Your Health Insurance Is Getting More Expensive Again. Here's One Way to Think About It.
You've probably noticed your health insurance costs going up. You're not imagining it.
Earlier this month, the health-policy nonprofit KFF released a preview of what marketplace insurers are asking for in 2027. Across 77 insurers in 16 states and DC, the median premium increase they're proposing is 14%. Most are asking for hikes between 10% and 20%. Twenty of them want more than 20%.
If those numbers hold, typical marketplace premiums will be up more than a third between 2025 and 2027.
That's on top of what already happened this year: when the enhanced ACA tax credits expired at the end of 2025, out-of-pocket premiums jumped 58% on average for many people, and deductibles went up by about $1,000 per person. People with household incomes above 400% of the federal poverty level (about $62,600 for a single person, and higher for larger households) lost those credits entirely and are now paying the full cost themselves.
I'm not writing this to scare you. Most of what's driving these numbers is structural — the underlying cost of medical care and prescription drugs is rising, labor costs are up, and the risk pool has thinned as healthier people opted out.
I'm writing this because there's a window coming up where you get to make a decision about what happens next.
What open enrollment actually is
Between November 1 and December 15, 2026, the ACA marketplace opens for 2027 coverage. Colorado runs its own marketplace (Connect for Health Colorado) and sometimes extends that deadline into mid-January, but the shape is the same: it's the one window in the year when most people can change how they buy insurance.
For most of us, we do the same thing every year — click "renew," see the new premium, sigh, and pay it.
There's another way to structure your primary care that changes what you're actually buying with those premium dollars.
The DpC + high-deductible plan idea
Direct primary care ("DpC") is a membership model — you pay your primary care doctor a flat monthly fee (at B2 Direct Care, that's $75 to $140 depending on the tier), and in exchange you get unlimited access: real visits, actual conversations, easy messaging, no copays, no insurance middleman on the primary care side.
The pairing that works well: a DpC membership plus a high-deductible health plan (HDHP) for everything else. Your DpC covers your day-to-day — the sinus infection, the rash, the "I've been feeling off lately," the routine chronic-condition management. Your HDHP is there for the hospitalization, the surgery, the cancer, the emergency.
What changes is what your monthly premium is for. Instead of paying a premium that mostly funds a system where a rushed visit is the default, you're paying a lower premium for catastrophic coverage — and a small, predictable membership fee for a doctor who actually has time for you.
For a middle-income household above 400% FPL — the group hit hardest by the 2026 subsidy expiration — the math on this pairing has been getting more compelling every year.
This isn't a pitch
I want to be honest about what this is and isn't.
It isn't a silver bullet. DpC doesn't cover specialist visits, hospitalizations, or emergencies — you need the HDHP for those. And DpC isn't the right fit for everyone: if you have very complex or highly specialized care needs, or if you're on Medicare, the math looks different.
It's also not free. You're still paying for both — just paying for different things, from different pockets.
But if you're already looking at your 2027 insurance premium and wondering whether there's a smarter way to structure what you're spending on your health, this is worth thinking through carefully before November.
If you want to have that conversation — no obligation, no hard sell — you know where to find me.
Data cited in this post is from the KFF news release "In Preliminary Rate Filings, ACA Marketplace Insurers Largely Propose Double-Digit Premium Increase For 2027" (published July 8, 2026). Full analysis at kff.org and the Peterson-KFF Health System Tracker.
Brian Bost, MD, MPH, is a Med-Peds physician and Physician-Founder of B2 Health Solutions and its clinical practice, B2 Direct Care — a hospitalist-informed, solo DpC micropractice in Denver, Colorado.
