay more of it yourself.

Catastrophic plans: These have low monthly prices and very high deductibles. A deductible is what you pay for covered care before your plan starts to pay. Catastrophic plans still cover maternity care. In 2027, more people can buy them, including people whose expected income is below 100% or above 250% of the federal poverty level. Plans can also last up to 10 years.

Bronze plans: CMS changed how much bronze plans can make you pay starting in 2027. Before you choose one, check its deductible and its out-of-pocket maximum.

Comparing plans takes more work in 2027

Standardized plans set up deductibles and copays the same way across insurers. That made it easy to compare them side by side. For 2027, CMS no longer requires insurers on HealthCare.gov to offer them. Some insurers still may.

Without them, two plans at the same metal level (like two silver plans) can work very differently. Here's an easy way to compare: open each plan's Summary of Benefits and Coverage. It's a short, standard form every plan has. It includes an example of what you'd pay to have a baby on that plan. Compare that number across plans.

Your 2027 timeline

  • Since tax year 2026: If you get too much help with your monthly bill, you pay all of it back at tax time.

  • November 1, 2026: Open enrollment for 2027 plans starts on HealthCare.gov.

  • December 15, 2026: Last day to pick a plan that starts January 1, 2027.

  • January 1, 2027: New plans, new deductibles, and the $12,000 yearly limit start.

  • January 15, 2027: Open enrollment ends. Plans picked after December 15 start February 1, 2027.

  • Within 60 days of your baby's birth: Add your baby, and switch plans if you want to.

  • Any time your household or income changes: Update your application.

What to do now

  1. Log in to your marketplace account. See your 2027 price and how much help you'll get. Do this before December 15, 2026.

  2. Update your income. Use what you expect to earn in 2027. Include any unpaid leave.

  3. Plan to add your baby. If your baby is due in 2027, update your household right after the birth.

  4. Compare the yearly limit, not only the monthly price. In a pregnancy year, you may reach it.

  5. Look at the "having a baby" example. It's in each plan's Summary of Benefits and Coverage.

  6. Be careful with catastrophic plans. Check the deductible before you pick one.

  7. Check your doctors, hospital, and lab. Make sure your OB, delivery hospital, and lab are in network for 2027.

  8. Pick by December 15. That's the last day for a plan that starts January 1, 2027.

How Granted helps with pregnancy bills in 2027

Granted is a medical bill advocate. It checks pregnancy bills against what your health plan says you owe. If a bill is wrong or too high, Granted works to fix it. In 2027, ACA plans have higher costs and some plans have new networks, so more pregnancy bills may need a second look. Granted is free to start, and you only pay if Granted lowers your bill.

Check your bill

Rule changes show up later, on your bills. A higher deductible means bigger bills early in the year. A new plan can mean a lab or hospital that's suddenly out of network. If a pregnancy bill doesn't match what your plan should cover, we check it against your EOB (explanation of benefits). That's the statement your insurance sends after it processes a claim. If something's wrong, we work to get it fixed.

Learn more about how we help with pregnancy bills. For more on choosing a plan, see our guide to open enrollment help.

If you're looking at a bill like this, upload it and get a second look before you pay. Free to start. You only pay if we lower your bill.

  1. You upload the bill. You can also connect your insurance so Granted can see your claims and EOBs. Granted works with 1,300+ insurance plans.

  2. Granted checks the bill against your EOB. It looks for amounts that don’t match, charges your plan should have covered, and billing errors.

  3. Granted works to fix what’s wrong. That can mean disputing an error with the provider, appealing a denied claim with your insurance, or negotiating the balance.

  4. Granted checks for income-based discounts. Many hospitals offer financial assistance based on income. Granted checks whether you may qualify.

  • The bill asks for more than the EOB says you owe

  • The same service shows up twice

  • Your plan denied a claim for care it should cover, like prenatal visits or delivery

  • In-network care billed as out of network

  • Your baby’s care billed under your name, or billed before your baby was added to your plan

  • Your deductible or out-of-pocket maximum applied the wrong way

Granted is free to start. You pay only if Granted lowers your bill. If your bill doesn’t go down, you owe Granted nothing. Each bill is different, and results vary.

Send Granted your bill before you pay, if you can. Errors are easier to fix before payment. A bill is worth checking if it:

  • Doesn’t match your EOB

  • Comes from a lab or hospital you didn’t expect to be out of network

  • Is much higher than you expected for your plan

  • Is for over $300

Frequently asked questions about ACA changes in 2027

Do ACA plans still cover pregnancy in 2027?

Yes. ACA marketplace plans still cover pregnancy, childbirth, and newborn care in 2027. These are required benefits. The 2027 changes affect how much you pay and which plans you can pick, not whether pregnancy is covered.

Will my ACA premium go up in 2027?

It may, for two reasons. Insurers asked for a median 15% price increase. And if your household makes more than 400% of the federal poverty level (about $86,560 for 2 people or $109,280 for 3), you may lose your help with the monthly bill. Log in to your marketplace account to see your real 2027 price.

Does having a baby lower my ACA premium?

It can. A bigger household can get more help at the same income. Update your marketplace application soon after the birth to see your new amount.

Do I have to pay back my premium tax credit if my income changes?

You may have to pay back your premium tax credit if your income changes. If your income ends up higher than you expected, you pay back the extra when you file taxes. Starting with tax year 2026, there's no limit on how much you pay back. Report income changes during the year so the amount stays close to right.

Is a catastrophic plan a good idea if I'm pregnant?

A catastrophic plan covers pregnancy, but you'll usually pay a lot before it helps, because the deductible is very high. If you expect a baby in 2027, compare its full-year cost with bronze and silver plans first.

Who is Granted?

Granted (Granted Health) is a digital health advocate. We review medical bills and EOBs, find billing errors, negotiate bills, and check if you qualify for income based discounts. If your 2027 plan leaves you with pregnancy bills that look wrong, we can check them against your coverage. Granted is free to start.

Key terms in this post

  • ACA (Affordable Care Act): The federal law behind marketplace health plans and the premium tax credit.

  • Premium: What you pay each month to keep your plan.

  • Premium tax credit: Government help that lowers your monthly bill, based on your income.

  • Federal poverty level: A yearly income guideline used to decide who gets help with the monthly bill.

  • Out-of-pocket maximum: The most you pay in a year for covered, in-network care.

  • Deductible: What you pay for covered care before your plan starts to pay.

  • Catastrophic plan: A plan with a low monthly price and a very high deductible.

  • Standardized plan: A plan with the same deductible and copay setup across insurers.

  • Summary of Benefits and Coverage: A short, standard form that lists a plan's costs, including an example of having a baby.

Sources & More information

Related guides

If you have a pregnancy bill over $300

Upload it and we'll check it for errors, look for ways to lower what you owe, and handle the work with you. Free to start. You only pay if we lower your bill.

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Connect your insurance, too. We cover 1,300+ insurance plans, so we can see your bills and claims together and keep an eye on them between visits.

Each bill is different, and results vary.

Last reviewed: November 5, 2026. We update this page when the rules change. This is general information, not legal or tax advice.

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