2027 Health Coverage for California Based Gestational Surrogates: Enrollment Dates, Deadlines and Pitfalls
***NEWSLETTER***
Open enrollment for 2027 individual health coverage begins November 1, 2026. For California surrogates purchasing coverage through Covered California, enrollment remains open through January 31, 2027. But for most surrogacy journeys, the more important date is December 31, 2026, the final day to enroll in coverage that begins January 1.
Every fall, we receive the same calls from agencies, attorneys, brokers, and intended parents: a match is progressing, transfer is approaching, and the surrogate’s health coverage remains uncertain. That is why the enrollment calendar matters so much. A surrogate generally needs appropriate coverage in force, reviewed, and cleared for the surrogacy journey before transfer occurs.
Outside open enrollment, a surrogate cannot simply purchase an individual health plan because a match has been completed. Once the window closes, the available options narrow quickly and may be limited to a qualifying life event, employer coverage, or a specialty surrogacy policy that can carry significantly greater cost.
Several developments make the 2027 enrollment cycle particularly important.
- First, the shorter federal enrollment period proposed for 2027 did not take effect. A 2025 federal rule would have ended open enrollment on December 15 nationwide. That change was struck down, and CMS confirmed in July 2026 that HealthCare.gov will operate from November 1, 2026 through January 15, 2027. State exchanges, including Covered California, retain their own enrollment schedules.
- Second, premium subsidies have changed. The enhanced premium tax credits expired December 31, 2025. Beginning with the 2026 tax year, individuals who receive more advance premium tax credit than they ultimately qualify for may be required to repay the full excess amount because the previous repayment caps no longer apply. For a surrogate whose household income changes during a compensated journey, that can create meaningful financial exposure.
- Third, pregnancy may become a qualifying enrollment event in California. AB 2066 would make pregnancy a triggering event for enrolling in or changing certain health coverage. The legislation was presented to the Governor on September 3, 2026 and remained awaiting action as of this writing. Even if enacted, however, pregnancy-based enrollment would be better understood as a potential backstop than a primary surrogacy coverage strategy. More on that below.
Covered California: The 2027 Calendar
For California based surrogates purchasing individual coverage through Covered California, the primary dates are:
- November 1, 2026: Open enrollment begins for 2027 coverage.
- December 31, 2026: Final day to enroll for coverage beginning January 1, 2027.
- January 1, 2027: Coverage begins for individuals who enrolled by December 31, assuming the first premium has been paid.
- January 1 through January 31, 2027: Enrollments completed during this period generally begin February 1.
- January 31, 2027: Open enrollment closes.
- February 1, 2027: Latest possible effective date for a plan obtained through the regular open enrollment period.
Source: Covered California, Open Enrollment dates and deadlines.
Two practical points deserve particular attention.
Selecting a Plan Is Not the Same as Having Coverage
Completing an application does not necessarily mean the policy is active. The plan generally must receive the first premium, commonly called the binder payment, before coverage becomes effective.
An application completed on December 30 without payment behind it is not the same as an active health policy. Before embryo transfer, we prefer to see evidence that the first premium has actually been paid and that the carrier recognizes the policy as effective.
Renewals Require a Fresh Review
Covered California may renew an existing member into the same plan if it remains available or move the member into a comparable plan if it does not. That does not mean the coverage should be treated as unchanged.
Carriers revise networks, Evidence of Coverage documents, reimbursement provisions, service areas, and plan terms from year to year. A plan that was appropriate for a surrogate in 2026 should be reviewed again for 2027. The surrogate’s obstetrician and anticipated delivery hospital should also be reconfirmed as participating providers for the new plan year.
If the pregnancy crosses December 31, remember that deductibles and out of pocket maximums generally reset on January 1. A pregnancy spanning two plan years may therefore require an escrow budget capable of absorbing expenses under both annual cost structures.
After January 31: Special Enrollment, Pregnancy, and Medi Cal
Once open enrollment closes, enrollment through Covered California generally requires a qualifying life event and a special enrollment period. Common examples include loss of qualifying health coverage, marriage, a qualifying move, birth, or adoption. The enrollment opportunity is typically limited to a specific period surrounding the qualifying event, often approximately 60 days.
Several recurring traps deserve attention.
