Your Guide to Open Enrollment and Health Insurance for 2027
As healthcare costs continue to climb, use these strategies to select an insurance plan with the coverage you need at a price you can afford.
It's fall, which means that for millions of Americans it's time to select a health insurance plan for next year. And in 2027, many will find themselves paying more for their coverage, thanks to persistently rising costs.
That goes both for people insured through an employer and for those who purchase coverage on the Affordable Care Act marketplace. Employers are predicting a median 9.2% increase in their healthcare costs for 2027, according to a survey by Business Group on Health. Another survey, by benefits consultant WTW, found that 73% of companies report more pressure related to healthcare costs than at any other point in the past decade.
As employers feel the prolonged pinch, many will pass an increasing share of those higher healthcare costs to workers. Some employers are also offering or considering new plan choices to make coverage more affordable — with fewer provider choices as a trade-off.
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"This is a good year to slow down and take some time during open enrollment,” says Beth Umland, director of employer research for health and benefits at Marsh (formerly known as Mercer), a human resource and benefits consulting firm. "Read the materials and find out if this is going to be a plan that works for you."
That advice also holds for people who purchase insurance on the Affordable Care Act marketplace. Over the summer, insurers who participate in the marketplace proposed a median premium increase of 15%, according to a Peterson-KFF analysis. To be sure, that figure isn't final, and you won't necessarily see a large increase in your own premium; while temporary, enhanced premium tax credits that made plans significantly more affordable for many enrollees expired at the end of 2025, the standard tax credits remain, and most marketplace participants qualify.
However you get your insurance, it's important to run the numbers to make sure you are getting the plan that best fits your medical needs, budget and preferences.
Employer plans 2027 changes
People who buy insurance through their employer should be prepared for a number of changes.
Higher out-of-pocket costs.
According to a Marsh survey, 48% of large employers are seriously considering plan changes that would raise out-of-pocket costs for employees, including increasing annual deductibles. And 66% plan to pass along a greater percentage of premium costs to employees in 2027 than in 2026.
On average, workers contributed 16% of the single premium and 26% of the family premium in 2025, which amounted to average monthly premiums of $120 and $571, according to KFF.
New plan designs.
To counteract rising costs, many employers are adding some less-expensive choices. About one-third of all large employers are using some kind of nontraditional health plan in 2026 or will do so in 2027, and another 38% are considering it, Marsh's survey found. "These provide a lower-cost option for employees who are willing to take the plunge and go to a different plan for lower premiums and cost sharing," says Umland.
Here's how some common models work:
- Variable co-payment plan. Instead of a set co-pay for primary care and specialty care, the co-pay varies by individual provider, depending on their quality and price. That information is transparent, letting you pick a provider that fits your budget, and plans often come with a low deductible — or no deductible at all. Large employers are especially enthusiastic about these, with 12% saying they have the plans in place or expect to use them for 2027 and another 34% considering them for 2027 or 2028, according to Marsh.
- High-performance network. With a standard preferred provider organization (PPO) plan, you pay less to see providers that are in your plan's network. A high-performance network adds another layer on top of that network, making it even less expensive to see a smaller circle of providers.
- Quality-based provider tools. These apps can steer you toward providers with better outcomes, at a lower cost to you, without restricting your existing network. Marsh found that 8% of large employers — and 10% of large tech companies — already offer these tools, with 31% considering it for 2027 or 2028.
Changes to GLP-1 coverage.
Drug costs are also putting pressure on employers, and you may see some differences in how your prescriptions, including expensive specialty drugs, are managed in 2027. This is especially important if, like 11% of U.S. adults, you take a GLP-1 drug for weight loss. The Business Group on Health survey found that 14% of employers have dropped coverage of those drugs for weight loss or will in 2027. (However, 98% of employers surveyed by BGH cover GLP-1 drugs for diabetes, and many cover them for other diseases.)
If your employer does cover GLP-1 drugs for weight loss, you may face higher coverage hurdles, such as making sure that you medically qualify or meeting requirements that you try a weight-management program while on a GLP-1 drug or before you use one.
How to choose from employer plans
Given all the changes afoot, here are some tips for approaching workplace open enrollment.
Don't go on autopilot.
