As we wrap up 2025 and look ahead to 2026, it’s a good time to check in on what’s changing in employer-sponsored health insurance. Costs are shifting, employee expectations are evolving, and new coverage options are opening up. Here are three trends small business owners should have on their radar.
Costs Are Still Climbing
Let’s start with the big one: health care costs aren’t slowing down.
Analysts at PwC expect premiums to rise 8.5% in 2026, and a Business Group on Health survey shows employers bracing for around a 9% increase. For context, we’ve seen steady bumps every year — 4.6% in 2022, 7.5% in 2023, and about 8.2% in 2024.
What’s driving the increase? A mix of rising Rx costs, technology advancements, hospital consolidation, and overall higher utilization. It’s a lot — and employers across the country are feeling it.
Plan Designs Are Evolving
As costs go up, benefit designs are shifting too. The Mercer Survey of Health and Benefit Strategies is anticipating employer shifts in response to rising higher costs.
- Weight-lost meds and their impact on cost. A 2025 report from RAND says nearly 12 percent of Americans have used GLP-1 drugs for weight loss. That includes about one-fifth of women aged 50 to 64. Fourteen percent are interested in the injectable drugs. A survey by PwC in 2024 found 8-10% of adults taking GLP-1s – and another 30-35% interested in them. Those figures could climb in 2026 as the drugs are prescribed for uses beyond diabetes and weight loss. That includes cardiovascular health, kidney and liver conditions, and even Alzheimer’s and dementia. It could also change as two possible weight loss pills enter the market in 2026. One big unknown: how insurers will handle coverage as demand grows.
- Employee well-being is becoming essential: Businesses want to help employees cope with stress and mental health issues. Health plans may look to increase member access to digital and other stress management resources. That includes meditation apps and referrals to other in-person and online resources. Prioritizing well-being also gives you an edge in recruiting and retaining talent.
- Telehealth is here to stay: What began as a pandemic workaround is now a baseline expectation. McKinsey reports telehealth usage is still 38x higher than before COVID-19. Employees want the convenience, and plans continue to build around it.
- Alternative care is gaining traction: More employees are mixing traditional care with complementary therapies like acupuncture, meditation, and integrative medicine. The NIH reports usage jumped from 19% in 2002 to nearly 37% in 2022.
ICHRAs and HSAs Are Poised for Growth
A key part of the One Big Beautiful Bill (OBBB) aims to strengthen and expand Individual Coverage Health Reimbursement Arrangements (ICHRAs), soon to be known as CHOICE arrangements. These changes could make it easier for employers to fund individual on-exchange plans for their employees.
The bill also expands HSA eligibility and adds new tax credits for small businesses offering CHOICE HRA arrangements. For many employers, this could open up more flexible and cost-predictable ways to offer benefits.
Thinking About a Change? Talk with Your Broker
2026 could be the right time to adjust your benefits strategy. That could mean exploring new plan designs, evaluating networks, or reassessing what you’re contributing toward employee coverage.
A few reminders as you plan ahead:
- Ask your broker about any plan or network changes since your last renewal.
- Review your employee count to confirm whether you now qualify as an Applicable Large Employer (ALE) under ACA rules.
- And remember: With CaliforniaChoice, you can update your Defined Contribution each year. Stick with your current Fixed Percentage or Fixed Dollar Amount or adjust if it’s time for a new direction.