Open Enrollment for 2027: Understanding Your Options—and Where Direct Primary Care Fits
Choosing health insurance can feel like trying to predict the future. How many appointments will you need? Will your medications still be covered? Is a lower monthly premium worth a higher deductible?
When household expenses are rising, these decisions deserve careful attention. But choosing healthcare involves more than finding an insurance plan. It also means thinking about how you will receive everyday care—and whether that arrangement meets your needs.
Open enrollment is an opportunity to consider the whole picture: coverage, costs, access, and continuity. Here’s what to know when making decisions for 2027.
When is open enrollment?
Open enrollment is the annual period when you can enroll in health insurance or change your existing plan.
For Florida residents purchasing individual or family coverage through HealthCare.gov, the current enrollment schedule is:
November 1, 2026: Open enrollment begins.
December 15, 2026: Deadline to select coverage starting January 1, 2027.
January 15, 2027: Open enrollment ends. Plans selected December 16–January 15 generally begin February 1.
You must also pay your first premium by the insurer’s deadline. Outside this window, you generally need a qualifying life event, such as losing other coverage, to enroll or change plans.
Employer plans follow their own enrollment calendars. Medicare’s annual enrollment period for health and prescription drug plan changes runs October 15–December 7.
What looks different for 2027?
Insurance costs remain under pressure. An August analysis by KFF (Kaiser Family Foundation), an independent nonprofit health policy research organization, found a median proposed premium increase of 15% among Marketplace insurers nationwide. That is a proposed national figure—not a prediction of your personal increase. Your actual cost depends on final rates, your location, your plan, and any financial assistance you receive.
Financial assistance has changed. Enhanced Marketplace premium tax credits expired after 2025, affecting affordability beginning in 2026. Regular premium tax credits remain available to eligible households. Update your application using your expected 2027 income and household information, rather than assuming last year’s assistance will stay the same.
Look closely at what each plan actually covers. Changes to federal rules for 2027 give insurers more flexibility in how they design some plans. Two Bronze plans, for example, may charge different amounts for office visits, tests, and prescriptions. Compare those details rather than assuming plans in the same category work the same way.
Even if you like your current coverage, review your renewal notice and compare your options before accepting automatic renewal.
Look beyond the monthly premium
The premium is the amount you pay each month to keep your insurance. It is only one part of your healthcare spending.
Also review:
Deductible: What you pay for services subject to the deductible before insurance starts sharing those costs.
Copays and coinsurance: Your share of covered appointments, tests, treatments, and medications.
Out-of-pocket maximum: Your annual spending limit for covered, in-network care. Premiums and noncovered services are additional.
Provider network: Whether your preferred doctors, specialists, hospitals, and laboratories participate in the specific plan.
Think about both an ordinary year and an expensive year. A lower premium may be helpful, but could you manage the deductible if someone needed surgery or ongoing specialty treatment?
Depending on your household income, a Silver plan could offer extra savings. Some people qualify for lower deductibles and smaller bills for covered visits, tests, and prescriptions—but these savings are available only if you choose a Silver plan. Check whether you qualify before choosing a plan based on its monthly premium alone.
Give your medications their own review
A plan’s drug formulary is its list of covered medications. Reviewing it is particularly important if you take medication regularly. Before choosing a plan, check:
Is your exact medication, strength, and formulation covered?
What tier is it on, and what will you pay?
Does a deductible apply before prescription benefits begin?
Is prior authorization required?
Must you try another medication first—a requirement called step therapy?
Are there quantity limits or restrictions on which pharmacy you can use?
A medication can be “covered” and still be expensive. This is a very important concept to understand. Some plans charge a fixed copay; others require you to pay a percentage of the cost.
Check the 2027 formulary and prescription benefit details, even if the insurer or plan name looks familiar. A lower monthly premium can quickly lose its advantage if your prescriptions become substantially more expensive.
Where does Direct Primary Care fit?
Direct Primary Care, or DPC, provides primary care through a predictable membership fee. Depending on the practice, membership may include office visits, virtual care, direct physician communication, and management of ongoing medical conditions. Labs, medications, and procedures may be included or priced separately, but often are priced affordably.
DPC is not health insurance. It does not replace coverage for hospitalizations, surgery, emergency care, or expensive specialty treatment. It can, however, be a practical way to organize everyday healthcare alongside insurance. That makes it worth considering during open enrollment.
Some people compare a higher-premium insurance plan with a lower-premium plan paired with DPC. Others keep their existing insurance and choose DPC for access and continuity. The best fit depends on the complete cost and the care a person or family needs.
What might this look like in everyday life?
These hypothetical examples illustrate how primary care arrangements can affect costs, convenience, and communication. Actual experiences vary. Many traditional practices provide timely, attentive care, and DPC availability and included services differ by practice.
1. A sore throat that needs attention today
Patient A has insurance without a DPC membership.
She develops a sore throat and calls her primary care office. If a same-day appointment is available, she may pay her regular office copay. If the schedule is full, she may be directed to urgent care.
At urgent care, she is examined, has a rapid strep test, and receives a prescription after testing positive. She then fills the prescription at a pharmacy.
