2026 Employer Health Benefits Survey

This is the 28th annual Employer Health Benefits Survey. As in years past, the survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, and employer practices. This year we asked employers detailed questions about satisfaction with their health plans; coverage for GLP-1 agonists and IVF; actions taken in response to projected cost increases; and firms’ ability to obtain information about health care costs and utilization. The 2026 survey includes 1,937 interviews with non-federal public and private firms.

Annual premiums for employer-sponsored family health coverage reached $28,303 this year, 5% higher than in 2025. On average, covered workers contributed $7,471 toward the cost of family coverage. The average deductible among covered workers in a plan with a general annual deductible was $1,955 for single coverage.

Survey results are published as a full report with downloadable tables on a variety of topics, as well as an abbreviated summary of findings.

Key Resources

• This interactive graphing tool allows users to look at changes in premiums and worker contributions for covered workers at different types of firms over time: Premiums and Worker Contributions Among Workers Covered by Employer-Sponsored Coverage, 1999-2026.

• Key slides from the 2026 Employer Health Benefits Survey are here.

• Employer Health Benefits Surveys from 1998–2025 are available here. Please note that historic survey reports have not been revised with methodological changes.

Contact Us

For questions about the Employer Health Benefits Survey, please visit Contact Us and choose “TOPIC: Health Costs.”

Researchers may request a public use dataset by completing a data use agreement (available here).

Employer-sponsored insurance covers almost 157 million people under age 65¹. To provide a current snapshot of employer-sponsored health benefits, KFF conducts an annual survey of private and non-federal public employers with ten or more workers. This is the 28th Employer Health Benefits Survey (EHBS), reflecting employer-sponsored health benefits in 2026.

HEALTH INSURANCE PREMIUMS AND WORKER CONTRIBUTIONS

The average annual premiums for employer-sponsored health insurance in 2026 are $9,804 for single coverage and $28,303 for family coverage. Over the last year, the average single premium increased by 5%, and the average family premium increased by 5%. By comparison, workers’ wages increased by 3.7%, while inflation was 2.7%.^{2 3} Over the last five years, the average premium for family coverage has increased by 28%, compared with a 26.9% increase in workers’ wages and inflation of 24.4% [Figure A, Figure B].

The average premium for smaller firms (firms with 10 to 199 workers) is similar to the average premium at larger firms for covered workers with single coverage ($9,593 and $9,865) but lower for covered workers with family coverage ($27,288 vs. $28,592) [Figure C]. The average premiums for covered workers in HSA-qualified plans are lower than the overall average premiums for both single coverage ($8,989) and family coverage ($26,450). The average premiums for covered workers enrolled in PPOs are higher than the overall average premiums for both single ($10,272) and family coverage ($29,522).

Premiums also vary with firm characteristics. Average premiums for covered workers are relatively high in the Northeast for both single coverage ($10,806) and for family coverage ($31,378) and are relatively low in the South for both single coverage ($9,272) and for family coverage ($26,702). The average premiums for covered workers at firms with relatively large shares of higher-wage workers (where at least 35% of workers earn $82,000 a year or more) are higher than the average premiums for covered workers at firms with smaller shares of higher-wage workers for family ($29,139 vs. $27,664) coverage. The average premium for family coverage for covered workers at firms with a relatively large share of older workers (where at least 35% of the workers are age 50 or older) is higher than the average premium for covered workers at firms with a smaller share of older workers ($28,689 vs. $27,889). The average premium for single coverage for covered workers in private, for-profit firms is relatively low ($9,291); the average premiums for covered workers in private, not-for-profit firms are relatively high for both single ($10,927) and family ($30,783) coverage [Figure C].

Figure A: Average Annual Worker and Employer Premium Contributions for Family Coverage, 2016, 2021, and 2026

Figure B: Average Annual Increases in Premiums for Family Coverage Compared to Other Indicators, 2016-2026

Figure C: Average Annual Worker Contributions for Family Coverage, by Firm Size, 2025-2026

Most covered workers contribute to the cost of the premium directly. On average, covered workers contribute 18% of the premium for single coverage and 27% of the premium for family coverage, similar to the percentages contributed in 2025. The average contribution rates for single coverage are similar for covered workers in smaller firms and larger firms (16% vs. 18%) but the average contribution rate for family coverage is much higher for covered workers in smaller firms than for those in larger firms (37% vs. 25%). On average, covered workers at private, for-profit firms have a relatively high premium contribution rate for single coverage (20%). The average contribution rate for family coverage is higher for covered workers in firms with relatively large shares of lower-wage workers (where at least 35% earn $38,000 or less annually) than those in firms with smaller shares of lower-wage workers (31% vs. 27%).