"Historically, employees tend to re-enroll in their current plans," says Karen Burke, an HR knowledge adviser at SHRM, an organization for HR professionals. But plans change, as do your needs. Go beyond comparing premiums.
You should also consider:
- Deductibles. How much do you have to pay out of pocket for covered services before your benefit kicks in? High-deductible plans have lower premiums, but you are responsible for all up-front costs until you hit your deductible threshold.
- Cost-sharing. Once you meet your deductible, what percentage of the bill is your responsibility? Or will you owe a set co-pay instead? What's the difference between your cost-sharing responsibility for a specialist compared with a primary-care provider?
- Provider network. Are your preferred physicians or hospital systems in the plan's network? If they aren't, will they be covered at all, and on what terms? This is especially important to consider with some of the newer plan designs, which often cost less but have more-restricted networks.
- Out-of-pocket maximum. What is the annual cap on your cost-sharing responsibility? These caps can vary a lot. According to KFF, the 2025 out-of-pocket limit was $2,000 or less for 12% of covered employees subject to a maximum, while 21% had an out-of-pocket max greater than $6,000.
- Anticipated health needs. Do you or family members see specialists regularly or anticipate any elective procedures in 2027? If you do, be sure you calculate how that could affect your choice of plan. You may come out ahead by paying higher premiums up front and a lower amount when you receive care.
- Prescription drugs. Ask your HR department for the 2027 drug formulary for your plan to make sure it covers the drugs you take regularly. Check to see what cost tier your medications are on and whether you will be required to try lower-cost options first.
Take advantage of your open-enrollment guide, virtual benefits fairs and any available side-by-side cost-comparison tools for making the best decision. Especially with new plan designs, make sure you fully understand the specifics to determine whether a plan is the right fit for you, says Julie Noblick, a senior director at WTW.
Look at all your possible HR benefits.
Employers offer a host of other health-related benefits outside of basic medical coverage, which may include gym-membership reimbursements, free subscriptions to meditation or fitness apps, or digital-first employee assistance plans (EAPs) with discounted mental-health support.
Many large employers now provide coverage for in vitro fertilization, adoption expenses and surrogacy, according to Marsh. And one-third of employers provide some specialized support for menopause. "Open enrollment is an opportunity to review the full benefits portfolio," says Noblick.
Consider an HSA.
If you are enrolled in a high-deductible health plan (HDHP), you can contribute to a health savings account, which provides a triple tax benefit: You get a tax deduction on your contributions, the earnings on those funds compound tax-free, and you can withdraw the money tax-free to pay for qualified medical expenses, including deductibles and co-pays.
To qualify in 2027, your insurance plan must have a deductible of at least $1,750 for individuals or $3,500 for families. You will be able to contribute up to $4,500 for individual coverage or $9,000 for family coverage, and you can boost that by $1,000 if you're 55 or older. Some employers will contribute to your HSA as well.
Marketplace 2027 changes
Open enrollment to purchase a plan via HealthCare.gov begins November 1 and runs through January 15, 2027. (If you want coverage to start January 1, you need to sign up by December 15 in most states.) If your state has its own marketplace, check its schedule, which may differ. Here's what you can expect.
Higher premiums.
The ACA marketplaces have been roiled by the expiration of enhanced premium tax credits at the end of 2025. About 19.2 million people enrolled and paid premiums in 2026, down by 2.6 million from 2025 following the expiration of those credits. The leavers tended to be healthy enough to take a chance on going without insurance. "That means that insurers in 2027 are raising premiums even higher because they now have to cover a relatively sicker group of people," says Matt McGough, a policy analyst at KFF.
Next year's proposed increase of 15% marks the second consecutive year of double-digit hikes. As KFF notes, if this year's proposed rates stick, that will mean premiums have gone up by more than one-third over two years. However, that's before any subsidies are calculated.
Subsidy cliff continues.
Last year, 87% of the people who did enroll in the marketplace received subsidies. Congress has not extended the enhanced premium tax credit, so subsidies are again limited to people whose modified adjusted gross income is less than 400% of the federal poverty level, or $63,840 for an individual and $132,000 for a family of four.
Those limits will apply to your 2027 income, which you'll estimate when you sign up. (The MAGI calculated for ACA subsidies isn't the same as the adjusted income used to determine eligibility for other tax benefits, such as a Roth IRA.)
