U.S. Health Benefit Costs Set to Soar in 2026 — Here’s What It Means for Workers and Employers
- willrothconsulting
- Sep 9, 2025
- 3 min read
U.S. employees should brace for a sharp rise in healthcare costs in 2026. Recent surveys and analysis suggest employer-sponsored health insurance premiums will jump 6 % to 7%, with some projections going as high as 9%. Plans purchased through the Affordable Care Act (ACA) marketplaces face even steeper hikes, up to 18%, with the threat of premium tax credits expiring looming over consumers.
What's Driving the Spike
Rising prices and utilization: Both the cost of healthcare services and usage rates are on the rise. New, advanced—and costly—treatments like cancer therapies and GLP-1 weight-loss drugs are major price drivers. Additionally, virtual care, especially for behavioral health, has increased utilization.
Disruption from inflation and consolidation: General inflation, rising wages for healthcare workers, and industry consolidation have boosted reimbursement costs for insurers.
Shift to employees: Over half of employer plan to shift more costs onto workers via higher deductibles, copayments, or employee contributions. That number rose from 48% in 2024 to 56% in 2025.
Marketplace risks: ACA marketplace premiums are expected to rise by a median of 18%. But if enhanced premium tax credits expire at the end of 2025, out-of-pocket costs could increase by up to 75%.
Employer Cost Trends: A Deeper Dive
Source | Projected Increase in 2026 | With Cost-Control Measures |
Mercer (Employer Plans) | 6.5% average (up to 9% without changes) | Included in estimate |
Business Group on Health | 9% median increase | Lowered to ~7.6% with redesign |
Segal (Plan Cost Projections) | Medical: ~9%; Prescription: double-digit | — |
What Employers Are Doing
Many employers are balancing cost increases against workforce well-being:
Benefit redesigns: Raising cost-sharing elements like deductibles and copays.
Targeted cost strategies: Focusing on high-cost claim management and evaluating program value.
Behavioral health: Two-thirds of large employers' plan to expand access, viewing it as both a support tool and long-term cost-control investment.
What Consumers Should Prepare For
Higher premiums and out-of-pocket expenses across the board.
Marketplace users hit hardest — especially if tax credits aren't extended.
Act now to compare plans during open enrollment. Use HSAs, prescription discounts, and shop for generics to soften the impact.
Plan ahead for 2026, because cost increases are already baked into employer and insurer forecasts.
Why This Matters
This may be the steepest rise in health coverage costs in over a decade, affecting both employees and employers deeply. Whether you’re reviewing your benefits package or simply budgeting, 2026 will demand a more proactive approach to healthcare planning.
Sources:
Sources
Reuters. US employee health insurance premiums to rise 6% next year, Mercer says. September 4, 2025. Link
Financial Times. Americans face biggest increase in health insurance costs in 15 years. September 2025. Link
Associated Press. Expect health insurance prices to rise next year, brokers and experts say. September 2025. Link
Mercer. Employers prepare for the highest health benefit cost increase in 15 years. August 2025. Link
Fierce Healthcare. Mercer survey: Employers anticipate highest health benefit cost increase in 15 years in 2026. August 2025. Link
Business Group on Health. 2026 Employer Health Care Strategy Survey. August 2025. Link
Segal. 2026 Health Plan Cost Trend Survey. 2025. Link
Investopedia. Why Your Health Insurance Expenses Might Soar in 2026 — and Steps to Take Now. September 2025. Link
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