Twenty-nine percent of covered workers at smaller firms are enrolled in a plan where the employer pays the entire premium for single coverage, compared with only 5% of covered workers at larger firms. In contrast, 32% of covered workers at smaller firms are in a plan where they must contribute more than half of the premium for family coverage, compared to 6% of covered workers at larger firms [Figure D].

The average annual contribution amounts for covered workers are $1,672 for single coverage and $7,471 for family coverage, both higher than last year. The average contribution amount for family coverage for covered workers at smaller firms ($9,687) is higher than the amount for covered workers at larger firms ($6,840) [Figure C]. Thirteen percent of covered workers, including 31% of covered workers at smaller firms, are in a plan with a worker contribution of $12,000 or more for family coverage. The average contribution amount for family coverage for covered workers enrolled in HSA-qualified plans is lower than the overall average contribution amount for covered workers ($6,211 vs. $7,471).

REACTIONS TO HIGHER PROJECTED COSTS

Employers have multiple avenues by which they can respond to higher health care costs. These include increasing the amount of the premium that workers pay for coverage, changing provider networks, or modifying benefits. The cost of health benefits was projected to increase substantially in 2026, and early projections for 2027 point to further cost growth. Firms offering health benefits were asked whether they took certain actions in response to projected cost increases for their plan with the largest enrollment.

The most commonly reported employer action by large firms was increasing the share of the premium that workers contribute toward their coverage (44%). Other actions by large firms included increasing deductibles or other cost sharing for most services (21%), changing insurers or plan administrators (16%), increasing cost sharing for specific services (14%), adding utilization management requirements, such as prior authorization, for some services (10%), switching to a plan with a tiered or narrower provider network (7%), and reducing or tightening eligibility for certain benefits (4%) [Figure D].

Large firms offering health benefits were generally more likely to report taking actions in response to projected cost increases compared to firms overall. Among all firms, 18% increased the share of premiums paid by workers, and 4% increased deductibles or other cost sharing for most services.

Figure D: Among Large Firms Offering Health Benefits, Firm Responses to Higher Projected Health Plan Costs, 2026

PLAN ENROLLMENT

Health plans are often categorized into plan types based on their coverage of out-of-network services and whether they require primary care referrals. This survey classifies plans into five plan types. Beginning in 2026, this survey changed how it classifies high-deductible health plans associated with a Health Reimbursement Arrangement (HRA). In previous years, these plans were grouped with HSA-qualified plans in a broader HDHP/SO (high-deductible health plan with a savings option) category. HRA plans are now classified as PPOs, POS plans, or HMOs based on their plan characteristics. HSA-qualified plans are now reported as a separate plan type.

PPOs continue to be the most common plan type in 2026. Fifty percent of covered workers are enrolled in a PPO, 29% are enrolled in an HSA-qualified plan, 12% are enrolled in an HMO, 8% are enrolled in a POS plan, and less than one percent are enrolled in a conventional (also known as an indemnity) plan.

SELF-FUNDING

Many firms, particularly larger firms, have self-funded health plans, which means that they pay for health services for enrollees directly from their own funds, rather than through the purchase of health insurance. Seventy-one percent of covered workers, including 25% of covered workers at smaller firms and 85% at larger firms, are enrolled in plans that are self-funded.

Thirty-eight percent of covered workers in smaller firms are covered by a level-funded plan, similar to the percentage in 2025. Level-funded arrangements combine a relatively small self-funded component with stop-loss insurance, which limits the employer’s liability and transfers a substantial share of risk to insurers. These plans have the potential to meaningfully affect competition in the small group market because, unlike insured plans, they may use health status in rating and underwriting. Level-funded plans are also not required to provide all of the essential health benefits that are mandatory for insured plans.

EMPLOYEE COST SHARING

Eighty-eight percent of workers with single coverage have a general annual deductible that must be met before most services are paid for by the plan, the same as the percentage last year (88%).

