How to budget for a health insurance premium increase in 2027

I read a lot of ledgers, and health insurance is one of the few lines that most people never look at twice. It is a fixed bill, it leaves the account on the same day every month, and it only changes once a year. This year that one change is large enough to look at properly.

For people who buy their own cover on the ACA Marketplace, KFF's review of early rate filings, reported on 8 July 2026, found insurers asking for a median increase of 14% for 2027, on top of a median 20% rise for 2026. By late September, healthinsurance.org put the nationwide median proposed increase at about 15% (29 September 2026), with insurers leaving the Marketplace in 24 states. Employer cover is moving too: Forbes, on 18 September 2026, reported employer health costs projected to rise 8.2% per employee, with about two-thirds of large employers expecting to raise the share their staff pay.

Open enrollment for Marketplace plans starts on 1 November in most states. Here is how to budget for a health insurance premium increase before the renewal letter decides for you.

When does open enrollment start, and what are the deadlines?#

The dates that matter for a budget, as Forbes summarised them:

• Marketplace plans: 1 November to 15 January in most states. Pick a plan by 15 December for cover that starts on 1 January; enrol between 16 December and 15 January and cover starts on 1 February. Some state-run exchanges use different dates.
• Employer plans: each employer sets its own window, usually in the autumn. The new deduction normally shows up on the first payslip of January.
• Medicare: 15 October to 7 December, with changes from 1 January.

Put the deadline that applies to you in your calendar today, with a reminder a week before. Plans chosen in a rush tend to be chosen on the monthly price alone, and the monthly price is only half the cost.

Step 1: price the renewal before you shop#

Your insurer or your employer will tell you what your current plan costs next year. Start with that number, because it is the cost of doing nothing.

Work out three figures:

1. The new monthly premium, after any subsidy or employer contribution. This is what actually leaves your account.
2. The yearly difference. New monthly premium minus the old one, times 12.
3. The monthly gap in your budget. That is the yearly difference divided by 12, or simply the new premium minus the old one.

If you get subsidised Marketplace cover, update your income estimate before you look at prices. The subsidy depends on it, and an out-of-date estimate gives you a wrong price, or a bill at tax time.

Step 2: compare plans on total yearly cost, not the premium#

A cheaper premium usually comes with a higher deductible: the amount you pay for care before the plan starts to share the cost. So the honest comparison is not "which plan costs less a month" but "which plan costs less a year, in a normal year and in a bad one".

For each plan you are considering, write down:

• the monthly premium, times 12;
• the deductible;
• the out-of-pocket maximum, which is the most you can pay for covered care in a year. For 2027 the legal ceiling for one person is $12,000, up from $10,600, according to healthinsurance.org.

Then add up two totals:

• A quiet year: yearly premiums plus the care you expect anyway (regular prescriptions, check-ups, the visits you know about).
• A bad year: yearly premiums plus the out-of-pocket maximum.

The quiet-year total tells you what the plan will probably cost. The bad-year total tells you how much you need to be able to absorb if something goes wrong. Both belong in the decision.

Before you compare prices, check that your doctors and your prescriptions are covered by each plan. Networks and drug lists change every year, and a cheap plan that drops your doctor is not cheap.

A worked example: one renewal, two plans#

Say she buys her own cover. In 2026 she pays $420 a month after her subsidy. Her renewal letter says the same plan will cost 15% more in 2027: $420 × 1.15 = $483 a month.

That is $483 × 12 = $5,796 a year instead of $420 × 12 = $5,040, so $756 more a year, or $63 a month.

She looks at one cheaper plan as well. The plan figures below are an example for the arithmetic, not real prices for any state:

Her ledger shows about $1,200 a year of care she pays for anyway: four doctor visits at $150 ($600) and a prescription at $50 a month ($600). Both deductibles are higher than $1,200, so in a quiet year she pays all of it herself under either plan.

• Quiet year, Plan A: $5,796 + $1,200 = $6,996.
• Quiet year, Plan B: $389 × 12 = $4,668, plus $1,200 = $5,868.
• Bad year, Plan A: $5,796 + $9,000 = $14,796.
• Bad year, Plan B: $4,668 + $10,600 = $15,268.

So Plan B is $1,128 cheaper in a quiet year and $472 more expensive in the worst year. Notice that $1,128 is exactly the premium saving: $483 − $389 = $94 a month, and $94 × 12 = $1,128.

Neither answer is right for everyone. Plan B is cheaper only if she could pay up to $10,600 in a bad year without borrowing. Her emergency fund is $6,000, so a bad year on Plan B would leave her $4,600 short. She keeps Plan A for 2027, and decides to look at Plan B again next autumn, when her emergency fund is larger.

Step 3: put the new numbers in the budget#

Once the plan is chosen, the budget needs two lines, not one.

The premium, as a recurring bill. For her, $483 a month from January. The $63 a month increase has to come from somewhere. This is a good moment for a subscription audit: in that example, cancelling one unused streaming service and one forgotten app freed $21.98 a month, about a third of the gap, before touching anything she uses.

A health sinking fund for the care you expect. Her $1,200 a year of expected care is $1,200 ÷ 12 = $100 a month set aside, so a doctor's bill is paid from money already saved instead of from the grocery budget. The sinking funds post shows how to set one up.

Her total health budget for 2027 is $483 + $100 = $583 a month. In 2026 it was $420 for the premium and nothing for care, which is why her doctor's bills always felt like surprises.

If your plan is eligible for a health savings account, the sinking fund can live there. The 2027 contribution limits are $4,500 for self-only cover and $9,000 for family cover, according to healthinsurance.org. Whether an HSA makes sense depends on your taxes and your plan, so check the rules for your situation.

Three mistakes to avoid#

1. Letting the plan renew automatically. If your insurer is leaving the Marketplace, you may be moved to a replacement plan you did not choose. Look at every renewal notice.
2. Comparing only the monthly premium. The table above shows how a plan that saves $94 a month can still cost more in the year it matters most.
3. Forgetting the January payslip. If your cover comes through work, check your first payslip of 2027. A higher deduction means a smaller take-home pay, and every budget built on the old figure is now slightly wrong.

None of this is advice about your health cover specifically. It is arithmetic you can run on your own renewal letter, and the Azno ledger already holds most of the numbers it needs.

What to ask an advisor about it#

Inside Azno, your recurring bills, your budgets and your emergency fund sit in one ledger, so these become questions rather than an evening with a spreadsheet:

• "How much did I spend on health care in the last twelve months, not counting the insurance premium?" — the number you need for the quiet-year total.
• "If my health insurance goes from $420 to $483 a month in January, which budget categories could cover the $63 difference?" — the gap, matched against where you actually spend.
• "Create a health sinking fund goal of $1,200 for 2027, saving $100 a month." — this comes back as a proposal, and nothing is written until you approve it. The Advisor never picks a plan or moves money for you.

If your renewal letter is already in, create an account and put both plans in. Seeing the quiet year and the bad year side by side usually makes the choice clear.