Choosing a plan · Ongoing care
How to pick a 2027 plan when you have a chronic condition
If you see doctors and fill prescriptions every month, the cheapest premium is rarely the cheapest plan. Here’s a checklist built from HealthCare.gov’s own rules.
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- Pre-existing conditions covered
- Check the drug list
- 2027 cap: $12,000
Check my doctors and drugs
Your info goes to Nexus only. Never sold. No pitch, no obligation.
Your protections
- No insurance plan can reject you, charge you more, or refuse to pay for essential health benefits for a condition you had before coverage started.[1]
- Once you’re enrolled, the plan can’t deny coverage or raise your rates based only on your health.[1]
- Prescription drugs are one of the 10 essential health benefits every Marketplace plan covers, at every metal level and plan type.[3]
Step 1: Your doctors and hospitals
HMOs usually limit coverage to doctors who work for or contract with the HMO, except in an emergency; PPOs cost less in network but let you go out of network for an additional cost.[4] When you compare plans on HealthCare.gov, you can select your doctors and facilities and it will tell you whether each plan covers them in network.[2] In Michigan’s 2026 plan file, 116 of 116 plans listed a provider network link.[5] See HMO vs. PPO in Michigan.
Step 2: Your prescriptions
- A formulary is the list of prescription drugs a plan covers, also called a drug list.[6] 116 of 116 Michigan plans in 2026 published a formulary link in the CMS file.[5]
- Search your drugs when you compare plans; HealthCare.gov shows whether each plan covers them.[2]
- Look for prior authorization: approval a plan may require before you fill a prescription or get a service for it to be covered.[7]
Step 3: Total cost for the year
Think about both the monthly premium and the out-of-pocket costs, including the deductible, when you get care.[2] The out-of-pocket maximum is the most you pay for covered in-network services in a plan year; it doesn’t include premiums or out-of-network care.[8]
| Marketplace out-of-pocket limit | Individual | Family |
|---|---|---|
| 2026 | $10,600 | $21,200 |
| 2027 | $12,000 | $24,000 |
Source: HealthCare.gov.[8]
If your income qualifies for cost-sharing reductions, a Silver plan’s deductibles and copays drop.[9] See Bronze vs. Silver. Pick by December 15 for January 1 coverage.[10]
Sources
- HealthCare.gov, Coverage for pre-existing conditions. https://www.healthcare.gov/coverage/pre-existing-conditions/
- HealthCare.gov, 3 things to know before you pick a health insurance plan. https://www.healthcare.gov/choose-a-plan/comparing-plans/
- HealthCare.gov, What Marketplace health insurance plans cover. https://www.healthcare.gov/coverage/what-marketplace-plans-cover/
- HealthCare.gov, Health insurance plan & network types: HMOs, PPOs, and more. https://www.healthcare.gov/choose-a-plan/plan-types/
- CMS, QHP Landscape Individual Market Medical file, plan year 2026 (HealthCare.gov states), Michigan rows. https://data.healthcare.gov/datafile/py2026/individual_market_medical.zip
- HealthCare.gov glossary, Formulary. https://www.healthcare.gov/glossary/formulary/
- HealthCare.gov glossary, Prior authorization. https://www.healthcare.gov/glossary/prior-authorization/
- HealthCare.gov glossary, Out-of-pocket maximum/limit (2026 and 2027 limits). https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/
- HealthCare.gov, Cost-sharing reductions. https://www.healthcare.gov/lower-costs/save-on-out-of-pocket-costs/
- HealthCare.gov, Dates and deadlines. https://www.healthcare.gov/quick-guide/dates-and-deadlines/
Checked October 16, 2026. 2027 Marketplace plans and final 2027 rates aren’t published yet; we’ll update this page when they are.
Frequently asked questions
Can a Michigan Marketplace plan deny me for a chronic condition?
No. Marketplace plans must cover pre-existing conditions and can't reject you or charge you more because of one.
How do I know if my medication is covered?
Check each plan's formulary (drug list). On HealthCare.gov you can search your prescriptions when comparing plans and see whether each plan covers them.
What is the most I could pay in 2027?
Marketplace out-of-pocket limits for 2027 are $12,000 for an individual and $24,000 for a family for covered in-network care, not counting premiums.
Will you sell my information?
No. Your information goes to Nexus Benefit Solutions only and is never sold.