- Voluntarily dropping coverage or losing coverage for nonpayment generally does not create a qualifying enrollment event. A surrogate who cancels a plan between journeys or allows it to terminate because premiums were not paid may be unable to purchase another individual plan until the next open enrollment period unless a separate qualifying event occurs.
- A move does not automatically create enrollment rights. Relocating to California generally requires evidence of prior qualifying coverage for the move to create a special enrollment opportunity.
- Pregnancy is not currently a qualifying event in California. AB 2066 could change that for applicable California regulated coverage if enacted. Even then, the distinction is important. Pregnancy can only be confirmed after conception. In a gestational surrogacy journey, the insurance analysis should already have been completed before embryo transfer, and many IVF practices and agencies will not proceed without verified coverage.
For that reason, even if AB 2066 becomes law, we would view pregnancy-based enrollment as a potential safety mechanism rather than a substitute for proper insurance planning.
What About Medi Cal?
Pregnancy related Medi Cal coverage is available throughout the year to individuals who meet applicable eligibility requirements, which can make it appear to be an easy solution when traditional enrollment options have closed.
Surrogacy creates additional considerations. Eligibility depends in part on household financial circumstances, and surrogate compensation may raise questions regarding income reporting and qualification. Surrogacy agreements and agency policies may also restrict or prohibit reliance on Medi Cal for expenses associated with a compensated pregnancy.
A surrogate already receiving Medi Cal should review her specific circumstances with appropriate legal and insurance professionals before proceeding. Similar considerations may arise with the Medi Cal Access Program for qualifying middle income pregnant Californians.
Do Not Ignore the Tax Credit Issue
A surrogate purchasing coverage through Covered California with advance premium tax credits should also pay close attention to projected household income.
Beginning with the 2026 tax year, excess advance premium tax credits may be subject to full repayment. How surrogacy compensation is treated for tax purposes is a question for the surrogate’s tax professional, but the income estimate reported to Covered California should be made thoughtfully and updated when appropriate rather than guessed at the beginning of the journey.
Employer Coverage: Often the Best Option, Never a Sure Thing
Many surrogates are covered through their own job or a spouse's. Employer open enrollment is set by the employer, not by Covered California. For calendar-year plans it usually falls between October and early December, and some employers run plan years that start mid-year. We suggest asking for the actual dates now; they may close well before December 31.
Outside that window, a mid-year change generally requires a HIPAA special enrollment event (marriage, birth or adoption, loss of other coverage, usually with a 30-day window) or a qualifying change in status under the employer's cafeteria plan. Pregnancy alone does not open the door.
The next question is whether the employer plan is fully insured or self funded.
A fully insured California plan is generally regulated by the California Department of Managed Health Care or the California Department of Insurance. Maternity coverage is required, and exclusions directed at a plan member serving as a surrogate are generally more limited, although reimbursement provisions may still create substantial exposure.
A self funded employer plan operates primarily under federal ERISA law. State insurance mandates generally do not control the plan in the same manner. The written plan terms become particularly important because some self funded plans expressly exclude medical expenses associated with a member acting as a gestational carrier.
For a fully insured plan, the Evidence of Coverage is essential. For a self funded plan, counsel and the insurance reviewer should obtain the Summary Plan Description and, where necessary, the governing plan document itself.
The Summary of Benefits and Coverage is rarely enough.
Where self funded plan language is unclear, written confirmation from the plan administrator can be valuable.
Kaiser's large-group disclosure form is a good illustration of the California pattern. It excludes "services related to conception, pregnancy, or delivery in connection with a Surrogacy Arrangement, except for otherwise-covered Services provided to a Member who is a surrogate" (example, 2025 Kaiser Choice HMO disclosure). In other words, the surrogate is covered, but the plan reserves its rights elsewhere in the document.
The Summary of Benefits and Coverage will not tell you any of this. The full EOC or SPD is the document that matters, and for a self-funded plan, written confirmation from the plan administrator can help where the language is unclear.
Two Additional Employer Plan Issues
COBRA preserves the existing plan, including its limitations. If the surrogate or her spouse loses employer coverage during the journey, COBRA may provide continuity. But it continues the same plan terms, including any surrogacy exclusion or reimbursement provision, and the parties must account for the full premium cost.
