Employer Health Insurance in 2027: What to Check at Open Enrollment

Quick answer: Employer health insurance for 2027 is likely to cost employees more, especially for family coverage. During your company’s open enrollment, compare your payroll deduction, deductible and out-of-pocket max against this year’s; confirm your doctors and prescriptions are still covered; and check whether your spouse and kids could get coverage elsewhere for less. If family coverage at work costs more than 10.22% of your household income in 2027, your family may qualify for Marketplace savings even though you stay on the work plan.

Who this is for

Employees who get health insurance through work and cover a spouse, kids or both
Anyone whose company holds open enrollment this fall
Families who saw a bigger payroll deduction this year and want to know if there’s a better setup
Small business owners deciding what to offer employees in 2027

Why employer health insurance costs keep rising

Health insurance through work has never been cheap, and it keeps getting more expensive. According to the KFF 2025 Employer Health Benefits Survey, the average annual premium for family coverage reached $26,993 in 2025. Workers paid an average of $6,850 of that directly out of their paychecks, and employers paid the rest.

Those are averages. Employees at small companies often pay a bigger share, and many plans have also raised deductibles, so the cost of actually using your coverage has gone up on top of the premium.

The cost drivers haven’t gone away for 2027: higher hospital and provider prices, more expensive prescription drugs, and more people using care. That’s why your company’s open enrollment this fall deserves more than a quick click on “keep my current plan.”

What actually changes when your employer renews

When your employer renews its health plan, three things can change at the same time, and the renewal packet doesn’t always make them obvious:

Your payroll deduction. The same plan can cost you more per paycheck, especially if your employer shifts more of the premium to employees.
Your cost when you use care. Deductibles, copays and the out-of-pocket maximum can all go up. For 2027, federal rules let the out-of-pocket maximum on ACA-compliant plans go as high as $12,000 for one person and $24,000 for a family, up from $10,600 and $21,200 in 2026 (CMS 2027 parameters).
Your network and drug list. Doctors and hospitals can leave the network, and medications can move to a more expensive tier.

Your 2027 employer open enrollment checklist

Use this list during your company’s enrollment window. Most of it takes 15 to 20 minutes.

Compare the paycheck deduction line by line. Write down what you pay per paycheck now and what you’ll pay in 2027 for each plan option and coverage tier (employee only, employee + spouse, employee + children, family).
Compare the deductible and out-of-pocket max. A plan that costs $40 less per paycheck but has a deductible $3,000 higher may cost you more if anyone in the family needs care.
Check every doctor and prescription. Look up each family member’s doctors in the 2027 provider directory and each medication in the 2027 drug list.
Look at the HSA option if there is one. If your employer offers a high-deductible plan with a Health Savings Account, the 2027 contribution limits are $4,500 for self-only and $9,000 for family coverage, plus $1,000 if you’re 55 or older (IRS). HSA money is tax-advantaged and rolls over year to year.
Run the family affordability test. This is the step almost everyone skips. Since 2023, IRS rules look at whether family coverage at work is affordable, not just employee-only coverage. If your share of the family premium is more than 10.22% of your household income in 2027 (IRS Rev. Proc. 2026-26), your spouse and kids may qualify for Marketplace tax credits, as long as household income is at or below 400% of the federal poverty level ($132,000 for a family of four). We walk through the math in the 10.22% test.
Compare your spouse’s employer plan. If both of you are offered coverage at work, compare all the combinations: everyone on your plan, everyone on your spouse’s plan, or each of you on your own plan with the kids on whichever costs less.
Ask what happens mid-year. Find out how your plan handles a new baby, a marriage or a job change. Those life events usually let you change plans outside of open enrollment.

Questions to ask HR before your deadline

HR and your benefits portal can answer most of these in a few minutes, and the answers change the math:

What will each plan cost per paycheck in 2027 for each coverage tier?
Is there a spousal surcharge if my spouse could get coverage at their own job?
Does the company contribute to an HSA or HRA, and how much?
Which plan is the lowest-cost option that covers my family and meets minimum value? (You’ll need this for the affordability test.)
When does 2027 coverage start, and when is the enrollment deadline?
If I drop my family from the plan now, can I add them back mid-year?

Write the answers down. If you end up comparing Marketplace or private options for your spouse and kids, a broker will ask for the same numbers.

