Choosing a 2027 Health Plan When Someone in Your Family Needs Addiction Treatment

If someone in your family is in addiction treatment, or you think they may need it next year, the health plan you pick this fall shapes what that care looks like. It decides which programs are in network, which medications are covered, what needs approval first and how much you pay before the plan pays the rest. Open enrollment is the one time each year most people can change plans for any reason. This guide covers the 2027 dates in New Hampshire and Massachusetts, what changed with financial help, and what to check before you choose. The dates and rules below were checked on the official pages in September 2026.

Open enrollment dates for 2027 coverage

Massachusetts: the Health Connector

Massachusetts runs its own marketplace, the Health Connector, and its open enrollment for 2027 starts earlier and runs longer than usual (Health Connector):

• October 23, 2026: open enrollment begins.
• December 23, 2026: last day to choose a plan and pay for coverage that starts January 1, 2027.
• January 23, 2027: open enrollment ends, and plans chosen by this date start February 1.

If you qualify for MassHealth or for a ConnectorCare plan, you can enroll at any time of year (Health Connector).

New Hampshire: HealthCare.gov

New Hampshire uses the federally facilitated Marketplace, so residents buy individual coverage on HealthCare.gov (New Hampshire Insurance Department, HealthCare.gov):

• November 1, 2026: open enrollment begins.
• December 15, 2026: last day to enroll in or change plans for coverage that starts January 1.
• January 15, 2027: open enrollment ends. Plans chosen from December 16 through January 15 start February 1.

You can apply for Medicaid at any time of year. If your coverage comes through a job, the employer runs its own enrollment period, so ask when it opens.

Financial help is smaller than it was in 2025

The enhanced premium tax credits that lowered Marketplace premiums from 2021 through 2025 expired on December 31, 2025. Many people still qualify for help, but the amounts are smaller, and households with income above 400% of the federal poverty level no longer qualify at all. For 2026 that line was about $62,600 for one person (Health Connector).

On January 8, 2026, the House passed H.R. 1834, which would extend the enhanced credits through 2028, by a vote of 230 to 196. The Senate placed it on its calendar on February 10, 2026, and as of late September 2026 it had not acted on it (Congress.gov).

Two more federal changes are worth knowing about (Health Connector):

• No cap on paying back extra help. Starting with tax year 2026, there is no limit on how much excess premium tax credit you may have to repay at tax time if your income ends up higher than you estimated. Report income changes as they happen.
• New limits for some immigrants. Starting January 1, 2027, lawfully present immigrants can still buy a plan, but only green card holders, Cuban and Haitian entrants and Compact of Free Association migrants can get help paying for it. The Health Connector estimates about 35,000 of its current enrollees may lose that help.

What every plan has to cover

All Marketplace plans cover substance use disorder treatment as an essential health benefit. They cannot deny coverage or charge more because of a pre-existing condition, including a substance use disorder, and they cannot put yearly or lifetime dollar limits on that care (HealthCare.gov).

Parity rules add another layer. Under the federal Mental Health Parity and Addiction Equity Act, a plan that covers substance use care cannot make its copays, coinsurance or visit limits more restrictive than those for comparable medical and surgical care, and rules such as prior authorization have to be comparable too (CMS, U.S. Department of Labor). The law applies to individual coverage and to employer plans with more than 50 employees. It does not require large employer plans to cover substance use treatment at all, but the Affordable Care Act requires it in non-grandfathered individual and small group plans (CMS).

Each state adds its own protections for plans it regulates:

• New Hampshire requires plans that cover substance use treatment to offer at least one FDA-approved medication-assisted treatment option for substance use disorders without prior authorization, and not to require renewal of a prior authorization for medication-assisted treatment more than once every 12 months (RSA 420-J:18).
• Massachusetts requires insured plans to cover up to a combined 14 days of medically necessary acute treatment services (24-hour medically supervised care that includes withdrawal management) and clinical stabilization services, without preauthorization, although the plan may begin utilization review on day 7 (M.G.L. c. 175, § 47GG). A 2024 law added coverage of opioid overdose reversal medications such as naloxone, and of licensed recovery coach services, both without prior authorization and without a deductible, copay or coinsurance, except where dropping cost sharing would cost a plan its federal tax-exempt status (Chapter 285 of the Acts of 2024).

