Open enrollment for Marketplace health coverage opens this Sunday, November 1. The insurers selling those plans asked for a median 15% increase for 2027. Last year the median increase that actually took effect was 20%.

If you get coverage through work instead, your number landed last Thursday. KFF's 2026 Employer Health Benefits Survey puts the average family premium at $28,303, up 5%. The part workers pay rose 9%, to $7,471. Wages rose 3.7% over the same period.

Two different markets, two different numbers, one direction. A week before an election in which 69% of voters call health care a top issue, here is what each number actually says, and what it doesn't.

KFF's analysis of 276 insurers with public filings across all 50 states and D.C. found a median proposed increase of 15% for 2027. That is lower than last year's 18% request, which regulators finalized at 20%, but it is still the second-highest requested change since 2018, and the second straight year of double-digit increases.

The median hides the range. healthinsurance.org, which tracks state approvals and updated its tally October 19, has final rates in for about half the states and a weighted average that also lands near 15%. At the top: Arizona finalized at 27.9%, Alabama proposed 25%, New Mexico finalized at 24.4%. At the bottom: Vermont at 3%, Iowa at 5.7%, and New York, where regulators approved 6% against a 20.6% request.

New York is the clearest reminder that a proposed rate is a request, not a bill. The number on your renewal notice is the one that counts.

KFF names rising health care prices as the primary driver, alongside higher costs for services, general inflation and labor shortages. Two factors are specific to this market: the enhanced premium tax credits expired at the end of 2025, and the people who stayed enrolled after that were, on average, sicker. Insurers price for the pool they expect to have.

One thing the 15% is not: it is not what most enrollees will pay. The headline is the increase before subsidies. The original ACA subsidies are still in place and still cap premiums as a share of income for households under four times the poverty line. Above that line the cliff is back, and the full increase is yours.

KFF surveyed 1,937 employers with at least 10 workers. Family premiums averaged $28,303, up $1,310. Workers contributed $7,471 of that, up $621. Employers paid the remaining $20,833. Single coverage averaged $9,804, of which workers paid $1,672.

Do the division and the split is sharper than the percentages suggest. Workers pay about 26% of the total family premium. But of this year's $1,310 increase, workers absorbed $621, or 47%. Employers passed through nearly half of the increase to people who pay about a quarter of the bill. That is our math from KFF's published figures.

Where you work matters as much as what you earn. Workers at smaller firms pay $9,687 a year for family coverage, 37% of the premium. At larger firms it is $6,840, or 25%. STAT notes the 9% worker increase follows years of 6% and 7%, and that employers had been absorbing most of the cost until now.

The Marketplace filings say it directly: the price of care is the main driver. Employer plans buy from the same hospitals and the same drug makers, so when the price of care rises, both markets rise. The difference is who sits between you and the increase. On the Marketplace it is a state regulator and a subsidy formula. At work it is your employer's decision about how much to pass along, and this year they passed along more.

Voters have noticed. In KFF's latest tracking poll, 82% of voters say health care costs are very or extremely important for candidates to talk about, second only to the cost of living at 90%. AP-NORC finds 69% name health care a top issue, behind the economy at 85% and cost of living at 84%.

If you buy on the Marketplace and get a subsidy: your net premium depends on the benchmark plan in your county, not the state headline. Do not auto-renew. Compare plans between Sunday and your state's deadline, and read every notice from your insurer. If your carrier is leaving your market, picking a new plan by December 31 gets you coverage January 1.

If you buy on the Marketplace and earn more than four times the poverty line: the full increase is yours. Compare total expected cost, premium plus deductible, across metal tiers rather than premium alone. A plan with a lower premium and a higher deductible can cost less or more depending on how much care you use.

If you get coverage through work: your open enrollment is probably running now too. The 9% is an average. Ask HR two questions: did the premium change, and did the deductible change? Both can move in the same year.

If you work at a small company: you are already paying $2,800 a year more than a worker at a large one for the same family coverage, by KFF's averages. That gap is the one to ask about at your next review.

If you run a small business: you are the one deciding the split this year. The large-employer average is a 25% worker share. If yours is near 37%, that is a retention number, not just a benefits number.

Proposed is not final. Half the states had not finalized 2027 rates when healthinsurance.org last updated, and New York cut a 20.6% request to 6%. The finished median could land a point or two below 15%.

The employer survey is a national average. It cannot tell you what your plan did. Some employers held the premium and raised the deductible, which the premium figure does not show.

One year is not a trend. The 9% worker increase follows 6% and 7%. It could be a reset after years of employers absorbing costs, or the start of a steeper pass-through. We will know when the 2027 survey lands.

Claim: When KFF publishes its tally of finalized 2027 Marketplace rate changes, the median across insurers will land between 13% and 17%.

Stated confidence: 70% · Verification date: November 30, 2026 · Status: OPEN

What would make us wrong: regulators in several large states cutting requests the way New York did, pulling the finalized median under 13%.

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