Among covered workers in a plan with a general annual deductible in 2026, the average deductible amount is $1,955, similar to the amount last year. The average deductible for covered workers at smaller firms ($2,624) is higher than the average deductible at larger firms ($1,772). For covered workers in a plan with a general annual deductible, the average deductible for single coverage has increased 18% over the last five years and 34% over the last 10 years.

Thirty-eight percent of covered workers in 2026 are in a plan with a general annual deductible of $2,000 or more for single coverage, similar to the percentage (34%) last year. Over half (55%) of covered workers in smaller firms are in such a plan, compared with 33% of covered workers in larger firms [Figure E]. The share of covered workers in a plan with a general annual deductible of $2,000 or more for single coverage has increased 31% over the last five years and 63% over the last ten years.

Figure E: Percentage of Covered Workers Enrolled in a Plan With a General Annual Deductible of $2,000 or More for Single Coverage, by Firm Size, 2009-2026

Some workers in health plans with high deductibles also receive contributions to savings accounts from their employers, which can be used to reduce cost sharing liability. Among covered workers in an HSA-qualified health plan, 3% receive an account contribution for single coverage that is greater than or equal to their deductible amount, and an additional 10% of covered workers in an HSA-qualified plan receive account contributions that, if applied to their deductible, would reduce their personal annual liability to less than $1,000. Some workers also have access to funds in health reimbursement arrangements (HRAs) established by their employers, which can often be used for cost sharing. As of 2026, this survey no longer collects the amounts contributed to HRAs, so the impacts of these contributions on worker cost sharing cannot be calculated. In 2026, 8% of covered workers are in a plan that is offered along with a health reimbursement arrangement. Among these covered workers, 61% are in a plan where the HRA contribution can be used to reduce plan cost sharing liability.

In addition to any general annual deductible they may have, most covered workers also pay a portion of the cost of care when they use health care services, typically a copayment (a fixed dollar amount) or coinsurance (a percentage of the covered amount). For physician office visits, the average copayment for a primary care visit is $27 and the average copayment for a visit to a specialist is $46. Each of these amounts is similar to the amount last year. The average coinsurance rate is 20% for both primary care and specialist visits, similar to the percentages last year.

When admitted to the hospital, 60% of covered workers have a coinsurance requirement, 11% have a copayment, and 10% have both. The average coinsurance rate for a hospital admission is 20% and the average copayment amount is $317. The cost sharing requirements for outpatient surgery follow a similar pattern to those for hospital admissions, although the average copayment amount for outpatient surgery is lower ($205).

Virtually all covered workers are in plans with an annual limit on in-network cost sharing (called an out-of-pocket maximum) for single coverage, although these limits vary significantly. Among covered workers in plans with an out-of-pocket maximum for single coverage, 14% are in a plan with an out-of-pocket limit of $2,000 or less, while 24% are in a plan with a limit above $6,000.

AVAILABILITY OF EMPLOYER-SPONSORED COVERAGE

In 2026, 67% of firms with 10 or more workers offer health benefits, higher than the percentage last year (61%) but similar to the percentage two years ago (65%) and lower than the percentage (73%) five years ago.

Because most firms are small, the overall offer rate can fluctuate over time, as estimates for smaller firms tend to vary considerably from year to year. Most workers, however, work for larger firms, where offer rates are higher and much more stable. Among firms with 200 or more workers, 98% of firms with 200 to 999 workers and over 99% of firms with 1,000 or more workers offer health benefits to at least some of their workers. Overall, 92% of workers are employed by a firm that offers health benefits to at least some of its workers, lower than the percentage (94%) five years ago.

Inducements Not to Enroll. Among firms with ten or more employees that offer health benefits, 8% provide additional compensation or benefits to employees if they enroll in a spouse’s plan, and 7% provide additional compensation or benefits to employees if they do not participate in the firm’s health benefits.

Even in firms offering health benefits, many workers are not covered by health benefits provided by the firm. Some are not eligible to enroll (due to factors such as waiting periods or part-time/temporary work status), while others who are eligible choose not to enroll (they may feel the coverage is too expensive, or they may be covered through another source). Additionally, some firms provide incentives for workers or spouses of workers not to enroll in their plans, or to enroll in a spouse’s plan. On average, at firms that offer coverage, 80% of workers are eligible. Among eligible workers, 74% take up the firm’s offer. Overall, 59% of workers at firms that offer health benefits are enrolled in that coverage. All of these percentages are similar to the percentages in 2025.

