With employee benefits moving in the opposite direction as many commercial lines, health care costs are rising at the fastest pace in more than a decade, driven by several converging factors, including:

A significant increase in health care utilization. Utilization rates for various health services have been rising over the past two years, driven by deferred care during COVID-19, easing provider labor constraints through AI-enabled efficiencies, and growing consumer adoption of virtual care — particularly in behavioral health — which expands access and convenience.
Accelerating health care spending growth. Following a brief post-pandemic slowdown, health care spending rebounded to the highest growth rate in more than two decades in 2023. The Centers for Medicare & Medicaid Services expects it to continue to outpace national inflation levels for the next decade, with health care expected to exceed 20% of U.S. GDP by the year 2033.
Inflation in medical goods, prescription drugs, and provider costs. Drug spending in the U.S. grew by $50 billion in 2024 at net manufacturer prices, up from $20 billion of growth in 2023. Advances in diagnostics and therapeutics, such as cancer treatments and weight-loss drugs, produce better outcomes, however, they typically cost more than the treatments they replace. The trend is expected to extend into the coming years, driven by growth in oncology, immunology, cardiovascular, obesity and diabetes drugs.
Uncertainty surrounding federal subsidies that impact more than 20 million people. Enhanced ACA premium tax credits improved affordability and increased enrollment, but expired in 2025, prompting congressional debate on their extension. Without extended subsidies, premiums could rise significantly, potentially leading to coverage losses, especially among middle-income and older adults, affecting market stability.

What advisors and employers should expect

For starters, expect double-digit increases. Based on the projections, 2026 will be the fourth consecutive year of elevated health benefit cost growth following a decade of moderate annual increases. For some groups, renewals can easily increase by as much as 30% or more. The benefits line remains the most acute challenge for 2026 and the area where strategic design and data-driven decision-making matter most. With that in mind, Advisors and other insurance professionals should consider offering three foundational strategies that employers can use in the face of skyrocketing costs.

Understand the data: A deep review of employee census, claims utilization, chronic conditions, prescription drug spend, and geographic variables provides a clearer picture of cost drivers. Without this baseline, plan design improvements are nearly impossible.
Redesign plan structures: Many employers with steep increases are tied to legacy plans that don't reflect current utilization or cost trends. Introducing reasonable deductibles, copays, and tiering, while still protecting employees, can significantly reduce renewal pressure. In many cases, a 30%–35% increase can be reduced to the low teens through thoughtful design.
Strengthen preventive care and wellness strategies: Studies show that more than a quarter of Americans are not up to date with their health screenings and immunizations. Preventive care helps avoid high-cost claims later and supports better long-term health outcomes. In fact, the CDC reports that if every person in the U.S. received the recommended clinical preventive care, 100,000 lives each year could be saved. Incentives for physicals, screenings, and ongoing care can help organizations keep a healthy workforce and save money in the long run.

The way forward: Preparation defines performance

Uncertainty will continue to shape the insurance landscape in 2026. The focus should be helping businesses make informed, strategic decisions in a market that continues to evolve. The years ahead bring challenges, but it also provides opportunities for organizations that prepare early and partner closely with risk advisors who understand the full landscape.

Instant Insights /

Pivot to data driven decision making as legacy health plans underperform

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