Find the Right Health Plan During Open Enrollment
When you enroll in a 2026 health insurance plan this fall, don’t be surprised if you see a significant increase in your premium, whether you get coverage from your employer or on the Affordable Care Act marketplace.
Large employers expect health care costs for employee coverage to rise by a median 9% in 2026, according to the Business Group on Health. “This is the highest single-year forecast in more than a decade,” says Ellen Kelsay, BGH president and CEO.
Employers plan to pass along more of the increase to employees than they have in the past few years, and some are offering new kinds of plans with restricted provider networks as another way to manage their expenses.
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The sticker shock will be even more intense for people who buy insurance on the ACA marketplace. When health insurance companies filed their proposed rates for 2026 with regulators over the summer, the median premium increase from 2025 was 18% — the largest rate change insurers have requested since 2018, according to an analysis by KFF, a health care research organization.
And that’s just part of the picture for marketplace plans. If you’ve qualified for a premium subsidy to reduce costs based on your income in recent years, that may change: The enhanced premium tax credits that enlarged the subsidies starting in 2021 are set to expire at the end of 2025, unless Congress makes a last-minute change.
If they are not extended, the subsidies will shrink for people earning less than 400% of the federal poverty level; for 2026 plans, 400% of the poverty level is $62,600 for singles and $84,600 for couples in most states. People earning more than that won’t receive a subsidy.
Despite these developments, you still have solid strategies at your disposal to make smart health care decisions and manage the costs during open enrollment. Here’s what to expect when assessing your plan options this fall.
New employer-plan options
The BGH study’s 9% projected increase in health care costs is driven primarily by the rising price of pharmaceuticals, the growing popularity of obesity treatments (especially GLP-1 medications, such as Ozempic), an increase in cancer diagnoses, and higher usage of mental health services, which many employers have expanded in the past few years.
The employers who responded to the survey expect to moderate the increase to a median of 7.6% by tweaking the design of their health plans, including some changes that affect employees’ options and costs. The plans may limit or reduce coverage for GLP-1 medications and require prior authorization for more procedures and services before they provide coverage.
Employers may also pass along a larger share of the cost increase to employees than they have over the past few years, through higher premiums, deductibles and co-payments. The median estimate of employee contributions to annual premiums is rising from $2,983 to $3,251 per employee in 2026 (including both single and family coverage), and the median yearly out-of-pocket cost for employees is increasing from $1,825 to $2,224, according to the BGH study.
But a growing number of employers are also looking for alternatives to increasing deductibles, recognizing that high deductibles can cause people to avoid seeking care, leading to more expensive medical issues in the future.
More than one-third of the plans surveyed by Mercer, a human resources and employee benefits consulting firm, expect to offer a medical plan with no deductible or a low deductible, and 12% expect to offer at least one plan with no premiums for employees.
Some employers hope to reduce costs by offering plans with incentives for employees to use certain providers that offer high-quality and cost-efficient services. So you may see plans with new types of provider networks on the menu.
For example, if your plan includes a “high-performance network,” you may have lower deductibles and co-payments when you use certain providers than you do when you visit the rest of the providers in your plan’s standard network. A high-performance network is “generally like a PPO, but it’s a more curated network,” says Tracy Watts, senior partner at Mercer.
With these plans, you may be able to use out-of-network providers, but with higher costs for you, as is typical with a PPO (preferred provider organization). Another version of these high-performance network plans, called EPO (exclusive provider organization) plans, restricts coverage to in-network providers only.
As another option, some employers are offering “variable co-pay plans” that have no deductible and provide a range of co-payments that vary by provider, which the employees see up front. “The idea is you’re getting somebody to do their homework before they call the doctor,” says Watts.
You may also be able to use centers of excellence, which are hospitals that may be outside your area but specialize in certain conditions. More than half the companies surveyed by BGH plan to include centers of excellence in their networks in 2026 for bariatric surgery, musculoskeletal conditions, fertility treatments, or cancer. Centers of excellence are more commonly included in large-employer plans than those from smaller employers.
Employers and their health plans have also been beefing up navigator programs. Health care navigators can help you learn about your care options if you’re diagnosed with a medical condition and find in-network providers in your area. Navigators may let you know whether your plan offers a center of excellence for your condition or whether you may be eligible to participate in a clinical trial, says Watts. They can provide information about other programs the employer offers, too, such as employee assistance programs, which provide a growing number of in-person and online counseling options and other benefits.
Strategies for workers
Because of the increasing costs and changes to employer health insurance, it’s worth making an extra effort to review all your choices during open enrollment this year. The following steps can help.
Make the most of each spouse’s benefits. If both you and your spouse have coverage at work, compare the options. “Don’t assume that if you work for a bigger company, your family should all go on your plan,” says Watts. It may make sense to stay on your own company’s plan, but have your children on your spouse’s plan. Or you could get medical coverage through your plan, but dental and vision coverage through your spouse’s employer.
Do the math. Add up premiums plus the costs for the care and prescription drugs you and your family need regularly under the plans offered by your employers. Also check coverage if you were to get a serious diagnosis, such as cancer or a condition that requires major surgery, so you’ll understand how your medical care may be covered under each plan, says Watts. If you choose a high-deductible health insurance policy paired with a health savings account and the employer contributes money to the HSA on your behalf, subtract that amount from the potential costs.
Contribute to an HSA if you do choose a high-deductible policy. Many employers seed HSAs for employees with eligible health plans or match their contributions. To qualify for an HSA in 2026, your policy must have a deductible of at least $1,700 for single coverage or $3,400 for family coverage. You’ll be able to contribute up to $4,400 in 2026 if you have self-only coverage or $8,750 for family coverage, plus an extra $1,000 if you’re 55 or older.
