Open enrollment guide for 2027: How to choose a plan for mental health coverage

Choosing health insurance is rarely anyone’s favorite task, and — depending on how you purchase your plan — this year comes with more moving parts than usual. Deadlines for those buying their own insurance changed, then changed back. We also saw subsidies that lower premiums for millions of people disappear. Premiums for employer-provided plans may be changing as well. If you see a therapist or are thinking about starting therapy, those shifts can affect what you pay per session and even whether your existing provider stays in-network.

There is good news, though. You don’t need to understand every nitty-gritty policy detail to make the best choice. A handful of dates, a few terms, and where to look in a plan document can go a long way to bridge the knowledge gap. This guide covers what open enrollment is, what’s different for 2027, and how to compare plans with your mental health in mind.

What is open enrollment?

What open enrollment is and why it matters for mental health care

Open enrollment is the annual window when you can sign up for health insurance, switch plans, or change your coverage for the year ahead. Outside that window, most people can only make changes after a qualifying life event such as marriage, a new baby, or losing other coverage.

For anyone receiving or considering mental health care, open enrollment is an opportunity to select coverage that supports your mental health needs and access to care in the year ahead. Whether your therapist is in network, how much you pay per session, and whether virtual visits are covered are all determined by the plan you pick now and are locked in for 12 months. A plan that works well for occasional urgent care can be a poor fit for weekly therapy, and corrections later in the year may be out of reach.

Open enrollment affects more people than just those buying on the Marketplace. If you get coverage through an employer, your company runs its own enrollment window, usually beginning in October or November. If you have Medicare, Medicaid, or a student health plan, your enrollment timeline and options may look a little different. We’ll walk through those later in this guide. The common thread is that this is your once-a-year chance to make your insurance match how you actually use care.

Before anything else, look at the past year. How often did you attend therapy? Did you hit your deductible? Were there sessions you skipped because of cost? Those answers are the most useful input you have.

When does open enrollment for 2027 start?

Key 2027 dates and deadlines to know

For most states, Marketplace open enrollment for 2027 coverage begins on November 1, 2026, and ends on January 15, 2027.

In this window, there are two deadlines to distinguish:

• December 15, 2026: Enroll in a plan by this date to have your coverage begin January 1, 2027.

• January 15, 2027: This is the last day to enroll in a plan in states that use HealthCare.gov. If you enroll after December 15, your new coverage will generally begin February 1, meaning you may start the new year with your existing coverage or, in some cases, a gap in coverage.

If you take medication or attend therapy regularly, avoiding a gap in coverage can help prevent disruptions to your care. Consider treating December 15 as your personal enrollment deadline to help ensure your new coverage begins January 1.

These dates were uncertain for much of 2026. A federal rule finalized in 2025 would have ended enrollment on December 15 in HealthCare.gov states and removed the February 1 start date entirely. A federal judge vacated that provision in June 2026, and in early August, federal officials confirmed in writing that the window would run November 1 through January 15.

Where you can enroll in coverage in 2027

Where you enroll will depend on how you receive your health insurance. If you enroll through the Marketplace, most states use HealthCare.gov. Roughly a dozen states plus Washington, D.C., run their own exchanges and set their own calendars. A few open earlier than November 1, and several changed their deadlines twice this year as litigation moved forward. Enrollment dates can change from year to year, so it’s always a good idea to confirm the current deadlines.

When enrolling through an employer, your employer sets the enrollment window, not the federal government. Most companies with a January 1 plan year hold enrollment in October or November. Check with your HR or benefits team to confirm your enrollment dates and available options.

Finally, Medicaid enrollment is open year-round for those who qualify, and Medicare has its own annual enrollment period with different dates.

What’s changing for open enrollment in 2027?

One of the biggest changes this year isn’t how mental health care is covered, but how much your overall coverage may cost. This change comes from tax credits introduced during the height of the COVID-19 pandemic that expired at the beginning of 2026. These credits helped many people pay less each month for Marketplace health insurance and allowed some people with higher incomes to qualify for financial assistance. Congress debated an extension throughout 2026 and the House passed one, but no extension has been signed into law.

