Sticker Shock Season: 5 Things to Check Before You Pick a 2027 Health Plan

Sticker Shock Season: 5 Things to Check Before You Pick a 2027 Health Plan

Open enrollment is back, and this year it matters more than usual. Premiums are climbing by double digits for the second year in a row, deductibles and savings-account limits are shifting, and millions of enrollees will need to shop harder to avoid overpaying. Whether you buy through an employer, the federal marketplace, or Medicare, here are the five checks to run before you sign up.

Federal Marketplace Opens Nov. 1, California Runs to Jan. 31

Open enrollment is the once-a-year window to sign up for, renew, change, or drop health coverage. In states using the federal ACA marketplace, the 2027 plan-year window runs Nov. 1, 2026, through Jan. 15, 2027. Enroll by Dec. 15, 2026, and pay the first premium, and coverage starts Jan. 1, 2027; enroll or switch between Dec. 16 and Jan. 15 and coverage starts Feb. 1. Covered California extends its deadline to Jan. 31. Medicare's fall open enrollment runs Oct. 15 through Dec. 7, and employer-plan windows vary by company, so check with HR now.

Officials Say Compare Total Costs, Not Just Premiums

The National Association of Insurance Commissioners advises shoppers to pull three things before choosing: the plan's annual notice of changes, their own record of doctor visits and prescriptions from the past year, and the total-cost math for each option, including deductibles, copays, coinsurance, and networks. For Medicare beneficiaries, Medicare.gov shows whether a Medicare Advantage plan will still be offered next year; plans that are closing were supposed to mail notices in the first week of October. Medicare Part B premiums for 2027 will rise by more than $6 a month on average.

Second Straight Double-Digit Hike Adds Up to 42% in Two Years

The reason for extra homework is price. KFF's analysis of insurer filings puts the median proposed premium increase for 2027 at 15%, the second consecutive year of double-digit hikes. Rates finalized in 37 states plus Washington, D.C., show a typical increase of about 16%, with the vast majority of hikes nationally between 10 and 20%; large parts of Arizona, New Mexico, and Montana average more than 20%. Measured on benchmark silver premiums, the national average rose 26% from 2025 to 2026 and another 13% from 2026 to 2027: 16% in state-based marketplaces, 11% in HealthCare.gov states, and 42% cumulatively over 2025 to 2027. ACA Signups tracking puts the average full-price 2026 premium at about $741 a month; a 15% rise takes it to roughly $854, costing a full-price enrollee more than $1,300 extra a year. KFF attributes about 10 percentage points of the increase to rising medical costs and about 4 points to risk-pool deterioration after the enhanced premium tax credits expired.

Expiring Subsidies and Shrinking Enrollment Hit Marketplace Shoppers

The people most affected are marketplace enrollees. About 19.2 million people held ACA marketplace coverage in February 2026, down 13% from 2025, after the enhanced premium tax credits lapsed at the end of 2025. At least seven insurers have said they will stop selling marketplace coverage in 2027, and some Medicare Advantage plans are closing in certain markets, forcing those members to switch. Workers on employer plans face the same math from the other side: a low-premium, high-deductible option looks cheap until a high-care year pushes out-of-pocket spending past the premium savings.

Run the Five-Point Checklist Before You Commit

First, calendar your deadlines: Nov. 1, Dec. 15, and Jan. 15 for marketplace plans; Oct. 15 to Dec. 7 for Medicare; your employer's own window for workplace coverage. Second, do worst-case math, not premium math: add premiums to deductibles, copays, coinsurance, and the out-of-pocket maximum under both a light-care year and an expensive year. Third, verify your doctors and drugs: confirm each 2027 option still covers your physicians, hospitals, and prescriptions. Fourth, check HSA eligibility and set contributions: for 2027 the IRS limit is $4,500 for self-only and $9,000 for family coverage, plus a $1,000 catch-up at 55 and older; the minimum deductible for an HSA-qualified plan rises to $1,750 individual and $3,500 family; and since 2026, Bronze and Catastrophic marketplace plans also confer HSA eligibility, newly covering more than seven million people. Contributions go in pre-tax, grow tax-free, and come out tax-free for qualified expenses, with balances rolling over indefinitely. Fifth, shop around: eHealth estimates that comparison shoppers save on average more than $2,000 a year on premiums at comparable benefit levels, a habit that pays most in a year like this one.

Discussion

When you pick a health plan, do you prioritize a lower monthly premium or lower costs when you actually need care, and why?