Your premium went up. The letter says so, and the number looks worse than last year. Before you adjust anything, do the arithmetic on the whole plan, because the premium is only the part of the bill that shows up on schedule. The rest arrives later, in pieces, from doctors and pharmacies.

Start with the full yearly cost, not the monthly premium

HealthCare.gov gives a simple formula for total yearly cost. Take the monthly premium times 12. Then add the deductibles, copayments and coinsurance you expect to pay, up to the plan's out-of-pocket maximum. That is the number to compare across plans.

A lower monthly premium can lose this contest. A plan that costs less each month but carries a higher deductible can cost more over a year if you actually use it. Comparing only the monthly figure hides that. Write down three numbers for each option, side by side: premium, deductible and out-of-pocket maximum. It takes ten minutes and a sheet of paper.

A household budget worksheet with three columns of handwritten figures for comparing health plan options, lit softly by a window beside a pencil and reading glasses.
A household budget worksheet with three columns for plan options, each listing monthly premium, deductible and out-of-pocket maximum

Understand how deductibles, copays and coinsurance shape your bills

A deductible is what you pay for covered services and prescription drugs before the plan starts paying. Free preventive services are usually excluded. A copayment is a fixed amount per visit. Coinsurance is a percentage of the charge. Both go to the provider each time you get care, so they show up as separate bills, not one tidy sum.

HealthCare.gov walks through an example. Say the deductible is $1,500, coinsurance is 20% and the out-of-pocket maximum is $5,000. A $125 office visit costs you the full $125 until the deductible is met. After that, it costs $25, which is 20%. Once you hit $5,000, the plan pays 100% of covered services for the rest of the coverage period.

Run your own version. Count the visits and prescriptions you expect, and see where the deductible gets used up. Costs climb fast early, then flatten.

Plan for the range, not a single number

You do not know how much care you will need. So budget for two years, not one.

  1. Low-use year: premiums times 12, plus a few copays.
  2. High-use year: premiums times 12, plus the full out-of-pocket maximum.

The gap between those two totals is what your household may need to cover beyond the premium. The out-of-pocket maximum caps covered in-network costs, which makes it the worst-case number for planning. Then decide how to cover the gap: monthly set-asides, a dedicated savings line, or a mix. The sources here do not prescribe a method, so that choice depends on your own numbers and cash flow.

Premium pressure is not limited to the Marketplace. KFF's 2026 survey found workers with employer family coverage pay an average of $7,471 a year toward premiums, up 9% ($621) from 2025. The total family premium, including the employer share, averages $28,303. Your own plan may differ, so check your benefits materials.

Know what a changing premium can and cannot be paid from

Check whether the plan's metal level changed. HealthCare.gov estimates the plan/member split at about 60/40 for Bronze, 70/30 for Silver, 80/20 for Gold and 90/10 for Platinum. These are estimates, and actual costs vary. The level says nothing about quality of care, only how costs are shared. Silver plans can also carry extra savings for people whose income qualifies, which lower deductibles and copays.

Then there is the Health Savings Account, or HSA. It is a tax-advantaged account used with high-deductible plans to pay qualified medical expenses. Contributions may be tax-deductible. But HSA funds generally cannot pay premiums, so a budget that assumes they can will be off. Starting in plan year 2026, ACA-compliant Bronze and Catastrophic plans are HSA-eligible. An HSA-eligible plan is still a high-deductible plan, so weigh the chance of higher costs against your other short-term spending. For tax details, check an official source or a qualified tax professional.

Use the questions and checks before open enrollment closes

Ask the same questions of every plan:

  • What is the deductible, and which services does it apply to?
  • What coinsurance or copay applies to the care I expect to use?
  • What is the out-of-pocket maximum?
  • Does the plan qualify for extra savings based on my income?
  • Does it work with an HSA, and what would contributions do to my costs?

HealthCare.gov has an "Eligible for an HSA" filter for finding compatible plans. Write the answers down so the comparison stays consistent.

One limit worth stating plainly. The sources I used do not list 2027 premiums for individual plans or state-level changes, so you cannot calculate your own increase from them. The enhanced premium tax credits expired in 2026, and KFF expects further Marketplace changes for 2027 enrollment, which begins November 1, 2026 in most states. Once your actual figures arrive, redo the budget with them. This is general education, not advice for your situation, so confirm details with HealthCare.gov or a qualified professional.

Please seek a professional. This article is general information, not financial, tax or insurance advice. Please seek a licensed financial, tax or insurance professional about your own situation.