For 2027, premium tax credits return to the Affordable Care Act formula, a sliding scale based on your household income as a percentage of the federal poverty level. Here’s how this change could affect you:

• Your subsidy amount may be similar to what it was two years ago, even if your income hasn’t changed.

• If your income is above roughly four times the federal poverty level, you may not qualify for a subsidy at all.

• Estimating your income accurately matters more than it used to. If you earn more than you projected, you may owe the difference back at tax time.

Premiums themselves are also expected to rise by 7.7% this year for marketplace plans. Additionally, some people may be moved from Medicaid into Marketplace or employer coverage mid-year due to the new Medicaid eligibility requirements expected to take effect in January 2027.

How do I choose the best plan for mental health coverage?

Start with your mental health care needs

Think about what your mental health care looked like over the past year and what you may need in the year ahead. How often did you attend therapy? Do you see a psychiatrist or take medication that requires regular follow-up appointments? Do you prefer virtual care, in-person sessions, or a combination of both?

Something to consider is how often you may need therapy. Sessions often begin once a week and may become less frequent over time, depending on your needs. Getting started with therapy can help you think through what kind of support may be right for you.

Also consider the mental health care needs of anyone else on your plan, as coverage for couples therapy, family therapy, and care for children can differ.

Consider your budget

Four numbers to look at when considering your open enrollment options:

• Premium: This is what you pay monthly whether you use care or not

• Deductible: What you pay before the plan starts sharing costs

• Copay or coinsurance: Your share per session

• Out-of-pocket maximum: The ceiling on what you’ll pay in a year

A plan with a higher deductible and a lower monthly premium may make sense if you don’t use health care often. But if you attend therapy regularly, you could end up paying the full session cost for several months before your plan begins covering more of the expense. With premiums higher this year, it may be tempting to choose the lowest monthly option, but take a moment to consider your total costs before deciding.

Compare plan benefits

Every plan publishes a summary of benefits and coverage (SBC), a standardized document that lets you compare options directly. When you’ve accessed your SBC, find the section on mental health, behavioral health, and substance use services.

Once you’re there, look for whether individual, group, and family therapy are covered, whether psychiatry and medication management are listed separately, whether virtual visits are covered at the same rate as in-person, and whether any annual visit limits or prior authorization requirements apply.

The Affordable Care Act requires most plans to cover mental health services, and parity rules require that those benefits be comparable to medical benefits. Comparable is not identical, though, and the details still vary plan to plan.

Confirm network status

In-network care costs significantly less than out-of-network care, so this is an important step. Start by searching the insurer’s provider directory for your therapist by full name and location. Then, confirm the exact plan name and network type. Directories are frequently out of date, so verify a second time by calling your therapist’s office or the insurer directly. Ask specifically whether they are in-network for the 2027 plan year, since participation can change between years.

If you use a platform for care, confirm the platform and your specific provider are both covered. Grow’s cost estimate tool can check insurance acceptance quickly.

Evaluate out-of-pocket costs

Even with insurance, you’ll likely have some out-of-pocket costs for therapy, such as copays, coinsurance, or payments toward your deductible. Review how these costs differ across plans. For example, one plan might charge a $20 copay for each therapy session, while another could require 20% coinsurance after your deductible is met.

So, what could this look like in practice? Imagine you plan to attend therapy once a week, or about 50 sessions over the course of a year:

• Plan A charges a $20 copay per session and has a $0 deductible. You’d pay roughly $1,000 per year for therapy.

• Plan B has 20% coinsurance after a $1,000 deductible. If each session costs $150, you’d first pay the full $1,000 to meet your deductible. After that, you’d owe 20% of each remaining session at about $30. That’s roughly $1,000 (deductible) + $1,300 (coinsurance) = $2,300 total for the year.

Even though Plan B might have a lower monthly premium, Plan A could be more cost-effective if you use therapy frequently.