The coverage rate varies with workforce characteristics. Among workers at firms offering health benefits, those working for firms with a relatively large share of younger workers are less likely to be covered by their own firm than workers in firms with a smaller share of younger workers (44% vs. 62%) and those working at firms with a relatively large share of lower-wage workers are less likely to be covered by their own firm than workers at firms with a smaller share of lower-wage workers (47% vs. 61%)⁴. Workers at public organizations are more likely to be covered by their own employer (72%) than workers at private for-profit firms (57%), or private not-for-profit firms (57%).

Across firms that offer health benefits and firms that do not, 55% of workers are covered by a health plan offered by their employer, the same percentage as last year.

GLP-1 DRUG COVERAGE FOR WEIGHT LOSS

GLP-1 (glucagon-like peptide-1) agonists, used to help control blood sugar levels in people with type 2 diabetes, have also been shown to be effective at helping people lose weight. Health plans generally have covered these medications when prescribed for people with diabetes, but there is now widespread interest in their use for people who have a clinical need to lose weight. Although the cost of these drugs has been decreasing, the large number of people who may benefit from them, combined with the potential of long-term maintenance usage, has raised questions about their impact on plan costs. The increasing availability of direct-to-consumer programs for these medications, often at relatively low costs, has also provided options for employers to potentially fund access to these medications through account contributions.

Among firms that offer health benefits with 200 or more workers, 16% of firms with 200 to 999 workers, 29% of firms with 1,000 to 4,999 workers, and 33% of firms with 5,000 or more workers cover GLP-1 agonists when used primarily for weight loss in 2026. The overall percentage of firms with 200 or more workers that cover GLP-1 agonists for weight loss (18%) is similar to the percentage last year (19%) and two years ago [Figure F]. Forty percent of firms that cover these medications for weight loss, including 59% of firms with 5,000 or more workers, require enrollees to meet with a dietitian, case manager, or therapist, or participate in a lifestyle program in order for the drug to be covered, similar to the percentage (34%) last year.

Among firms with 200 or more workers that cover GLP-1 agonists for weight loss in their plan with the largest enrollment, 29% say that covering these medications has had a “significant” impact on their plan’s prescription drug spending, 27% say that the impact on spending has been “moderate”, 23% say that the impact on spending has been “minor”, 10% say that there has been no impact on spending, and 11% say they do not know. The share of these firms saying that covering GLP-1 agonists for weight loss has had a significant impact on prescription drug spending increases with firm size, ranging from 21% of firms with 200 to 999 workers to 61% of firms with 5,000 or more workers.

Among firms with 200 or more workers that offer health benefits and do not cover GLP-1 agonists for weight loss, only 1% say that they are “very likely” to begin covering GLP-1 agonists for weight loss within the next 12 months, 13% say that they are “somewhat likely,” 79% say that they are “not likely,” and 7% do not know the answer to the question. Twelve percent of these firms say that they have stopped covering these medications for weight loss within the last 12 months.

Figure F: Percentage of Large Firms Whose Largest Plan Includes Coverage for GLP-1 Agonists When Used Primarily for Weight Loss, by Firm Size, 2024-2026

PRESCRIPTION DRUG POLICY

Some employers are pursuing strategies outside of their health plan or pharmacy benefit manager (PBM) to help workers obtain lower-cost prescription drugs. Firms with 50 or more workers offering prescription drug coverage were asked about several of these approaches. Thirty-three percent of these employers offer enrollees access to lower-cost mail-order generic drugs through a third-party vendor, such as Mark Cuban Cost Plus, SingleCare, or GoodRx.

Eleven percent of these employers limit coverage for certain prescriptions exclusively to mail-order pharmacies. In these cases, the plan does not pay for those prescriptions if an enrollee uses an in-person pharmacy.

A smaller share of employers participate in an international prescription drug purchasing service, such as ScriptSourcing or CanaRx, which provides access to discounted maintenance medications purchased outside the United States (rg).

IN VITRO FERTILIZATION

Improving affordable access to in vitro fertilization (IVF) and other assisted reproductive services has been a topic of public debate in recent years, particularly after President Trump campaigned on the idea of providing access to these services at no cost. Among firms with 200 or more workers, 24% of firms with 200 to 999 workers, 38% of firms with 1,000 to 4,999 workers, and 47% of firms with 5,000 or more workers provide coverage for IVF services in their plan with largest enrollment, either through their plan or through a third-party vendor. Firms with 200 to 999 workers are more likely than larger firms to say that they do not know (27% vs. 9%).

