New ACA rules may leave consumers with harder health plan choices

The Centers for Medicare & Medicaid Services has issued final rules that could significantly reshape Affordable Care Act health insurance plans beginning in 2027.

In an interview, Jae Oh, author of Maximize Your Medicare, explained how the changes may create more plan choices, blur distinctions between coverage tiers and make healthcare decisions more intertwined with retirement and financial planning.

Below is a transcript of the interview with Oh, edited for brevity and clarity.

Why 2027 ACA changes matter

Robert Powell: A lot to break down here.

Jae Oh: It's wide-sweeping changes. Probably the most dramatic changes in a number of years.

Powell: Where should we begin? What's the most important thing people need to know?

Oh: There's a growing sense that rising healthcare costs mean something has to change. What it looks like is the possible introduction of a broader set of weaker plans that may help some people reduce premiums.

The question is whether consumers will be able to navigate all of the changes happening at once with very little preparation.

New catastrophic plans could change consumer choices

Powell: These new plans have been described as non-network plans. Is that accurate?

Oh: The first place to start is an entirely new tier of catastrophic plans. The Affordable Care Act allows consumers to switch plans every year, so the idea of long-duration catastrophic plans is interesting.

These catastrophic plans would not allow consumers to claim advanced premium tax credits. But for people in very good health who rarely use doctors or hospitals and mainly want protection against a catastrophic financial event, a weaker plan with an out-of-pocket maximum could be a rational choice.

That's the underlying idea behind this new tier of catastrophic plans.

Comparing plans may get harder

Powell: Consumers currently use Healthcare.gov or state exchanges to compare plans. Do you see that changing?

Oh: Yes. The lines between plans appear likely to blur.

Today, plans fit within familiar metal tiers – platinum, gold, silver and bronze – based on the percentage of healthcare costs they're designed to cover. Silver plans, for example, became a benchmark for many consumers.

The issue now is that standardization and benchmarking may become less defined beginning in 2027.

That could make it much harder for consumers to compare plans. In some markets, consumers already face more than 100 plan choices. If distinctions between plans become less clear, it creates additional challenges.

Why provider networks matter more now

Powell: People with complex health conditions may need to pay close attention to whether their doctors remain in-network.

Oh: Absolutely. People with known healthcare conditions will want to identify their core providers – primary care physicians, specialists, clinics and hospitals – before selecting coverage.

There may be a complicated resetting of what plans work best financially and medically. Definitions around network and non-network coverage may change. That creates challenges not only for consumers but also for insurers and healthcare providers.

Even for me, parts of it are confusing.

The takeaway is that consumers will need to double-check whether the plan they select for 2027 actually matches their healthcare needs.

State exchanges may respond differently

Powell: Will the rules work the same way on Healthcare.gov and state-run exchanges like Massachusetts?

Oh: That remains to be seen.

Insurance is still regulated at the state level. Some states may apply tighter standards or create a more demanding approval process. Massachusetts, for example, operates its own exchange and may approach implementation differently than other states.

Healthcare costs are becoming a financial-planning issue

Powell: There's an Employee Benefit Research Institute study showing increased prevalence of deductibles. This seems less like a health insurance issue and more like a financial-planning issue.

Oh: That's fair.

Healthcare costs directly affect household finances. The money people spend on premiums, deductibles and out-of-pocket expenses is post-tax cash flow. Anything affecting that is, by definition, a financial matter.

And as healthcare costs continue rising, those issues become even more important.

HSAs may become more valuable

Powell: What's the actionable advice for households?

Oh: One takeaway is the increased importance of health savings accounts.

Because of their triple-tax advantages, HSAs can serve as an emergency reserve fund for healthcare expenses. Healthcare costs remain one of the biggest unknowns facing households, and HSAs offer a tax-efficient way to build reserves.

Consumers should also understand how advanced premium tax credits work. While the enhanced premium tax credits have generated controversy, the base premium tax credits still exist.

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For married couples especially, managing taxable income appropriately can dramatically reduce health insurance premiums. That can materially affect retirement outcomes.

Powell: And some ACA plans remain HSA-eligible.

Oh: Correct. Some ACA plans already qualify for HSA contributions, and HSAs can later be used for Medicare out-of-pocket costs as well.

"Everything affects everything"

Powell: Consumers are being asked to make a lot of interconnected decisions.

Oh: A client recently told me, "Everything affects everything."

That's exactly right.

Healthcare planning, taxes, Roth conversions, Social Security timing, Medicare surcharges and retirement withdrawals all interact with each other. These decisions do not exist in isolation.

The rising cost of healthcare has simply made those interactions impossible to ignore.

The differences created by understanding these relationships can be larger than the differences investors focus on inside brokerage statements.

The need for individualized planning

Powell: What's your best advice for consumers trying to avoid mistakes?

Oh: Guidelines only go so far because outcomes vary by individual circumstances and by state.

Some areas already have fragmented provider networks and difficult plan structures. In those markets, some of these changes could potentially improve options.

But consumers should avoid being blindsided. The best approach is gathering as much information as possible about household healthcare and financial needs before making decisions.

Financial planning becomes more important

Powell: Anything else people should keep in mind?

Oh: It's still early, but the financial-planning aspects of healthcare decisions have become more important, not less important.

People need emergency funds. They need to understand how taxable income affects premiums and subsidies. And they need to understand how healthcare choices interact with the rest of their financial lives.

That takes work, but households that understand these relationships may be able to improve their overall outcomes.

Actionable advice for ACA marketplace enrollees

• Before open enrollment, verify whether your plan is a traditional network plan or an indemnity/non-network plan - and if it's non-network, get written confirmation of what specific providers accept the plan's benefit amount as payment in full before enrolling.
• If you have a complex condition or a specialist relationship you depend on, non-network plans are high-risk; the absence of contracted rates means your exposure to balance billing could be substantial.
• Catastrophic plan buyers should model the new $15,600 individual/$27,000 family out-of-pocket thresholds before assuming these plans are "cheap" coverage.

Related: Dave Ramsey flagged three behaviors shrinking retirement savings

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This story was originally published May 27, 2026 at 8:07 AM.