Comparing your options at a glance

Setup	Best for	Watch out for
Whole family on your employer plan	Families who use a lot of care or need a specific network	Family premium share can be very high
Whole family on your spouse’s plan	When your spouse’s employer pays more of the family premium	Network differences, spousal surcharges
You on your work plan; spouse and kids on a Marketplace plan	Families where work family coverage costs more than 10.22% of income and income is under 400% FPL	Need to run the numbers carefully; separate deductibles
You on your work plan; healthy family members on a private plan	Healthy families over the subsidy cliff	Private plans are medically underwritten, not HSA-eligible, and may not cover pre-existing conditions

Real-world scenarios

These are illustrative examples, not quotes.

The family that splits coverage (Marketplace). A Scottsdale couple with two kids earns $95,000. The employee’s share of family coverage at work is about $1,050 a month ($12,600 a year), which is more than 10.22% of their income ($9,709). The employee stays on the work plan for about $120 a month for self-only coverage. The spouse and kids move to a Marketplace plan with tax credits, and the family’s total premium drops.

The family that stays put. A Mesa family has a child with a chronic condition and a specialist who’s only in their employer plan’s network. Their family coverage passes the affordability test anyway. Staying on the work plan, and using the HSA option to set aside tax-free money, is the right call for them.

The healthy family over the cliff. A Phoenix family of four earns $160,000, above the 400% line, so the Marketplace offers no tax credits. Their work plan’s family share is high. Because everyone is healthy, they compare a private medically underwritten plan for the spouse and kids against the work plan. The private plan isn’t HSA-eligible and wouldn’t cover pre-existing conditions, so they weigh that carefully before deciding.

Action checklist

Get your 2027 benefits guide and rate sheet from HR
Write down this year’s and next year’s paycheck deduction for each tier
Compare deductibles and out-of-pocket maximums
Check doctors and prescriptions for everyone in the family
Run the 10.22% family affordability test
Compare your spouse’s employer plan
Book a free comparison before your company’s enrollment deadline

Frequently asked questions

Is employer health insurance going up in 2027?

For most employees, yes. Family premiums were already about $26,993 a year on average in 2025, with workers paying $6,850 (KFF), and the cost drivers behind those increases are still in place. Your exact change depends on your employer and plan.

When is open enrollment for employer health insurance?

Each employer sets its own window, and many hold it in the fall for plans that start January 1. Check with HR, because employer open enrollment is separate from the Marketplace’s open enrollment window, which runs November 1, 2026 to January 15, 2027 in Arizona (enroll by December 15 for coverage starting January 1).

Can my spouse and kids get a Marketplace plan if I have insurance through work?

Yes, they can always buy one. Whether they get tax credits depends on whether your family coverage is “affordable.” For 2027, if your share of family coverage costs more than 10.22% of household income, and income is at or below 400% FPL, they may qualify.

Can I drop my employer plan and get a subsidized Marketplace plan instead?

Usually not with a tax credit. If your employee-only coverage costs 10.22% of household income or less in 2027, you generally can’t get Marketplace tax credits for yourself.

What’s the out-of-pocket maximum for 2027?

For ACA-compliant plans, it can be up to $12,000 for one person and $24,000 for a family. Many employer plans are lower.

Are private health plans an option for my family?

For healthy family members, possibly. Private plans are medically underwritten, can be bought year-round, aren’t HSA-eligible and may not cover pre-existing conditions. They work best as a complement to Marketplace or employer coverage, not a blanket replacement.

Does it cost anything to have a broker compare my options?

No. A licensed broker is paid by the insurance company, so a comparison is free.

Bottom line

Employer open enrollment is the one time a year you can reset your family’s coverage at work, and in 2027 it’s worth more than a quick click. Compare the paycheck deduction and the deductible, confirm your doctors and drugs, and run the family affordability test. For many families the work plan is still the best deal. For others, splitting coverage or using a spouse’s plan saves thousands. You won’t know which group you’re in until you run the numbers.

Get a free 2027 benefits comparison

Not sure your work plan is still the best deal for your family? I’ll compare your employer plan against Marketplace and private options before your enrollment deadline. It’s free.

Derek Greenlee, Greenlee Health Insurance
Phone: 480-375-1652
Email: derek@greenleehealthinsurance.com
Website: greenleehealthinsurance.com

Book a free consultation