If you’re on an employer health plan or buying your own coverage on the ACA marketplace, you probably already know costs have been creeping up.
But 2027 is shaping up to be worse than the usual creep. The numbers being floated right now are significant, and open enrollment starts Nov. 1.
On the employer side, health benefit costs per worker are projected to rise 8% to 11% next year. On the ACA marketplace, insurers have proposed a median premium increase of 15% for 2027, according to CNBC.
Those are still proposals, not final numbers. But the proposals for 2026 came in at 18% and the final number landed at 20%, so the direction is pretty clear.
A few things are all pushing in the same direction at once. GLP-1 drugs. Medical inflation. Hospital consolidation. Expiring ACA subsidies.
None of it is reversing anytime soon. And depending on your plan and your income, you could feel this as a higher monthly premium, a bigger deductible, or both.
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What’s happening with employer plans
About 166 million Americans under 65 get health insurance through an employer, according to a KFF analysis. Your company usually covers most of the premium. But when your employer’s costs go up, it tends to find its way to you.
Could be a higher payroll deduction. Could be a bigger deductible. Sometimes it’s both, plus a narrower network on top of it.
Three separate firms put out projections on this. Marsh has employer health benefit costs rising 8.2% per worker in 2027, according to Fierce Healthcare. That would be the biggest single-year jump since 2003. WTW came in higher at 11.1%.
Aon landed at 9.5%. None of them are calling for costs to come down. Workers’ total healthcare tab already climbed 7.9% in 2026, the sharpest annual rise in ten years. Aon isn’t expecting it to let up.
Nearly six in 10 employers say they’re planning to make cost-cutting changes to their health benefits, reports Fierce Healthcare.
Raising deductibles is the most common approach. A higher deductible keeps the monthly premium from climbing as fast, but it means you’re paying more before your insurance actually does anything. If you stay healthy, you might not notice. If something goes wrong, you will.
About 166 million Americans under 65 get health insurance through an employer.MoMo Productions / Getty Images
What ACA marketplace enrollees are looking at
The ACA marketplace is where about 19.2 million Americans get their coverage. We’re talking self-employed workers, gig workers, early retirees, people who don’t have access to a job-based plan.
Premiums on those plans have been rising sharply, and there’s no sign 2027 is going to be any different.
Insurers have proposed a median 15% premium increase for 2027, based on a KFF analysis of filings from 276 insurers. That would be the second consecutive year of double-digit proposed increases. And as 2026 showed, proposed increases tend to get finalized at levels that are just as high or higher.
Some marketplace enrollees could be looking at premiums that are 30% to 40% higher than they were two years ago.
Now, a lot of people on the marketplace do get premium tax credits, and those help. The federal government picks up part of the tab based on your income. But that help has a ceiling.
If you earn above 400% of the federal poverty level, you’re mostly out of luck. For a single person, that’s somewhere around $64,000 a year. For a family of four it’s closer to $132,000.
There were enhanced subsidies that used to reach people in that range, but they expired at the end of 2025. About 1.6 million people on the marketplace were in that income bracket last year. Whatever the final 2027 increase looks like, they’re paying it.
What’s driving costs this high
GLP-1 weight loss medications are one of the biggest new cost drivers for employers right now. As these drugs have grown more popular, covering them has gotten expensive fast, as TheStreet reported.
Marsh estimates that rising GLP-1 use alone will add about one percentage point to overall employer health cost growth in 2027. Some employers are already pulling back. They’re adding prior authorization requirements, restricting coverage, or shifting more of the cost onto workers.
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Regular inflation is doing its part too. Hospitals, insurers, and medical practices are paying more for staff and supplies. Healthcare wages have climbed as labor shortages drag on. When an insurer’s costs go up this year, it shows up in your premiums next year. That’s just how the math works.
Hospital consolidation has made it worse over time. When big health systems absorb smaller practices, they get more leverage in negotiations with insurers. That usually leads to higher reimbursements, which flows through to higher premiums and bigger out-of-pocket costs for patients.
On the ACA side, insurers are also pricing in the risk that healthier people drop coverage because it’s gotten too expensive. If that happens, the remaining pool skews older and sicker, which costs more to cover, which pushes premiums higher still.
What to do before open enrollment
Most people zero in on the monthly premium. That’s the number that shows up first and feels the most real. But it’s not what you actually pay for healthcare. It’s what you pay to have healthcare.
Marketplace deductibles went up 37% in 2026, adding more than $1,000 per person and landing at a record average of $3,786, according to KFF. Monthly premiums climbed 58% that same year.
A plan can look affordable on the premium line and still wipe you out when you actually go to use it, especially if the deductible is steep or the prescription coverage is weak.
Before you pick a plan, think through what you actually expect to use in the next year. Look at deductibles and out-of-pocket maximums alongside the monthly premium. Check whether your doctors and the hospitals you’d actually go to are still in-network.
If you’re on a GLP-1 medication, check whether it’s covered before you sign up. Coverage varies a lot by plan, and finding out after enrollment isn’t fun.
If you’re buying on the ACA marketplace, update your projected income before you enroll. Your subsidy amount is based on what you expect to earn. If you get it wrong, you could owe money back when you file your taxes.
If your income shifted in 2026 or looks different for 2027, take the time to run those numbers carefully. And if your plan qualifies for a health savings account, using one lets you cover out-of-pocket costs with pre-tax dollars, which is a real reduction in what coverage actually costs you.
Costs aren’t going down in 2027. But how much of the increase lands on you depends a lot on the choices you make before enrollment closes.
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