For illustration, suppose her urgent-care copay is $75 and her prescription costs $10. That is $85, plus any separate patient responsibility for testing. A $75 urgent-care copay appears in some current Florida plans, but it is not a universal price. Testing may be included or billed separately, depending on the plan and provider.
Patient B has insurance plus a DPC membership.
She contacts her DPC office and gets an available same-day appointment. Her physician examines her and performs a rapid strep test. If the test is positive and an appropriate antibiotic is stocked, she may be able to obtain it before leaving.
The visit is covered by her membership. If rapid strep testing is also included, there is no additional visit or testing charge. Medication may carry a separate, disclosed price, but very often, the cost of this medication is significant less than it might be at the local retail pharmacy.
The consideration: DPC may simplify an unexpected sick visit and reduce additional expenses. But the membership itself has a cost. A fair comparison includes the annual membership fee, how often care is needed, and what is covered.
2. High blood pressure that needs ongoing follow-up
Patient A has insurance without a DPC membership.
He calls to schedule a blood pressure follow-up and learns that the next routine appointment is several months away. He requests an earlier appointment or cancellation opening. At his eventual visit, his clinician identifies an EKG finding that warrants a cardiology evaluation and sends a referral. When he does not hear from the specialist, he calls his primary care office for help. His message takes several days to resolve. A separate medication refill request requires additional calls.
His insurance may cover these services, but he still spends time coordinating appointments, tracking messages, and making sure he has enough medication.
Patient B has insurance plus a DPC membership.
His DPC practice has capacity to see him sooner. When the same EKG finding appears, his physician explains the concern, determines how urgently it needs evaluation, and helps coordinate the referral.
The practice follows up on whether the referral was received, communicates relevant findings, and addresses medication refills while he waits.
The specialist appointment still depends on clinical urgency, availability, and his insurance network. Specialist visits and outside testing remain subject to his insurance benefits.
The consideration: The value here is ongoing access and help coordinating care. Membership does not eliminate specialist expenses, but it may make the steps between appointments easier to manage.
3. A question about a new medication
Patient A has insurance without a DPC membership.
After starting a medication, she notices a mild symptom and wonders whether it could be a side effect. She calls her primary care office and leaves a message for the clinical team.
The nurse or medical assistant returns her call later that day or the following day, gathers more information, and relays the question to her clinician if needed. While waiting, she remains unsure what to do about her next dose.
Patient B has insurance plus a DPC membership.
She sends a secure message to her DPC practice. In this example, her physician responds within a few hours and calls her directly to discuss the symptom, explain the next step, and arrange follow-up if needed.
This communication is included in her membership. Response times depend on office hours, the urgency of the concern, and the practice’s communication policies.
The consideration: Access to a clinician who knows your history can make medication questions easier to address. Ask any prospective practice how messages are handled, who responds, and what to expect after hours. (Severe or rapidly worsening symptoms require urgent evaluation rather than waiting for an office message.)
Does DPC make financial sense for your household?
Start by comparing: Annual insurance premiums + annual DPC membership, if applicable + expected medical and prescription expenses. Then consider what you could owe during a more expensive medical year.
DPC membership fees generally do not count toward an insurance deductible or out-of-pocket maximum. Membership also does not change your insurer’s network, referral requirements, or coverage rules for outside services.
If switching insurance lowers your premium, compare the annual savings with the membership cost—and consider any increase in your deductible or prescription expenses.
For some households, DPC paired with appropriate insurance may be the most affordable and useful arrangement. Others may benefit more from generous employer coverage, a Silver plan with extra savings, or another option.
Access matters, too. Predictable primary care expenses, timely appointments, and help managing ongoing concerns can offer value beyond the cost of an individual visit.
Could an HSA help?
Changes that began in 2026 expanded Health Savings Account options, including broader HSA compatibility for individual-market Bronze and Catastrophic plans. Qualifying DPC membership fees can also be paid with HSA funds tax-free. Specific requirements apply to other coverage, membership fees, and included services. Confirm that your insurance and DPC arrangement meet the rules before assuming you can contribute to an HSA or use it for membership payments.
Before you enroll
Take time to:
Update your information. Review your renewal notice and expected 2027 household income.
Check your prescriptions. Confirm formulary coverage, restrictions, pharmacy requirements, and costs.
Verify your providers. Check the specific plan’s network.
Compare total expenses. Include premiums, membership fees, expected care, and potential out-of-pocket costs.
Consider access. Ask how appointments, messages, refills, and referrals are handled.
Meet the deadlines. Confirm your enrollment date and first-payment requirements.
For help comparing insurance options, start with HealthCare.gov or its local enrollment assistance directory.
The goal is to choose coverage and care that work together—for your budget, your medical needs, and the way your family actually uses healthcare.
At Cardona Direct Primary Care, Dr. Cardona and Dr. Garland provide personalized healthcare, including direct primary care, obesity medicine, and aesthetic treatments. Dr. Cardona is board-certified in both family medicine and obesity medicine and has a special interest in medical weight loss. Dr. Garland is board-certified in family medicine and is a certified medical marijuana provider. She has a special interest in skincare and is eager to assist with your individual skincare needs. Located in Jacksonville, FL, we are dedicated to prioritizing you. Contact us at 904-551-4625 or visit our website at www.cardonadpc.com to learn more and schedule your appointment today!
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