The intended parents’ health plan generally does not cover the surrogate’s pregnancy care. California’s IVF coverage requirements under SB 729 took effect January 1, 2026 for applicable fully insured large group plans and may cover certain reproductive services involving a gestational carrier, such as testing or embryo transfer. That should not be confused with coverage for the surrogate’s prenatal care, delivery, or pregnancy complications.
Coverage Lapses: How Insurance Disappears During Pregnancy
The health policy needs to remain active from before transfer through delivery and the applicable postpartum period, including treatment for pregnancy related complications.
One of the most common ways that protection fails is surprisingly simple: a missed premium.
For Covered California plans receiving premium tax credits, the applicable grace period may extend for three months. Claims during the first month are generally paid, while claims during later portions of the grace period may be held. If the outstanding premium is not cured, coverage can terminate retroactively and the held claims may ultimately become the surrogate’s responsibility.
For coverage without premium tax credits, the grace period is generally much shorter, commonly 30 days.
Consider the practical consequences. Prenatal visits, imaging, laboratory work, or even an early hospital encounter may occur while claims are quietly being held. If the premium deficiency is not discovered and cured, the parties can suddenly find themselves without active insurance and without the ability to simply purchase another plan.
Most of these situations are preventable.
We recommend paying premiums directly from escrow whenever possible, using automatic payment when appropriate, collecting proof of payment each month, and requiring the surrogate to immediately forward carrier or Covered California notices involving payment, eligibility, income verification, or renewal.
If the pregnancy will continue into 2027, calendar the plan renewal and January reset before the year ends.
Surrogacy Exclusions and Reimbursement Clauses
ACA compliant individual and small group plans include maternity coverage, and a California carrier cannot refuse enrollment merely because the applicant is pregnant or intends to serve as a surrogate.
That does not necessarily mean the plan will ultimately absorb the cost of a compensated surrogacy pregnancy.
The important language is often buried outside the maternity section of the Evidence of Coverage.
Reimbursement Provisions
Some plans cover the surrogate’s pregnancy care but reserve the right to seek reimbursement because the pregnancy occurred pursuant to a surrogacy arrangement.
These provisions may assert a right to recover from the surrogate’s compensation, amounts owed under the surrogacy agreement, or an escrow account associated with the arrangement. Some plans limit recovery to a defined portion of the surrogate’s compensation, while others use broader language.
A reimbursement demand should not automatically be treated as the final amount owed. Depending on the plan language, applicable law, charges, contractual limits, and facts of the journey, an experienced lien reduction attorney or specialist may be able to reduce, minimize, or in some circumstances eliminate the reimbursement obligation through negotiation.
Notice Requirements
Some plans require written notice shortly after the member signs a surrogacy agreement. The plan may request the agreement itself, information concerning the intended parents, or other documentation.
Missing a contractual notice deadline can create unnecessary exposure and, depending on the policy language, may be characterized as a breach of the member’s obligations under the plan.
The actual 2027 Evidence of Coverage should therefore be reviewed for any notice provision, and the deadline should be calendared as soon as the surrogacy agreement is executed.
Third Party Recovery Language
General reimbursement and third-party recovery clauses should also be reviewed carefully. Depending on the wording, a plan may attempt to characterize the intended parents or the surrogacy arrangement as another source responsible for the cost of the pregnancy.
The interaction between general recovery language and a specific surrogacy reimbursement provision should be evaluated before a policy is approved for the journey.
California Already Requires Insurance Review
California Family Code section 7962 requires the surrogacy agreement to address responsibility for the surrogate’s medical expenses and, when insurance is being used, to disclose that the policy has been reviewed for surrogacy related provisions.
That review includes potential liability to the surrogate, possible third party claims or liens, and notice requirements. If the insurance consequences cannot be determined with certainty, that uncertainty can be disclosed, but the policy still needs to be reviewed.
In practice, that review is typically performed by a qualified insurance professional familiar with gestational surrogacy coverage.
Useful search terms when reviewing an Evidence of Coverage include surrogacy, surrogate, gestational carrier, surrogacy arrangement, compensation, third party, reimbursement, lien, and assisted reproduction agreement.
Do Not Forget the Newborn
The surrogate’s health plan generally does not provide continuing health coverage for the intended parents’ newborn.
The intended parents therefore need a separate plan for the child and a clear process for adding the baby after birth. Birth creates its own special enrollment event, but deadlines vary depending on the plan. Employer plans commonly use a 30 day window, while Covered California generally provides a longer special enrollment period.
