Key Takeaways
- Employer family coverage averages $26,993 a year; workers pay about $6,850 of it.
- Marketplace open enrollment for 2027 runs November 1 to December 15, 2026 in most states.
- Insurers propose a median 15% marketplace premium increase for 2027, and the subsidy cliff is back.
- 2027's out-of-pocket maximum rises to $12,000; refugees, asylees and TPS holders lose subsidy eligibility.
Choosing a health plan is now a five-figure decision. The average employer family plan costs $26,993 a year in premiums, with workers paying about $6,850 of that from their paychecks, per the latest KFF employer survey. Pick the wrong plan and you can easily leave a few thousand dollars on the table — through premiums you didn’t need to pay, or a deductible you didn’t see coming.
Open enrollment (OE) is when you can change coverage without a qualifying life event. Employer OE typically runs in October and November. On the ACA marketplace, OE for 2027 coverage starts November 1, 2026 and — in most states — now ends December 15, 2026, a shorter window than in past years.
Know the Terms Before You Compare Plans
Premium (contributions): what’s deducted from your paycheck, pre-tax, each pay period for coverage.
Copay: a flat dollar amount for a doctor visit or prescription. Specialist copays run higher.
Deductible: what you pay out of pocket before the plan starts covering its share. Preventive care is generally covered at 100% even before you hit it.
Coinsurance: your percentage of the bill after the deductible. With a $500 deductible and 80/20 coinsurance, a $1,000 hospital bill costs you $600 — the $500 deductible plus 20% of the remaining $500.
Out-of-pocket maximum: the most you can pay in a year before the plan covers 100%. This is the number your emergency fund should be able to absorb.
HMO vs PPO vs HDHP: HMOs are cheapest but require a primary-care physician and referrals. PPOs cost more but let you see specialists and out-of-network providers without pre-approval. High-deductible health plans (HDHPs) trade lower premiums for higher deductibles — and unlock an HSA, which I’d argue is the best tax-advantaged account in the code.
FSA: pre-tax money for out-of-pocket health costs — up to $3,400 in 2026, with up to $680 rolling over if your plan allows. The dependent care FSA limit jumped to $7,500 per household in 2026 under Trump’s One Big Beautiful Bill Act. Unlike an HSA, FSA money is largely use-it-or-lose-it.
What’s Different for 2026–2027
Several changes are reshaping this year’s decision:
The enhanced ACA subsidies are gone. The COVID-era enhanced premium tax credits expired at the end of 2025. Average marketplace premium payments more than doubled for many enrollees, and the subsidy cliff is back: earn even $1 over 400% of the federal poverty level and you get no premium help at all. If you buy your own coverage, estimating your income accurately matters more than it has in years.
More plans work with HSAs. Starting in 2026, bronze and catastrophic marketplace plans count as HSA-eligible coverage, and Direct Primary Care memberships (up to $150/month individual, $300 family) are HSA-compatible under OBBBA.
The marketplace window is shorter. Most states now close 2027 open enrollment on December 15, 2026 — not mid-January.
Marketplace premiums are climbing again. Insurers’ preliminary 2027 rate filings propose a median premium increase of about 15%, according to a KFF review of 276 insurers across all 50 states and DC — on top of a roughly 20% median increase for 2026. Insurers point to rising medical costs, GLP-1 drug use, and healthier people dropping coverage after the enhanced subsidies expired. Final rates vary a lot by state and plan, so compare actual quotes once open enrollment starts.
The out-of-pocket ceiling goes up. The ACA’s maximum out-of-pocket limit for 2027 is $12,000 for an individual and $24,000 for a family, up from $10,600 and $21,200 in 2026. Most plans come in under the cap, but it’s the worst-case number your emergency fund should be able to cover (see tip 10).
Fewer immigrants qualify for marketplace subsidies. Starting January 1, 2027, the One Big Beautiful Bill Act limits premium tax credits and cost-sharing reductions to U.S. citizens and nationals, green card holders, certain Cuban and Haitian entrants, and COFA migrants. Refugees, asylees, TPS holders, and most other lawfully present immigrants can still buy a marketplace plan but lose the financial help, and DACA recipients have been ineligible for marketplace coverage since August 2025. If that’s your household, budget for the full premium before you pick a plan.
10 Tips for Choosing the Right Plan
1. Do the total-cost math, not just the premium math. Add your annual premium to your realistic out-of-pocket costs under each plan (use last year’s claims as a guide). A plan that costs $150/month less but carries a $3,000 higher deductible only wins if you stay healthy — my advice from experience: if you have kids or a variable health history, err toward more coverage.
