Most Americans can expect to pay significantly more each month for health insurance next year, whether they get it through work, Obamacare or Medicare. In some cases, the premium increases may be the largest in decades and are driven by numerous economic pressures. But they won’t look the same for everyone. Some will pay more in the form of higher copays or deductibles.

“Healthcare costs are going up faster than they have in years, and open enrollment is when the healthcare affordability crisis is really going to hit home for people,” said Larry Levitt, executive vice president for health policy at KFF, a nonpartisan research group. “That’s true for whatever kind of insurance you have.”

Prices have shifted upward in every corner of daily life.

The rising healthcare costs stem in part from higher prices for hospital and other medical care, as well as the increased use of expensive prescription drugs — including GLP-1 weight loss medications — that are driving up spending for insurers and employers.

The pressures are unique to each type of coverage.

People who buy insurance through the Affordable Care Act marketplace, about 19 million adults, are set to face another year of steep premium increases after the enhanced federal subsidies expired last year.

On Thursday, the White House promised $500 rebate checks to an estimated 1 million ACA enrollees, alleging they were wrongly overcharged. It’s unclear where the money for the rebates would come from or whether the distribution would require approval from Congress, but experts say it’s unlikely to provide significant relief.

The $500 check “pales in comparison to the increased premiums that marketplace enrollees are facing due to the expiration of the enhanced subsidies,” said Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh.

Workers with job-based insurance may be asked to shoulder more of their employers’ rising health costs. And some Medicare beneficiaries could see changes to their prescription drug premiums after the Trump administration ended a temporary program that helped keep those premiums in check.

Here’s what to expect.

The Affordable Care Act

People who buy health insurance through the ACA are on track for a second straight year of double-digit premium increases.

Insurers who offer ACA plans are proposing a premium increase of about 15%, on average, for 2027, according to a KFF analysis of public filings from insurers across all 50 states and Washington, D.C. For 2026, insurers upped rates by an average of 20%.

An individual earning $80,000 a year who doesn’t qualify for standard ACA subsidies could see the cost of their bronze plan — the cheapest plan — rise by roughly $80 a month, adding almost $1,000 to their annual tab.

One of the biggest reasons insurers are hiking rates is that medical care is getting more expensive, Levitt said. Insurers have pointed to higher prices for hospital stays, doctor’s visits and prescription drugs, among other costs.

Insurers generally “have felt pressure to add coverage of GLP-1 drugs for weight loss, but they’re also seeing big, big increases in costs for those drugs,” Levitt said.

The ACA marketplace is also still adjusting to the expiration of the enhanced federal subsidies at the end of 2025. Those subsidies — first put in place during the pandemic — lowered monthly premiums for millions of people in the middle class. When they expired, people either paid significantly more for coverage in 2026 or downgraded their plans.

The expired subsidies also led ACA enrollment to fall by about 3 million.

Young adults — who are generally healthier and more likely to go without insurance when it becomes too expensive — accounted for a large portion of the enrollment decrease. That left insurers with a group of customers who, on average, need more medical care, Yaver said, which was also factored into insurers rates for 2027.

Job-based health insurance

Most Americans, about 165 million people, get health insurance through their jobs. Many of them may be feeling the price increases, too.

Employers expect the cost of providing health benefits to each worker to rise 8.2%, on average, in 2027 — the largest increase since 2003, according to a survey of more than 1,800 employers by Marsh, a benefits consulting group.

That doesn’t necessarily mean workers’ premiums will rise by 8.2%, said Dr. Kevin Schulman, a professor of medicine at the Stanford University School of Medicine who researches employer-based health insurance.

Employers typically subsidize a large portion of workers’ health coverage. But when healthcare costs rise too sharply, Schulman said, employers have several ways of passing some of the increase along to employees. They can charge workers more for their monthly premiums, raise deductibles or make other changes to their benefits.

Sometimes, they slow wage increases to offset the expense.

“Because the costs are going up, the employers are trying to reduce the rate of growth, and the easiest way to reduce the rate of growth of healthcare costs is to push more of the costs onto the employee,” Schulman said.

Many appear prepared to do just that.

The Marsh survey found about two-thirds of large employers — those with 500 or more employees — said they expected to increase how much employees contribute toward their premiums in 2027.

Others may shift costs in other ways, including waiving copays and deductibles for primary care visits while charging for other kinds of care, or keeping premiums the same while raising the deductible.

For workers, that makes it important to look beyond the premium during open enrollment, Schulman said. A plan that costs less or about the same each paycheck may come with a higher deductible or require people to pay more when they seek care.

Medicare

Monthly premiums are handled somewhat differently for the roughly 70 million people enrolled in Medicare.

People on Medicare generally have more than one premium to consider: typically, a premium for Part B, which covers doctor’s visits and other outpatient care; and, for 9 out of 10 enrollees, a separate premium for Part D, which covers prescription drugs.

Prescription drug costs are where enrollees may see the biggest changes, according to Yaver, of the University of Pittsburgh.

The Centers for Medicare & Medicaid Services projected in July that the baseline monthly cost for Part D coverage will rise about 6% in 2027, from $38.99 to $41.33.

What enrollees actually end up paying varies, depending on their income and their specific plan.

The increase stems from the Trump administration withdrawing its support for a temporary federal program that helped offset premium increases for Part D plans. The program began in 2025 as Medicare’s prescription drug benefit underwent major changes under the Inflation Reduction Act. Without it, enrollees would have seen their monthly premiums nearly double, according to a report from the Government Accountability Office.

The change will hurt seniors, Yaver said, noting that the program had reduced the average premium by 40% last year. People on Medicare are often retired and live on fixed incomes.

“Though seniors don’t change their Part D plans often, this year may be an exception, potentially resulting in seniors opting into lower-quality plans, leaving them less protected,” she said.

Enrollees will still have an annual out-of-pocket cap on prescription drugs. In 2027, the cap is $2,400.