Learn about new network options, which may be a way to reduce your costs. If you don’t have a strong relationship with any doctors, or if your current doctors happen to be in the network, making use of a plan that offers a preferred network could help you save money on premiums without paying a high deductible, says Watts. Find out whether the plan will cover out-of-network providers with higher cost-sharing or if it will cover only in-network providers.
Check how the plans will cover your medications, especially if you need expensive maintenance drugs. Some plans are altering their formularies, which specify whether a drug is covered and what your co-pay would be, says Watts. Even if the plan includes your drug, you may need to meet prior-authorization requirements before the insurer will cover it for you. Don’t assume your drugs will continue to be covered the way they had been in the past.
Take advantage of extra benefits. For example, employers are making their wellness programs more attractive to many employees. Employers may give you a few hundred dollars each quarter for a gym membership, for example, rather than require you to complete a complicated health assessment. Employers may also offer more mental health benefits and other programs, both in-person and remotely, such as virtual physical therapy.
Choosing a marketplace plan
If you buy insurance on the Affordable Care Act marketplace — either at HealthCare.gov or your state’s marketplace — you may see a particularly large jump in costs. The increase in premiums might not be quite as high as 18% by the time rates are finalized.
“But this gives us a really good signal of what insurers are thinking of the current state of the individual market and how health costs will change,” says Matt McGough, policy analyst in KFF’s program on the Affordable Care Act.
Final rates are available on HealthCare.gov starting the week before open enrollment begins, on November 1. Open enrollment for 2026 plans ends on January 15. (The time frame for open enrollment will be shorter, starting with 2027 plans.) Some states have different time frames.
The increases are due in part to rising health care costs, but they’re also fueled by uncertainty about what will happen to the enhanced premium tax credits.
“Last year, we saw record insurer participation,” says McGough. “Consumers had more choice than ever when it came to selecting a plan on the marketplace. But partially due to the uncertainty, a lot of insurers are pulling out because it might not be as profitable anymore.”
Some insurers are worried that if the enhanced subsidies expire, some healthier people will choose not to get a marketplace plan, which could leave the pool of insured individuals sicker and more expensive for insurers to cover.
“Insurers are going to try to protect themselves from what might be a sicker group of people,” says Sara Collins, senior scholar for health care coverage and access with the Commonwealth Fund, a health care research organization. If the insured people are less healthy overall, the costs go up for everyone — even those who are free of medical conditions.
Aetna, which had sold marketplace plans in 17 states, is leaving the ACA marketplace in 2026. Two large plans in Colorado announced in late August that they would exit the individual market. But regardless of whether the insurer that provides your current plan is sticking with the marketplace, it’s a good idea to shop around.
Your options will be based on where you live and whether you qualify for a premium subsidy. It’s important to look not only at the plan’s sticker price but also at your after-subsidy premiums and potential out-of-pocket costs.
“The amount you pay depends on your income and the plan you choose,” says Cheryl Fish-Parcham, director of private coverage at Families USA, a consumer health care advocacy organization.
“Don’t assume that what another person pays is what you’re going to pay,” said Fish-Parcham. Look at the plan choices, and make sure you’ve updated your income figures when shopping for a marketplace plan.”
To help estimate your premiums and possible subsidies, you can use the calculator at kff.org/interactive/subsidy-calculator. (KFF plans to update the tool for 2026 plans before open enrollment starts.)
Plans on the exchange are separated into bronze, silver, gold and platinum categories. Bronze policies generally offer the highest deductibles and lowest premiums; platinum policies provide the most robust coverage in exchange for higher premiums; and silver and gold policies fall in the middle.
Platinum plans aren’t available in most states, so you’ll likely be choosing among the other options. If you have a silver or gold plan now, you may be able to reduce your premiums by switching to a bronze-level plan — but be prepared to pay more for the deductible and cost-sharing. Make sure you understand the types of care that aren’t subject to the deductible, such as a lot of preventive care.
One important benefit to buying an ACA marketplace policy rather than going without insurance: All marketplace plans cap your maximum out-of-pocket costs for the year. In 2026, the cap will be $10,600 for individual plans and $21,200 for family plans. That limit protects you against the risk of incurring massive bills should you end up needing expensive health care.
A helpful development from the One Big Beautiful Bill Act (OBBBA), which the president signed into law in July, is that all bronze-level plans will be eligible for health savings accounts starting in the 2026 plan year.
Make the most of an HSA to build up tax-free savings, which can help you pay out-of-pocket health care costs now or in the future. Contributing to an HSA also reduces your modified adjusted gross income, which could help you qualify for a premium subsidy.
If your income is less than 250% of the federal poverty level (which will be $39,125 for singles and $52,875 for couples for 2026 plans), you can also qualify for a special subsidy that reduces your deductible and co-payments if you buy a silver-level plan, which could be a better deal for you than a bronze plan.
Understand how the network works. Is it a PPO that lets you use both in-network doctors and out-of-network doctors, but with higher co-pays, or is it an HMO that covers only in-network doctors? Find out whether your providers will continue to be in-network. Also, check the plan’s formulary to see how it will cover your medications.
Fish-Parcham recommends getting assistance from a helper or navigator in your area; you can find one through HealthCare.gov or your state marketplace. The federal government has cut back on funding to support these helpers. In case they’re stretched thin, it’s best to get started early so you have time to work with them.
Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here.
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