‘Your premiums will change. Your out-of-pocket costs can change. Drug coverage can change.’
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Millions of Americans are choosing their health insurance for 2027 or will be soon. Whether your coverage comes through an employer, the ACA Marketplace or Medicare, what you pay next year will likely change.
“Your premiums will change. Your out-of-pocket costs can change. Drug coverage can change,” said Louise Norris of healthinsurance.org.
To help you sort through your options, we spoke with health policy analyst Louise Norris.
Costs are rising
First up, employer-sponsored plans, which are the largest source of health coverage in the United States, serving over 60% of people under 65, are expected to get more expensive. The annual National Survey of Employer-Sponsored Health Plans projects the average cost of health benefits will rise more than 8% in 2027.
According to healthinsurance.org, 12 insurers are leaving the ACA marketplace at the end of 2026. Remaining insurers have proposed premium increases averaging 15%. Twenty-nine states and Washington, D.C., have finalized increases so far. However, Norris said, 87% of ACA insurees received some subsidy in 2026. “But it is probably still the vast majority of marketplace enrollees are getting a subsidy. And those subsidies do cover, for most people, the bulk of their premium. So average net premiums are much, much lower than average full-price premiums because of those subsidies,” said Norris.
Those with Medicare Part D plans may also experience a rise in the cost of prescription drugs. Not only is the deductible increasing from $615 to $700 in 2027, but so are the out-of-pocket limits. “The out-of-pocket limit was $2,100 this year for drugs covered by your Part D plan,” said Norris. “That is increasing to $2,400 for 2027.”
Even if you like your plan, shop around
“It will almost certainly change in some way and you don’t know if there might be a better option available to you unless you actively comparison shop,” said Norris.
That is true for every kind of coverage. If your employer offers more than one plan, or you buy on the Marketplace, or you want to make changes to your Medicare coverage, the open enrollment period is your chance to switch.
Start by doing your research. You can visit healthinsurance.org for helpful information on employer-sponsored plans and ACA Marketplace plans. And for a full breakdown on changes coming to Medicare, visit medicareresources.org.
Start with how you used your coverage
Before you renew or pick a new plan, review how you used your insurance this year:
How often did you go to the doctor?What prescriptions did you need?How much did you pay out of pocket?
The answers matter because plans differ in which doctors and drugs they cover. “Some plans cover some doctors and not others; some plans cover some drugs and not others,” Norris said. “Even if a drug is covered, you want to know what the out-of-pocket costs will be.”
Next, think about any major medical expenses you expect next year, such as a planned surgery.
Compare the total cost of each plan, not just the premium
Once you know your likely needs, compare the total cost of each plan, including the deductible, copays, coinsurance and out-of-pocket maximum.
Monthly premium (x 12): what you pay each month to have coverage.Deductible: what you pay for covered services and drugs before the plan pays anything, except free preventive care.Copayments and coinsurance: what you pay each time you get care, such as $20 for a doctor visit or 30% of a hospital bill.Out-of-pocket maximum: the most you’ll spend on covered services in a year. After that, the plan pays 100%.
Your expected usage can change which plan comes out ahead.
Also check how each plan handles doctor visits. One plan may charge a flat $25 copay, while another counts visits toward your deductible, and then you could pay $120, $150 or $200 per visit, depending on the rate the plan negotiated with that doctor.
Finally, check each plan’s doctors, hospitals and drug coverage. Every plan sets its own network and drug rules, and a covered drug can still cost very different amounts from plan to plan.
A word of caution for folks transitioning from an employer-sponsored plan to the ACA marketplace: “You don’t want to assume that the drug coverage or provider network is the same, even if you had that same company’s coverage through an employer,” said Norris. “People should know that they have different provider networks. They have different coverage rules.”
Consider a Health Savings Account
If a high-deductible plan makes sense for you, a health savings account (HSA) can help cover out-of-pocket medical costs. For 2027, HSA contribution limits increase to $4,500 for individuals and $9,000 for families.
Norris said an HSA can also offer reassurance. “If you are able to fund an HSA and you’re diligent about continuing to put money in there, it can certainly also bring peace of mind of knowing that if something happens and you need to meet your out-of-pocket max or hit your deductible, you have the money there.”
Key DatesOct. 15–Dec. 7, 2026: Medicare open enrollmentNov. 1, 2026: Marketplace open enrollment begins in most states (HealthCare.gov typically opens window shopping in the last week of October)Dec. 15, 2026: Deadline for Marketplace coverage starting Jan. 1January 15, 2027: Marketplace open enrollment ends in most statesEmployer-sponsored plan enrollment dates are set by the employer and usually take place between September and November.
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