When comparing plans, consider:

1. Your therapy frequency: More frequent sessions can make a low-copay plan more valuable.

2. Your deductible: High-deductible plans may cost more upfront, especially early in the year.

3. Your total annual cost: Add therapy expenses to your annual premiums to get a full financial picture.

Looking at the full picture can help you understand what a plan may actually cost you throughout the year, not just each month. If you plan to attend therapy regularly, factor in your copay or coinsurance when estimating your total yearly costs.

What do I need to know about insurance coverage for therapy?

Know what your plan covers

Most marketplace and employer-provided health insurance plans today are required to cover mental health services — they’re considered essential health benefits (EHBs) under the Affordable Care Act. That requirement establishes a standard, but it’s not a guarantee of good coverage. Two plans can both satisfy it and still leave you paying very different amounts for the same weekly session.

Mental health parity rules offer another layer of protection by requiring plans to cover mental health and substance use care comparably to medical and surgical care. This covers things like cost-sharing, visit limits, and prior authorization. It pays to read the specifics rather than assume the protections do the work for you.

If therapy is part of your regular care, your mental health benefits deserve just as much attention as the rest of your coverage.

How to verify if therapy is covered under your plan

Here are four steps to follow, in order of reliability:

1. Read the summary of benefits and coverage (SBC). Every plan has one, and they have a standard format. Look under the mental or behavioral health outpatient services section.

2. Find the evidence of coverage (EOC) or policy document. It’s longer and less reader-friendly, but this is where visit limits and authorization requirements are spelled out in full.

3. Search the provider directory. Confirm your therapist by name, location, and the exact plan network.

4. Call the insurer if you still have doubts. Ask what you’ll pay per outpatient therapy session, whether referral or prior authorization is required, and whether any annual visit cap applies. Note the date of the phone call and the representative’s name.

Grow’s guide to insurance coverage for therapy walks you through what these documents mean in more detail.

Coverage for individual, couples, and family therapy

Individual therapy is the most consistently covered format. Couples and family therapy are less predictable. Because insurance generally pays for treatment of a diagnosed condition, when couples or family sessions support treatment for the individual, they are often covered as well. When the sessions address relationship functioning itself, many plans classify that as something they don’t pay for, even though it’s valuable work.

A practical approach is to ask your insurer directly whether family or couples sessions are covered. You can also ask your provider how they bill for them. If the answer is that they aren’t covered, you can still ask about self-pay rates or whether individual sessions can address the same topics you’d like to cover in couples or family therapy.

Teletherapy and online mental health platform coverage

Most plans now cover virtual therapy, and many cover it at the same rate as an in-person visit. This isn’t universal, though. Some plans apply a separate copay to virtual visits, cap how many are covered, or restrict coverage to a specific telehealth vendor the insurer contracts with.

If virtual sessions are your preference or the only way your schedule allows therapy, verify three things before you enroll. The first is that teletherapy is covered. Secondly, verify that your therapist qualifies rather than only a designated platform. Finally, make sure that the cost-sharing matches in-person visits. Grow’s overview of online therapy that takes insurance covers what to expect.

Common pitfalls to avoid

Some health insurance plans appear affordable at first glance but come with hidden barriers to mental health care. Common issues include limited provider networks, high copays, or coverage that only includes certain therapy types. Other insurance plans may require a referral from a primary care physician before you can see a therapist, adding additional steps and potential delays.

Be cautious of plans that provide limited details about behavioral health coverage or make it hard to verify in-network therapists. If you’re not sure how to identify these red flags, compare how each insurer lists behavioral health coverage on their website. Clear, transparent information is a good sign the company values mental health parity and accessibility.

Special considerations by coverage type

Employer-sponsored plans and mental health benefits

Your employer sets its own enrollment window, typically in October and November. Rather than offering an open market, they usually have a small set of plans you can choose from.