State rules like these reach insured plans. Some employers pay claims themselves and use an insurer only to handle paperwork, which is called a self-funded plan. The Massachusetts Division of Insurance does not oversee those plans, and the federal Department of Labor oversees many of them. Your employer or plan administrator can tell you which kind you have (Massachusetts Division of Insurance).

What to check before you choose

Whether the treatment program is in network

In-network care costs less, and some plan types cover little else. An HMO or EPO generally covers only in-network care except in an emergency, while a PPO lets you go outside the network at an extra cost (HealthCare.gov). Search each plan's provider directory for the specific outpatient program and location your family member uses or is considering, then call the plan to confirm. Check the prescriber too if medication is part of treatment.

Which levels of care are covered, and what needs approval first

Outpatient addiction treatment comes in levels, from weekly counseling to intensive outpatient programs (IOP) and day programs, sometimes called partial hospitalization (PHP). Plans often cover the more intensive levels only after prior authorization and review progress before approving more days. Ask each plan which of these levels it covers, what needs approval before the first day, and how often it re-reviews. Our guide to IOP and PHP explains the difference between the levels, and our cost and payment page explains how each level is usually billed.

How the plan covers medications

If medication for opioid or alcohol use disorder is part of the plan, look up each drug on the plan's drug list, also called a formulary. That includes buprenorphine (including Suboxone) and naltrexone, which comes as a daily pill for alcohol use disorder or as a monthly injection (Vivitrol) for alcohol or opioid use disorder (SAMHSA). Check the tier, whether prior authorization applies, and whether the monthly injection is billed under the pharmacy benefit or the medical benefit, because the cost can differ.

What a full year of care would cost

Look past the monthly premium to the deductible, the copays or coinsurance for outpatient visits, and the out-of-pocket maximum. For a 2027 Marketplace plan, in-network out-of-pocket costs for covered care can be no more than $12,000 for one person or $24,000 for a family. That is a ceiling, and a plan's own limit can be lower. That maximum does not include premiums, services the plan does not cover, or out-of-network care (HealthCare.gov).

Metal levels are a rough guide to how costs are split. On average, a Bronze plan pays about 60% of covered costs and a Gold plan about 80%, and Bronze plans generally have higher deductibles. HealthCare.gov advises comparing plans by your total yearly spending on health care, with the premium as one part of it, and notes that extra savings on deductibles and copays, for people who qualify, only come with Silver plans (HealthCare.gov). If you expect ongoing treatment next year, a plan with a higher premium and a lower deductible can cost less over the whole year.

The plan's own summary, and your right to appeal

Every plan must give you a short, plain-language Summary of Benefits and Coverage, which makes side-by-side comparison easier (HealthCare.gov). If a plan later denies a claim, you can ask for an internal appeal, and then an external review by an independent third party (HealthCare.gov).

If money is tight

Check Medicaid before anything else. MassHealth and New Hampshire Medicaid, including Granite Advantage, take applications all year and cover substance use treatment. Our pages on NH Medicaid and MassHealth explain what those plans typically cover. Starting in January 2027, both states will apply new federal work requirements and more frequent renewals to many adults covered through Medicaid expansion, with exemptions that include people in substance use treatment programs (NH DHHS, MassHealth).

In Massachusetts, income-eligible residents may qualify for a ConnectorCare plan, which can also be joined at any time of year (Health Connector).

Where Clear Steps Recovery fits

Clear Steps Recovery's admissions team checks benefits with the carrier at no cost, so you can ask about a plan before you enroll in it. At the Londonderry, New Hampshire center, most major New Hampshire commercial and Medicaid managed care plans are accepted, and the program is listed in Anthem's and WellSense's published New Hampshire marketplace provider network files for 2026 and 2027. At the Needham, Massachusetts center, most major Massachusetts commercial plans are accepted, and admissions helps MassHealth and Health Connector members confirm their benefits. The New Hampshire insurance page and the Massachusetts insurance page list the plans, and the Anthem Blue Cross Blue Shield page covers Anthem plans in New Hampshire in detail. Call (603) 769-8981, answered 24/7, with the plan names you are comparing.