PRIOR AUTHORIZATION OF SERVICES

Health plan management practices, particularly prior authorization, have received considerable recent attention. Firms with 200 or more workers offering health benefits were asked about recent changes in the use of prior authorization in their plan with the largest enrollment. Seven percent of these firms say that the number of services subject to prior authorization is “higher” than it was last year, 2% say that it is “lower” than last year, 70% say that it is “about the same” as last year, and 21% say they do not know. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that the number of services subject to prior authorization is “higher” than it was last year (12% vs. 6%). Among firms that say that the number of services subject to prior authorization is “higher” than it was last year, 48% say that prior authorization was added to additional services to help control overall cost growth in the plan.

ABILITY OF EMPLOYERS TO OBTAIN INFORMATION ABOUT THE COST AND USE OF SERVICES

Firms that offer health benefits with 200 or more workers were asked about their ability to obtain information about the cost and use of medical services (other than prescription drugs) in their plan with the largest enrollment. This information might include summary information from an insurer or plan administrator or more specific data reports. Specifically, firms were asked how strongly they agree or disagree that they are able to obtain enough information to understand each of these areas [Figure G]:

• Service use by type of medical provider. Sixteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the service use of plan enrollees by type of medical provider, 54% of the firms “agree” that they are able to get this information, 12% “disagree” that they are able to get this information, 3% “strongly disagree” that they are able to get this information, and 16% say that they do not know. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand the service use of plan enrollees by type of medical provider (25% vs. 14%).
• The medical conditions of plan enrollees, including those that contribute the most to plan cost. Twenty percent of these firms “strongly agree” that they are able to get sufficient information to understand the medical conditions of plan enrollees, including those that contribute the most to plan cost, 52% of the firms “agree” that they are able to get this information, 11% “disagree” that they are able to get this information, 4% “strongly disagree” that they are able to get this information, and 14% say they do not know. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand the medical conditions of plan enrollees (28% vs. 18%).
• The prevalence of chronic conditions among plan enrollees. Eighteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the prevalence of chronic conditions among plan enrollees, 52% of the firms “agree” that they are able to get this information, 12% “disagree” that they were able to get this information, 2% “strongly disagree” that they are able to get this information, and 15% say they do not know. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand the prevalence of chronic conditions among plan enrollees (27% vs. 16%).
• The prices the plan pays to in-network providers, and how those prices compare to other providers. Fourteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the prices the plan pays to in-network providers and how those prices compare to other providers, 46% of the firms “agree” that they are able to get this information, 19% “disagree” that they are able to get this information, 4% “strongly disagree” that they are able to get this information, and 17% say they do not know.
• Areas where enrollees may have unmet needs or gaps in care. Ten percent of these firms “strongly agree” that are able to get sufficient information to understand areas of unmet needs or gaps in care, 45% of the firms “agree” that they are able to get this information, 20% “disagree” that they are able to get this information, 5% “strongly disagree” that they are able to get this information, and 19% say they do not know.

Figure G: Percentage of Large Firms That Agree They Can Obtain Information On the Cost and Use of Various Medical Services, 2026

PROVIDER NETWORKS

Employers that offer health benefits were asked to characterize the breadth of the provider network in their plan with the largest enrollment, for all providers as well as specifically for services for mental health and substance use conditions.

Fifty-one percent of firms characterize the network in their plan with the largest enrollment as “very broad,” 38% say it is “somewhat broad,” and 7% say it is “somewhat narrow” or “very narrow.” Firms with 200 or more employees are more likely than smaller firms to characterize the provider network in their plan with the largest enrollment as “very broad” (64% vs. 50%).

Twenty-two percent of firms characterize the network in their plan with the largest enrollment as “very broad” for mental health and substance use condition services, 42% say it is “somewhat broad” for these services, and 15% say it is “somewhat narrow” or “very narrow”. Firms with 200 or more employees are more likely than smaller firms to characterize the provider network in their plan with the largest enrollment as “very broad” for mental health and substance use condition services (32% vs. 21%).

Employers that offer health benefits are less likely to characterize the network in their plan with the largest enrollment as “very broad” for mental health and substance use condition services than for medical services overall. This is true for small firms (10 to 199 employees) (21% vs. 50%) and larger firms (32% vs. 64%).

