Every fall, millions of workers click through open enrollment in ten minutes, pick the same plan they had last year, and move on. This year that habit could cost real money. Employer surveys released over the summer point to the steepest jump in health benefit costs in more than two decades, and a growing share of that bill is landing in employees’ paychecks. If you got a raise this year, or you’re planning to ask for one, it’s worth understanding how your benefits choices can quietly shrink it.
What the 2027 numbers say
The forecasts are unusually consistent, and none of them are good news:
- Marsh’s National Survey of Employer-Sponsored Health Plans projects total health benefit cost per employee will rise 8.2% on average in 2027, the highest increase since 2003, even after employers make planned cuts. Without those changes, employers expect an 11% jump.
- Aon projects a 9.5% increase, pushing average employer costs above $19,000 per employee. It estimates the average worker will spend about $5,297 on health care in 2026, including $3,130 in payroll contributions and $2,167 out of pocket.
- Business Group on Health found large employers expect a median 9.2% cost trend, trimmed to 8% after plan design changes.
- The International Foundation of Employee Benefit Plans puts the median expected medical plan increase at 10%, driven by catastrophic claims, specialty drugs such as GLP-1s, and chronic conditions.
Why this hits your paycheck, not just your employer
For years, companies absorbed most premium growth and the share workers paid stayed fairly stable. That is changing. According to the KFF 2026 Employer Health Benefits Survey, average family premiums reached $28,303 this year, with workers contributing $7,471 of that. Among large firms, 44% responded to rising costs by increasing the share of premiums workers pay, and two thirds of employers with 5,000 or more employees did so. Marsh’s earlier research found about two thirds of large employers expect to raise employees’ premium share again in 2027, and 59% of employers plan cost-cutting changes such as higher deductibles.
Put that next to wages. KFF reports workers’ wages rose 3.7% over the past year while premiums rose 5%. If your raise was around 3% to 4% and your payroll deduction for health coverage climbs by double digits, a meaningful slice of that raise never reaches your bank account. On a family plan, an extra few hundred dollars a year in premiums can wipe out a good chunk of a modest raise before taxes even come into the picture.
Six moves to make before your enrollment window closes
1. Actually read the comparison sheet
Don’t let your current plan roll over by default. Employers are changing deductibles, networks, and drug coverage, and the plan that was the best deal last year may not be this year. Compare the full annual cost, meaning premiums plus the deductible and out-of-pocket maximum you’d realistically hit, not just the per-paycheck number.
2. Run your own numbers for a normal year and a bad year
Add up last year’s actual medical, prescription, and dental spending. Then price each plan two ways: a typical year for your household and a worst case where you hit the out-of-pocket maximum. A lower-premium, higher-deductible plan often wins in a healthy year, while a richer plan can protect you if someone in the family has a planned surgery, a baby on the way, or an ongoing condition.
3. Check your prescriptions and doctors by name
Specialty drugs are one of the biggest cost drivers this year, and some employers are tightening coverage or adding prior authorization. Look up each medication on the new formulary and confirm your doctors are still in network. A narrower network can look cheap until your specialist is no longer covered.
4. Use the tax-advantaged accounts you’re offered
If you pick a qualifying high-deductible plan, a health savings account lets you set aside pre-tax money for medical costs, and unused balances roll over year to year. A flexible spending account works on a use-it-or-lose-it basis, so fund it based on expenses you’re confident you’ll have. Check your employer’s materials for the current contribution limits and whether they add any seed money.
5. Don’t overlook the cheaper benefits
Many employers are adding or promoting lower-cost options such as telehealth, on-site or near-site clinics, and second-opinion services to rein in spending. These can save you real money on routine care, so learn what’s included before you need it.
6. Look at your whole offer, not just salary
Benefits are part of your pay. If your employer is shifting more cost onto workers, that belongs in your next compensation conversation. When you’re comparing a new job offer, ask for the benefits summary and premium rates up front, because a higher salary with an expensive plan can net out lower than a smaller salary with strong coverage. It’s a smart question to have ready when you’re preparing for an interview and reaching the offer stage.
How to bring benefits into a raise conversation
You don’t need to complain about premiums to make the point. Frame it around total compensation: if your take-home pay is shrinking because of higher deductions, a raise that merely matches inflation is effectively a pay cut. Bring numbers. Show your current premium, the new premium, and how much of your last raise it absorbs. Managers often have more flexibility on salary, bonuses, or one-time HSA contributions than on plan design, so ask about those levers specifically.
This isn’t a new tension. Even back in strong job markets, reports like this August labor report on pay keeping pace showed how quickly rising costs can eat into wage gains. The difference in 2027 is the size of the health cost jump.
The bottom line
Health costs are on track for their biggest increase since 2003, and more employers are passing part of that onto workers through higher premiums and deductibles. Take open enrollment seriously this year: compare total annual cost, check your drugs and doctors, use HSA or FSA accounts wisely, and count benefits as part of your pay. Thirty minutes of homework now can protect a raise you worked hard to earn.