平价医疗开放注册11月1日开始：2027年保费拟再涨中位数15% 增强补贴已到期不再延续
《平价医疗法案》（ACA）医保市场2027年度开放注册将于11月1日开启，至2027年1月15日结束。在 HealthCare.gov 投保的民众须在12月15日前完成注册，才能让保单在2027年1月1日生效；12月16日至1月15日注册的，保单自2月1日起生效。各州自营交易平台的日期可能有所不同。
保费方面，健康政策研究机构 KFF 对全美276家保险公司2027年费率申报的分析显示，拟议保费涨幅中位数为15%，各家从降价1%到涨价54%不等，多数集中在10%至25%区间，为连续第二年出现两位数涨幅。
涨幅背后的一大因素是增强版保费税收抵免已于2025年12月31日到期且未获延续。据 KFF 数据，2026年参保人实际自付保费平均上涨58%，从每月113美元升至178美元；自付额平均上涨37%至3786美元；2026年开放注册报名人数减少逾100万、降至2310万，为医保市场建立以来最大单年降幅。2027年个人自付费用上限将升至12000美元、家庭24000美元。
另据2027年规则，合法居留非公民的保费抵免资格将收窄至绿卡持有者等少数类别。分析普遍指出，今年逐一比对计划、而非直接自动续保，对参保人比往年更重要。
ACA Open Enrollment Opens November 1; Insurers Seek Median 15% Premium Increase for 2027 as Enhanced Subsidies Stay Expired
Open enrollment for 2027 coverage under the Affordable Care Act marketplace begins November 1 and runs through January 15, 2027. On HealthCare.gov, enrolling by December 15 ensures coverage starting January 1, 2027; those who enroll between December 16 and January 15 start coverage February 1. State-run exchanges may set different dates.
On premiums, a KFF analysis of 2027 rate filings from 276 insurers nationwide found a median proposed increase of 15%, ranging from a 1% decrease to a 54% increase, with most insurers proposing between 10% and 25% — a second straight year of double-digit increases.
A major driver is the expiration of the enhanced premium tax credits on December 31, 2025, which were not extended. Per KFF, enrollees' average premium payments rose 58% in 2026, from $113 to $178 a month; average deductibles climbed 37% to $3,786; and 2026 sign-ups fell by more than one million to 23.1 million, the sharpest single-year drop since the marketplaces launched. The out-of-pocket maximum rises to $12,000 for individuals and $24,000 for families in 2027.
Under 2027 rules, premium tax credit eligibility for lawfully present noncitizens also narrows to limited categories including lawful permanent residents. Analysts say comparing plans rather than simply auto-renewing matters more this year than in the past.
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图片来源：诊所候诊区（资料图）。图：Harrison Keely／Wikimedia Commons，CC BY 4.0。A clinic waiting room (file photo). Photo: Harrison Keely / Wikimedia Commons, CC BY 4.0.
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