Large employers are asking workers to shoulder more of their health insurance bill, and the trend could accelerate as forecasts point to near-double-digit premium increases in 2027, according to KFF’s 2026 Employer Health Benefits Survey, released this week.
Why it matters: For decades, the share of premiums paid by workers barely moved. A sustained shift puts affordability, and benefits as a retention tool, back on the agenda for HR leaders.
Costs continue to increase: Average family premiums hit $28,303 this year, up 5% and ahead of wage growth (3.7%) and inflation (2.7%). Individual coverage averaged $9,804. Workers paid an average of $6,840 toward family coverage at large firms, up 19% from 2025.
Employers are choosing to push costs to employees: The KFF report noted that employers generally have three primary avenues for responding to higher health costs: increasing workers’ premiums, changing provider networks, or modifying benefits. The survey data showed that employers are overwhelmingly choosing the first option:
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44% of large firms raised workers’ premium share in response to projected cost increases, including 66% of employers with 5,000 or more workers.
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21% raised deductibles or engaged in other cost sharing; 16% switched insurers or administrators; and 10% added prior authorization requirements.
GLP-1s remain a pressure point. A third of firms with 5,000 or more workers cover the drugs for weight loss, and 61% of those say coverage has had a significant impact on prescription drug spending. A majority (59%) now require a dietitian, case manager or lifestyle program as a condition of coverage, and 12% of large firms without coverage dropped it in the past year.
Data gaps persist. Only 14% of large employers strongly agree they can get enough information on the prices their plans pay in-network providers. A quarter say they can’t identify where enrollees have gaps in care.
Behavioral health access lags. Just 32% of large firms describe their mental health and substance use networks as very broad, compared with 64% for their networks overall.
What CHROs should consider:
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Contribution design: With two-thirds of the largest employers already shifting premium costs, wage-banded contributions can shield lower-wage workers, who are already less likely to enroll in employer coverage.
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Vendor leverage: 85% of covered workers at large firms are in self-funded plans. Build claims and pricing data access into renewals, then use it to judge network and PBM performance.
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GLP-1 strategy: Expect further tightening. Cheaper direct-to-consumer options may let employers fund access through account contributions rather than plan coverage.
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Open enrollment messaging: Cost increases landing this season will be felt in paychecks. A clear account of total plan value can soften the retention impact.
