Anne Cornwell considered two drastic strategies in her quest to get affordable health insurance premiums last year for herself and her retired husband.

One was divorce. Another was taking a 30 percent pay cut. She chose the latter.

That maneuver slashed the premiums for the couple, who live in Chattanooga, Tenn., from exorbitant to economical. Instead of $2,100 a month — the amount she had been quoted for 2017 — their premiums are just $87 monthly, her lost income more than compensated for by qualifying for insurance subsides.

Ms. Cornwell’s solution — which was completely legal — reflects how a growing number of Americans are incorporating strategies for affording health insurance into financial planning, adapting money and salaries to yield better choices — much as people place money into 401(k) plans to save for retirement while reducing their taxable income.

Her solution and others like it may resonate with other Americans who are now buying 2018 health plans on the individual market, through the Affordable Care Act’s online marketplaces or outside them. Double-digit premium price increases are forecast for many plans, a trend that has accelerated since President Trump announced that his administration would not pay some A.C.A. subsidies to insurers.