2. Actually read the plan documents each year. Doing nothing usually rolls you into your current plan at higher premiums — and coverage details shift every year (networks, drug tiers, telehealth rules). The 20 minutes of reading is the highest-paid time of your financial year.
3. Young children mean more visits. If you have little kids, weight the decision toward lower copays and a lower deductible. Two ER visits will eat any premium savings from a cheaper plan.
4. Check your doctors’ network status first. Price matters, but a plan your family’s doctors don’t participate in is a bad plan for you at any price. Verify before you switch — networks change annually.
5. Use the FSA — but budget it honestly. Contributing $3,000 pre-tax saves roughly $660–$900 in taxes for most middle-income households. Base your election on what you actually spent last year, keep every receipt (FSA card purchases still get audited), and remember only ~$680 rolls over.
6. Know your employer subsidy and your COBRA exposure. Employers pay roughly 74% of family premiums on average. If you lose your job, COBRA lets you keep the plan — but you pay the full premium plus 2%. Knowing the real total premium tells you what that safety net actually costs, and whether a marketplace plan would beat it.
7. If you’re healthy, look hard at the HDHP + HSA combo. Lower premiums, and the HSA gives a triple tax break (deductible in, grows tax-free, tax-free out for medical costs) with limits of $4,400 individual / $8,750 family in 2026 — see the HSA guide linked above for the full strategy. Many employers also seed the account with a few hundred dollars.
8. Don’t over-buy the extras. Most employer plans include free basic life and AD&D insurance. If you’re young with no dependents, that’s often enough. And take the wellness questionnaire money — most surveys pay a premium discount or cash reward just for completing them.
9. Buying on the marketplace? Model your income carefully. With the subsidy cliff back at 400% of the poverty level, a year-end bonus or extra freelance income can retroactively wipe out your premium credit. If you’re near the line, consider levers like traditional IRA or HSA contributions that reduce MAGI. This is one place where an hour with the healthcare.gov estimator pays for itself.
10. Match your out-of-pocket max to your emergency fund. Whatever plan you pick, you should be able to cover its OOP max without a credit card. If you can’t, the “cheap” high-deductible plan is riskier than it looks — and big unreimbursed costs may only help at tax time if you clear the 7.5% AGI floor for the medical expense deduction.
Here’s what the math looks like for two hypothetical employees:
Mark, 28, single and healthy, picks the HDHP: $95/month in premiums versus $210 for the PPO. He banks the $1,380 annual difference in his HSA, gets his employer’s $500 HSA seed, and his worst case is capped at the plan’s $4,000 out-of-pocket max.
Sarah, with two kids under 5, pays $180/month more for the PPO with $25 copays and a $1,000 deductible. Eleven pediatrician visits and one ER trip later, she’s come out roughly $1,900 ahead of what the HDHP would have cost her.
Common Issues to Watch Out For
Assuming your current plan is unchanged. Auto-renewal at higher premiums with a quietly narrowed network is the most common open-enrollment own-goal I hear about.
FSA money left on the table. Anything beyond the rollover limit is forfeited. Check your balance in November — glasses, dental work, and prescription refills are easy ways to spend it down legitimately.
Missing receipts. FSA administrators can and do request substantiation even for card purchases. I learned this one the hard way years ago — a $200 lesson.
The marketplace income guess. Underestimate your income and you may repay premium credits at tax time; earn past 400% of FPL and the cliff means repaying all of them.
Confusing HSA and FSA rules. You generally can’t contribute to both a general-purpose health FSA and an HSA in the same year — a limited-purpose FSA (dental/vision) is the workaround.
Looking Ahead: 2027 Outlook
The big open question is whether Congress revives any portion of the enhanced premium tax credits — there’s been plenty of debate but no law as of mid-2026, so plan your 2027 budget assuming current (less generous) subsidy rules. Employer premiums are on track for another mid-single-digit increase for 2027, and the FSA/HSA limits get their inflation bumps in the fall (the 2027 HSA figures are already out — see the HSA guide above).
On the marketplace side, the rest of the 2027 picture is already clearer than the subsidy debate: preliminary filings point to a median premium increase of about 15%, the out-of-pocket ceiling rises to $12,000, and insurers are pricing on the assumption that the enhanced credits stay expired. If you buy your own coverage, the November 1 to December 15 window is the time to re-shop rather than auto-renew.
I’ll update this page ahead of the fall open enrollment season and if Congress moves on the subsidies. Subscribe or follow us to get the update.