TREATMENT OPTIONS FOR SUBSTANCE USE CONDITIONS

Firms with 200 or more workers offering health benefits were asked whether they had made efforts in the last two years to expand the availability of services to treat substance use conditions. Among these firms, 34% say that they have added new virtual providers within the last two years, and 20% say that they have added new providers or facilities for in-person care.

EMPLOYER SATISFACTION WITH HEALTH PLANS

Firms that offer health benefits were asked about their satisfaction with several aspects of the health plans they offer [Figure H]:

• Cost of care: Employers have low levels of satisfaction with the overall cost of care for their workers. Only 17% of firms say they are “very satisfied” with the overall cost of care, while 51% say they are “satisfied.” In contrast, 29% say they are “dissatisfied” or “very dissatisfied”.
• Quality of network providers: Firms report higher levels of satisfaction with the quality of providers participating in their plan networks. Forty-two percent of firms say they are “very satisfied”, and 53% say they are “satisfied.” Only 2% say they are “dissatisfied” or “very dissatisfied” with the quality of network providers.
• Timely access to services: Thirty-three percent of firms say they are “very satisfied” with timely access to services in the health plans they offer, and 58% say they are “satisfied.” Only 5% say they are “dissatisfied” or “very dissatisfied.”
• Access to behavioral health care: Twenty-six percent of firms say they are “very satisfied” with access to behavioral health care in the health plans they offer, and 56% say they are “satisfied.” Only 7% say they are “dissatisfied” or “very dissatisfied.”
• Employee access to information about the cost and quality of treatment options: Twenty-four percent of firms say they are “very satisfied” with workers’ ability to obtain information about the cost and quality of treatment options before receiving care, and 60% say they are “satisfied.” 8% say they are “dissatisfied” or “very dissatisfied.”

Figure H: Firms’ Level of Satisfaction With Aspects of Their Health Plans, 2026

DISCUSSION

Despite early projections pointing toward higher costs in 2026, average premiums increased at a relatively modest pace. Over the last five years, family health insurance premiums have grown at about the same rate as general inflation and workers’ wages (28% vs 24.4% and 26.9%).

Heading into 2027, forecasts are again projecting premium increases approaching double digits. How and when higher health care spending projections translates into higher premiums remains to be seen, but employers may face increasing pressure to maintain the affordability of their plans if steep increases materialize. In 2026, 18% of employers, including 66% of employers with 5,000 or more employees, said they increased the share of premiums paid by workers in response to anticipated premium increases. After decades in which the average share of the premium paid by workers has remained relatively stable, a shift toward higher worker contributions could raise new affordability concerns.

Much of the policy response to rising health care costs has focused on increasing price transparency, strengthening employers’ negotiating position with providers, and giving purchasers more information to design efficient provider networks. Many employers agree or strongly agree that they have the data they need to understand key elements of their health plans, and most employers that have sought access to their claims data reported receiving it. How greater access to data will change employers’ role as health care purchasers will be an important policy topic over the next several years, particularly because many employers continue to place a high value on broad provider networks. Eighty-nine percent of employers described the provider network in their largest plan as “very broad” or “somewhat broad.” Mental health and substance use disorder services are one notable exception: only 64% described those networks as broad or very broad. Some large employers are addressing accessibility challenges for these conditions by adding virtual and in-person providers.

While rising costs remain a significant challenge for employer plans going forward, employers reported high levels of satisfaction with several key elements of their plans. Prescription drug costs remain an important area of focus for managing plan costs. Meaningful shares of large employers continue to cover GLP-1 drugs when prescribed primarily for weight loss, but lower prices available through direct-to-consumer arrangements, together with the significant cost of these drugs, may lead employers to continue adapting their coverage. Small shares of employers are also exploring alternative approaches to purchasing some prescription drugs, including international sourcing and alternative mail-order pharmacy arrangements.

METHODOLOGY

The KFF 2026 Employer Health Benefits Survey reports findings from a survey of 1,937 randomly selected non-federal public and private employers with ten or more workers. Davis Research, LLC conducted the fieldwork between January and July 2026. The overall response rate is 11%, which includes firms that offer and do not offer health benefits. Unless otherwise noted, differences referred to in the text and figures use the 0.05 confidence level as the threshold for significance. Small firms have 10 to 199 workers unless otherwise noted. Values below 3% are not shown on graphs to improve readability. Some distributions may not sum due to rounding. For more information about survey methodology, see the Survey Design and Methods section at http://ehbs.kff.org/.