Some states have made moves to help offset the effects of those expired tax credits. New Mexico, for example, fully compensated for them, and it was the only state that didn't see some decline in marketplace enrollment for this year.
Fewer choices for some markets.
According to KFF, as of July 30, seven insurance carriers, including Cigna, had said they will exit the ACA marketplace in 2027 in all or some of the states in which they now participate. (Five carriers have said they will move into new state marketplaces.) If your carrier is leaving your state, you will have to switch in 2027.
"Insurers came in droves into the marketplace" when the enhanced subsidies were in effect, says McGough. With the expiration of those credits, some carriers have rethought their participation. That means fewer choices for some consumers. "There are some counties with one or two insurers," McGough says.
How to choose from marketplace plans
In light of those changes, consider these strategies as you select an ACA plan.
Look at all your options.
Even if you are happy with your current coverage, run the numbers again for the coming year. "It's really important to shop and compare," says Anthony Wright, executive director of Families USA. "The best deal last year is not necessarily the best deal this year."
Marketplace plans are grouped by "metal levels" according to how the costs of care are split between you and the plan. Platinum plans have the highest monthly premiums, but the plans pick up an estimated 90% of the cost of care that you incur. Bronze plans have the lowest premiums, and those will cover an estimated 60% of the cost of care. In between are gold and silver plans. Subsidies can be applied to any metal level plan.
Choose wisely.
As with employer-based insurance, you'll want to consider not only the premiums and cost-sharing for different plans, but factors including provider networks (and whether your preferred physicians or health systems are included), drug formularies, and your anticipated medical needs in the coming year. All ACA plans will have a 2027 out-of-pocket maximum of $12,000 for an individual plan and $24,000 for family plans.
Many people dealt with higher 2026 premiums by moving to bronze plans, with their lower premiums (and higher deductibles). But you shouldn't assume that's the only option you can afford. If your projected 2027 income is less than 250% of the federal poverty level ($39,900 for individuals or $82,500 for a family of four), you qualify for extra cost savings for a silver plan that can make it more affordable.
An insurance agent, broker or independent navigator can help you pick the right plan and maximize your tax credits, says McGough. "Each individual and family has a set of preferences, which means they'll have unique plan choices and decisions to make," he says. You can find a navigator via your state exchange or HealthCare.gov. As a starting point, check out healthcare.gov/find-local-help, and look specifically for "assisters" or "navigators."
Be careful with income estimates.
Most people who purchase on the exchange take a tax credit in advance based on projected income for the year. In the past, if you exceeded your estimate, the amount you had to pay back to the government was capped.
But due to rules that took effect in 2026, you will now owe the total amount. That means if you underestimated your income to the degree that you are no longer eligible for any premium tax credits at all, you will owe the government the entirety of what you received. That could add up to thousands of dollars.
Because the stakes are now so high, it's crucial to make as accurate an estimate as you can of your 2027 income. You can update it during the year if circumstances change.
Manage your MAGI.
The subsidies have a strict cutoff: If you earn $1 more than the 400% limit, you don't qualify. But you may be able to manage your modified adjusted gross income so that you're under the limit.
People who are working but can't purchase employer-provided insurance have a few opportunities for lowering their MAGI, says Michael Ruger, a certified financial planner and a partner and chief investment officer at Greenbush Financial Group in Albany, N.Y.
If you have access to a workplace 401(k) plan, increasing your pretax contribution can lower your income. If your spouse is working and you file jointly, they can do the same. If you don't have access to a plan through work, you can start a solo 401(k) plan and can contribute to that as both employee and employer, says Ruger.
Starting in 2026, all bronze plans are considered high-deductible plans, which means enrollees are eligible to contribute to an HSA. Those contributions can also lower your MAGI. (Just remember that these plans subject you to a higher percentage of health costs, so you should consider your health as well as your overall financial picture when you pick a plan.)
You should consult a financial or tax professional to make sure you understand all your options and that your moves now fit with your long-term strategy. For example, withdrawing less from your pretax retirement accounts in favor of after-tax accounts might lower your MAGI enough for subsidies now, but leaving those pretax funds untouched could mean you will pay more for Medicare premiums when you eventually withdraw them.
Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here.
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