Compare the mental health sections of each plan side-by-side, and the differences are often larger than the premium differences alone. Also look at what else is included in the plan. Many employers offer what’s known as an Employee Assistance Program (EAP) that has a set number of free counseling sessions per year, typically between three and eight. An EAP is not a substitute for ongoing therapy, but it can cover a short course of care or a first appointment while you sort out longer-term coverage.

If your employer offers a health savings account (HSA) or flexible spending account (FSA), therapy copays are generally eligible expenses, which effectively discounts them by your tax rate.

Marketplace plans and income-based subsidies

Marketplace plans typically come in metal-themed tiers. Generally speaking, bronze plans offer the lowest premiums and highest deductibles. Silver plans are the only tier where cost-sharing reductions apply if you qualify. Gold and platinum cost more monthly and less per visit.

If you attend therapy regularly, a silver or gold plan may offer better overall value than a bronze plan, even if the monthly premium is higher. With less financial assistance available in 2027, a lower-cost bronze plan may be tempting. Before choosing, compare what you could spend over the full year, including premiums and your share of therapy costs.

Your subsidy is based on your expected household income for 2027, so aim for the most accurate estimate you can. Underestimating can mean repaying credits at tax time, and overestimating means paying more each month than you need to. If your income changes during the year, update your information with the Marketplace as soon as you can so your financial assistance can be adjusted if needed.

Medicaid mental health coverage basics

Medicaid covers mental health services, including therapy, and enrollment is open year-round rather than restricted to the open enrollment window. Eligibility and specific benefits vary by state.

Cost-sharing is minimal or nonexistent in most states, which makes Medicaid one of the most affordable routes to consistent care. The main limitation is network size, especially for those living in rural areas with fewer in-person options to begin with. Availability can be tighter as well, as fewer providers accept Medicaid overall.

Keep in mind that new federal eligibility requirements are scheduled to take effect in January 2027 and may affect continued enrollment for some people. Confirm your status with your state Medicaid office.

Understanding mental health coverage with Medicare

Medicare has a different calendar, with annual enrollment in the fall, separate from Marketplace open enrollment. It has its own deadlines too. For 2027, Medicare open enrollment runs from October 15, 2026, to December 7, 2026. Enrollment requests must be received by December 7 for coverage to begin on January 1.

Part B covers outpatient mental health services, including individual and group therapy, with coinsurance after the deductible. Part D covers prescription drugs, including psychiatric medications, with costs depending on your plan’s formulary. Medicare Advantage plans bundle these and may add benefits, but typically use a defined network.

If you’re on Medicare and see a therapist, confirm each year that your provider still accepts Medicare or remains in your Advantage plan’s network.

Student health plans and young adult options

If you’re under the age of 26, you can generally stay on a parent’s plan, which often provides broader coverage than a student plan. It’s worth comparing rather than defaulting to whatever your school offers.

Student health plans vary considerably in mental health coverage. Some are strong, while others cap counseling visits or restrict care to the campus counseling center. In that case, you may experience long waits or session limitations. If you attend school in a different state than where your parent’s plan is based, check whether that plan’s network reaches your campus, since an out-of-state network gap is a common and expensive surprise.

Marketplace coverage is also available to students, and income-based subsidies may apply if you file independently.

Final thoughts

Taking a little time to review your options during open enrollment can make a meaningful difference. Look at what you spent on care last year, review your plan’s benefits, confirm that your therapist will still be in network for 2027, and compare a few options based on what you may spend throughout the year, not just the monthly premium.

With changes to financial assistance, premiums, and plan options, it’s especially important to take a closer look before automatically renewing. Choosing health insurance can be challenging and it could also feel overwhelming, but you don’t have to get every detail perfect. The overall goal is to select coverage that supports your health, your budget, and the care you may need in the year ahead.

Need help figuring out what your mental health care could cost?Grow can help.

Grow works with most major insurance plans, and you can check what a therapy session may cost with a specific plan before you enroll. For more guidance, Grow’s resources on paying for therapy can help you understand your options and make a more informed choice, without all the insurance jargon.