---

Filling the need for trusted information on national health issues, KFF is a nonprofit organization based in San Francisco, California.

---

1. KFF’s analysis of data from the 2024 American Community Survey. See KFF. Health insurance coverage of the population ages 0–64 [Internet]. San Francisco (CA): KFF; [cited 2026 Aug 19]. [Time frame: 2024]. Available from: https://www.kff.org/state-health-policy-data/state-indicator/health-insurance-coverage-population-0-64/.↩︎
2. Bureau of Labor Statistics, Mid-Atlantic Information Office. Consumer Price Index historical tables for U.S. city average (1967=100), Consumer Price Index for All Urban Consumers (CPI-U) (not seasonally adjusted) [Internet]. Philadelphia (PA): BLS, Mid-Atlantic Information Office. Available from: https://www.bls.gov/regions/mid-atlantic/data/consumerpriceindexhistorical1967base_us_table.htm↩︎
3. Average hourly earnings of production and nonsupervisory employees (seasonally adjusted) from the Current Employment Statistics survey. See Bureau of Labor Statistics. Current Employment Statistics—CES (national) [Internet]. Washington (DC): BLS;. Available from: https://www.bls.gov/ces/data/↩︎
4. This threshold is based on the twenty-fifth percentile of workers’ earnings ($38,000 in 2026). Seasonally adjusted data from the Current Employment Statistics Survey. Bureau of Labor Statistics. Current Employment Statistics—CES (national) [Internet]. Washington (DC): BLS. Available from: https://www.bls.gov/ces/publications/highlights/highlights-archive.htm↩︎

KFF has conducted this annual survey of employer-sponsored health benefits since 1999. Since 2020, KFF has employed Davis Research LLC (Davis) to field the survey. From January to July 2026, Davis interviewed business owners as well as human resource and benefits managers at 1,937 firms.

SURVEY TOPICS

The survey includes questions on the cost of health insurance, offer rates, coverage, eligibility, plan type enrollment, premium contributions, employee cost sharing, prescription drug coverage, retiree health benefits, and wellness programs.

Firms that offer health benefits are asked about the attributes of their largest HMO, PPO, POS and HSA plans. Exclusive provider organizations (EPOs) are grouped with HMOs, and conventional (or indemnity) plans are grouped with PPOs.

Plan Definitions:

• HMO (Health Maintenance Organization): A plan that does not cover non-emergency services provided out of network.
• PPO (Preferred Provider Organization): A plan that allows use of both in-network and out-of-network providers, with lower cost sharing for in-network services and no requirement for a primary care referral.
• POS (Point-of-Service Plan): A plan with lower cost sharing for in-network services, but that requires a primary care gatekeeper for specialist or hospital visits.
• HSA (Health Savings Account): A plan with a deductible of at least $1,650 for single coverage or $3,300 for family coverage, paired with a health savings account. (See the introduction to Section 8 for more detail on HSAs and other high deductible health plans with savings options.)

To reduce respondent burden, questions on cost sharing for office visits, hospitalization, outpatient surgery, and prescription drugs are limited to the firm’s largest plan. Firms offering multiple plan types report premium contributions and deductibles for their two largest plans. Within each plan type, respondents are asked about the plan with the highest enrollment.

Firms report attributes of their current plans as of the time of the interview. While the survey fielding begins in January, many firms have plan years that do not align with the calendar year. In some cases, firms may report data based on the prior year’s plan. As a result, some reported attributes-such as HSA deductible thresholds-may not align with current regulatory requirements. Additionally, plan decisions may have been made months prior to the interview.

SAMPLE DESIGN

The sample for the annual KFF Employer Health Benefits Survey includes private firms and nonfederal government employers with ten or more employees. The universe is defined by the U.S. Census’ 2021 Statistics of U.S. Businesses (SUSB) for private firms and the 2022 Census of Governments (COG) for non-federal public employers. At the time of sample design (December 2025), this data represented the most current information on the number of public and private firms. The sample size is determined based on the number of firms needed to achieve a target number of completes across five firm-size categories and whether the firm was located in California.

We attempted to re-interview prior survey respondents who participated in either the 2024 or 2025 survey, or both. In total,* 207 firms participated in 2024,* 307 firms participated in 2025, and* 729 firms participated in both years.

