Your health plan is about to cost more. Here’s what to check at open enrollment

There’s an email coming, if it hasn’t landed already. Subject line: “Open Enrollment Is Here.” It will have a deadline, a link and a lot of plan names that sound like cell phone carriers.

Most people click “keep my current plan” and go back to work. This year, that click is going to cost more than usual. Here’s why, and how to spend ten minutes so it doesn’t hurt.

How much are health plan costs going up in 2027?

A lot. In preliminary results from a Mercer survey of more than 1,800 employers, total health benefit cost per employee is projected to rise 8.2% on average in 2027, the highest increase since 2003. That’s after employers’ planned cost-cutting changes. Without those changes, they said their current plans would have risen about 11%. The projected increase for 2026 was 6.7%.

Mercer is part of Marsh, and Fierce Healthcare’s coverage of the same research puts the jump at 8.2% for 2027 as well.

Why are costs rising?

The same survey names the causes. Ongoing pressures include advanced diagnostics and therapies, provider consolidation that gives health systems more bargaining power, and government payments that lag behind inflation. Newer factors include GLP-1 weight-management drugs, which add about one percentage point of growth, software that has increased the volume of claims submitted, and higher-than-predicted disputes and awards under the No Surprises Act’s arbitration process.

None of that is your doing. None of it is your employer’s doing, either, entirely. But the bill has to land on someone, and the next section is about who.

Who ends up paying more?

You do, in one of two ways. The Mercer survey found that 59% of employers plan cost-cutting changes, including higher deductibles that raise what members pay out of pocket. And in a separate Marsh survey, about two-thirds of large employers, those with 500 or more employees, expect to increase the share of premiums their workers pay. So many people will see paycheck deductions rise faster than the 8.2% headline.

For a worker who’s already stretching a check, that matters in a particular way. A higher deductible doesn’t show up in your paycheck. It shows up in February, when you need a specialist and learn you owe the first couple thousand dollars yourself. Many people in that spot skip the visit. Skipping care to avoid the bill is the real cost of a plan that looked cheaper in November.

I advise employers on this too, and I’ll tell you what I tell them: if you’re raising employee contributions, say so plainly and early. Employees forgive a price increase. They don’t forgive a surprise.

A ten-minute open enrollment checklist

Don’t just compare monthly premiums. Compare the whole year.

Find the total yearly cost. Add twelve months of premiums to the deductible. That’s the minimum you’d pay in a bad year before the plan really starts helping. Then check the out-of-pocket maximum. That’s the ceiling.

Check your doctors and your prescriptions. Look each one up in the plan’s directory and formulary before you choose. A cheaper plan that doesn’t cover your doctor isn’t cheaper.

Look for new tiers and surcharges. Some employers are adding lower-cost options, such as plans with variable copays, offered by 12% of large employers in 2027. Read the fine print on dependents and on anything labeled a surcharge.

Think about a health savings account. If you pick a high-deductible plan that qualifies, an HSA lets you set aside pre-tax money for medical costs. It only works if you can cover the higher deductible in a bad month, so be honest about your cushion.

Plan around a leave or a life change. If you might take time off for a baby, surgery or a family member’s care, check how that interacts with your coverage and your protected leave. My guide to California leave laws explains which protections apply.

Treat it as part of the offer. If you’re comparing jobs, benefits are pay. A role with a lower salary and a better plan can beat a higher salary with a plan that eats the difference. I cover how to run that math in comparing two job offers.

If you buy your own coverage

If you’re self-employed, a contractor, or between jobs, you’ll be on the individual market. In California, Covered California’s open enrollment runs November 1 through January 31, and signing up in November or December starts coverage on January 1. Check the current subsidy rules for your income before you decide, because they can change what a plan really costs.

For the employers reading this

If you run a small company, an 8% increase lands on your budget before it lands on anyone’s paycheck. Ask your broker for the renewal early, ask what each option does to employee cost, and decide how much of the increase you’ll absorb before you announce anything. If you want help weighing the tradeoffs, our page on whether a small business needs HR is a place to start, and you can book a free 20-minute conversation to talk it through. When you announce plan changes, remember that not everyone reads English first, a point made in language access in training.

McKinley holds a J.D. but is not a licensed attorney. Articles here are general information, not legal advice. For your specific situation, talk with an employment attorney.

Data current as of September 2026. Sources are linked where each figure appears.