The newborn coverage plan should be established before delivery rather than treated as a postpartum administrative task.
When Traditional Coverage Is Not Acceptable
When available ACA or employer plans contain reimbursement exposure that the parties are unwilling to accept, a surrogacy specific insurance policy may be considered.
These policies can eliminate some of the reimbursement concerns associated with traditional plans, but they are priced accordingly and may be extremely expensive.
The premium is only one part of the analysis. Deductibles, out of pocket obligations, coverage limits, networks, exclusions, and the amount the intended parents must fund before insurance begins paying all affect the actual cost of the pregnancy.
A specialty policy therefore deserves the same careful review as any other coverage option.
Points to consider for the 2027 season
- Now through October. Identify every surrogate whose journey will be active in 2027, including those who are pregnant, in screening, or waiting on a match. Confirm what coverage each has and whether it renews on January 1.
- Get employer open enrollment dates for any surrogate (or spouse) with job-based coverage. They may close before Thanksgiving.
- When 2027 EOCs are posted, read them. Don't rely on last year's review. Check exclusions, reimbursement clauses, notice deadlines, and the network for her OB and delivery hospital.
- Enroll by December 31, 2026 on Covered California for a January 1 start. January enrollments start February 1, and nothing is available after January 31 without a qualifying event.
- Confirm the binder payment and get written confirmation that the policy is effective before transfer.
- Confirm the insurance review is addressed in the agreement. Family Code section 7962 calls for this disclosure, including any known or uncertain reimbursement exposure and who bears it.
- Set up premium payment and proof of payment so a grace period never starts.
- Plan for the newborn under the intended parents' coverage, and calendar the post-birth enrollment deadline.
- Keep an eye on AB 2066. If it is signed, note its operative date and how Covered California implements it.
If your surrogate lives outside California
The planning principles above apply everywhere. The dates and a few of the rules do not.
HealthCare.gov States
For states using HealthCare.gov, open enrollment for 2027 runs from November 1, 2026 through January 15, 2027.
Enrollment by December 15, 2026 generally results in coverage beginning January 1, 2027.
Enrollment from December 16, 2026 through January 15, 2027 generally results in coverage beginning February 1.
That December 15 deadline is two weeks earlier than California’s December 31 deadline for a January 1 start. Agencies operating across several states should therefore avoid using a single enrollment calendar for every surrogate.
State Exchanges Have Their Own Deadlines
Several state operated exchanges use different final enrollment dates.
Idaho closes December 15 and opens earlier in October. Rhode Island closes December 31. Colorado, Connecticut, Georgia, Illinois, Kentucky, Maine, Maryland, Minnesota, Nevada, New Mexico, Oregon, Pennsylvania, and Vermont generally use January 15. Massachusetts extends later into January, as do Virginia, New Jersey, New York, and the District of Columbia under their respective schedules.
The deadline for obtaining a January 1 effective date can also differ from the final enrollment deadline. Before advising that coverage will begin on a specific date, confirm the current rules directly with the applicable exchange.
Pregnancy as a Qualifying Event
Several state exchanges already recognize pregnancy as a special enrollment trigger. Published lists and effective dates do not always align, so each state should be confirmed individually.
The same practical limitation applies everywhere: pregnancy-based enrollment can help after conception. It does not solve the insurance planning problem before embryo transfer.
Grace Periods
The federal three-month grace period applicable to certain individuals receiving premium tax credits applies across states. For individuals without subsidies, the grace period depends on state law and the policy itself and may differ from California’s framework.
Surrogacy Law and Insurance Review
Not every state requires an insurance review to be documented in the surrogacy agreement in the same manner as California. That does not make the review less important.
Some states regulate the issue directly. New York’s Child Parent Security Act, for example, includes health insurance protections for gestational surrogates extending beyond pregnancy. State rules concerning reimbursement from surrogate compensation also vary, while self-funded ERISA plans remain governed primarily by their plan documents and applicable federal law.
For multistate agencies and intended parents, the key principle is simple: do not assume California’s enrollment calendar, insurance protections, reimbursement rules, or surrogacy statutes apply elsewhere.
Every journey deserves its own insurance analysis.
Schedule a Consult today to see how we can help maximize your client’s recovery.