Cost & Insurance

Open Enrollment 2027: Price Your Deductible Against a Cash-Pay Surgery

If you know surgery is coming in 2027, the plan you choose this fall sets your real price. Run the numbers on the insurance route and the cash route before you sign up.

October 30, 2026 · 8 min read · Last checked: October 30, 2026

If you are planning surgery next year, compare two numbers before you pick a 2027 plan: what you would pay through insurance, and what you would pay in cash. HealthCare.gov Open Enrollment for 2027 runs November 1 to January 15. Enroll by December 15 for coverage that starts January 1.

For many people with high deductibles, those two numbers are closer than expected. Sometimes the cash price wins. This guide shows how to run the math with your own plan options.

Open Enrollment dates for 2027 coverage

HealthCare.gov lists these dates for 2027 Marketplace plans:

These are HealthCare.gov's dates. If your state runs its own Marketplace instead, confirm the dates on your state exchange's site.

If you have job-based coverage, your employer sets its own open enrollment window, so check your benefits portal for the dates. Your plan year may not match the calendar year either. HealthCare.gov notes a plan year is a 12-month period that may not line up with January to December.

How deductibles, coinsurance and the out-of-pocket max fit together

Three numbers decide what a surgery costs you on most plans. HealthCare.gov defines them this way:

• Deductible: what you pay for covered services before the plan starts to pay. Preventive care is covered before the deductible on Marketplace plans.
• Coinsurance: your percentage of covered costs after the deductible, such as 20%.
• Out-of-pocket maximum: the most you pay for covered services in a plan year. After you hit it, the plan pays 100% of covered services for the rest of that year.

All three apply to the allowed amount, the maximum the plan pays for a covered service. It is usually far below a hospital's list price. A preferred, in-network provider may not balance-bill you above it for covered services.

What does not count toward the cap

HealthCare.gov says these do not count toward the out-of-pocket maximum:

• Monthly premiums.
• Services your plan does not cover.
• Out-of-network care.
• Charges above the allowed amount that a provider may bill.

That first point matters most for plan comparisons. A plan with a lower deductible but higher premiums can cost more in total, even in a surgery year.

For 2026, the Marketplace cap was $10,600 for one person and $21,200 for a family. Your plan's own cap can be lower than the legal maximum; check its Summary of Benefits and Coverage.

A worked example: insurance route vs cash route

The numbers below are invented to show the method. They are not quotes or averages for any procedure. Replace each one with figures from your plan documents and your providers.

The same math is the core of our cash price vs insurance out-of-pocket guide. Our piece on the deductible trap takes it further, comparing it with traveling for care.

Now add premiums

During Open Enrollment you are often choosing between plans. For each one, add twelve months of premiums to your expected surgery share and to any other care you expect. The plan with the lowest total, not the lowest deductible, is the cheapest for a surgery year.

How to get real numbers for both routes

1. Get the procedure codes. Ask the surgeon's office for the CPT codes they expect to bill, plus where the surgery will happen.
2. Ask each plan for its estimate. Use the insurer's cost estimator or call member services with the codes and the provider names. Ask for the allowed amount, not just your share.
3. Check hospital price files. Hospitals must post a machine-readable file of all items and services and a consumer-friendly list of shoppable services, according to CMS. Our price transparency file lookup guide shows how to search one.
4. Request a Good Faith Estimate for the cash route. Tell the provider you will not use insurance and ask in writing.
5. Ask your insurer about cash credit. Ask whether a cash payment for a covered service will count toward your deductible and out-of-pocket maximum. Get the answer in writing.
6. Confirm prior authorization. If you will use insurance, ask whether the surgery needs preauthorization and how long it takes.

Your Good Faith Estimate rights as a self-pay patient

The No Surprises Act gives uninsured patients, and insured patients who choose not to use their coverage, a right to a Good Faith Estimate. CMS notes that people enrolled in federal programs such as Medicare, Medicaid and TRICARE are not eligible for this process.

A 2022 CMS guide sets out the timing rules:

• Scheduled at least 3 business days ahead: the estimate is due within 1 business day of scheduling.
• Scheduled at least 10 business days ahead, or when you ask about costs without scheduling: the estimate is due within 3 business days.

That 2022 guide also said estimates would cover expected charges from co-providers and co-facilities starting in 2023. In practice, ask each provider whether its estimate includes anesthesia, pathology and the facility, and request separate estimates from any that are left out.

If the bill is higher

According to CMS, you can use the patient-provider dispute resolution process if a provider bills at least $400 more than its Good Faith Estimate. The bill must be dated within the last 120 calendar days, and there is a $25 non-refundable fee. The $400 test is applied to each provider or facility separately.

Keep the estimate and the bill. Our guide to reading an EOB and itemized statement helps you match line items.

Where a cash price abroad fits in

Some readers compare a US cash price, their US deductible and a quoted price for the same surgery in Colombia. The same rules apply: get every price in writing, check what is included, and remember a foreign provider's charge generally will not count toward your US deductible.

A Good Faith Estimate is a US legal right. It does not apply to a clinic outside the US, so ask any foreign provider for an itemized written quote instead. Travel, lodging and a companion all belong in the total; for help with those, see colombiamedical.co.

The bottom line

For a planned surgery, the cheapest 2027 plan is the one with the lowest total of premiums plus expected cost-sharing. Run that math for each plan and for the cash route before December 15.

Get every number in writing: the insurer's estimate, the Good Faith Estimate and whether cash counts toward your deductible. Then pick the plan, or the price, that comes out lowest.