Non-panel firms were randomly selected within size and industry groups.

Since 2010, the sample has been drawn from a Dynata list (based on a census compiled by Dun & Bradstreet) of the nation’s private employers, and from the COG for public employers. Starting in 2025, we included an augmented sample of 50 firms from the Forbes America’s Largest Private Companies list. This list includes U.S.-based firms with annual revenue of $2 billion or more and is intended to complement the Dynata sample frame.

To increase precision, the sample is stratified by ten industry categories and six size categories. Education is treated as a separate category for sampling but included in the “Service” category for weighting.

For more information on changes to sampling methods over time, please consult the extended methods (http://ehbs.kff.org) which describes changes made in each year’s survey.

RESPONSE RATE

Response rates are calculated using a CASRO method, which accounts for firm eligibility in the study. The rate is computed by dividing the number of completes by the sum of refusals and the estimated number of eligible firms among those with unknown eligibility. The overall response rate is 11% [Figure M.1]. As in prior years, the response rate for panel firms is higher than for non-panel firms.

Similar to other employer and household surveys, response rates have declined over time. Since 2017, we have attempted to increase the number of completes by expanding the number of non-panel firms in the sample. While this strategy improves the precision of estimates-particularly for subgroups-it tends to reduce the overall response rate.

Most survey questions are asked only of firms that offer health benefits. A total of 1,668 of the 1,937 firms responding to the full survey indicated that they offer health benefits.

We asked one question of all firms we contacted by phone, even if they declined to complete the full survey: “Does your company offer a health insurance program as a benefit to any of your employees?” A total of 3,653 firms responded to this question, including 1,937 full survey respondents and 1,716 firms who responded to this question only.

These responses are included in the estimates of the percentage of firms offering health benefits presented in Chapter 2. The response rate for this question is 20.4% [Figure M.1].

Figure M.1: Response Rates for Various Subsets of the Sample, 2026

While response rates have decreased, elements of the survey design limit the potential impact of a response bias. Most major statistics are weighted by the number of covered workers at a firm. Collectively, 3,300,000 of the 70,400,000 workers covered by their own employer’s health benefits nationwide were employed at firms that completed the survey. The most important statistic weighted by the number of employers is the offer rate. Firms that do not complete the full survey are still asked whether they offer health benefits, ensuring a larger sample. As in previous years, most responding firms are very small. As a result, fluctuations in the offer rate for these small firms significantly influence the overall offer rate.

FIRM SIZES AND KEY DEFINITIONS

Throughout the report, we present data by firm size, region, and industry; [Figure M.2] displays selected characteristics of the sample. Unless otherwise noted, firm size is defined as follows: small firms have 10-199 workers, and large firms have 200 or more workers.

A firm’s primary industry classification is based on Dynata’s designation, which in turn is derived from the U.S. Census Bureau’s North American Industry Classification System (NAICS) [Figure M.3]. Firm ownership type, average wage level, and workforce age are based on respondents’ self-reported information.

While there is considerable overlap between firms categorized as “State/Local Government” in the industry classification and those identified as publicly owned, the two categories are not identical. For example, public school districts are included in the “Service” industry category, even though they are publicly owned.

Family coverage is defined as health insurance coverage for a family of four.

Figure M.2: Selected Characteristics of Firms in the Survey Sample, 2026

Figure M.3: Industries by NAICS code

[Figure M.4] shows the categorization of states into regions, based on the U.S. Census Bureau’s regional definitions. State-level data are not reported due to limited sample sizes in many states and because the survey collects information only on a firm’s primary location-not where employees may be based. Some mid-size and large employers operate in multiple states, so the location of a firm’s headquarters may not correspond to the location of the health plan for which premium information was collected.

Figure M.4: States by Region, 2025

[Figure M.5] displays the distribution of the nation’s firms, workers, and covered workers (employees receiving health coverage from their employer). Beginning in 2025, firms with fewer than 10 employees were excluded from the survey universe. Although most firms in the United States are small, most workers covered by health benefits are employed at large firms: 78% of the covered worker weight is controlled by firms with 200 or more employees. Conversely, firms with 10-199 employees represent 95% percent of the employer weight.

Because small firms make up the vast majority of all firms, they heavily influence statistics weighted by the number of employers. For this reason, most firm-level statistics are reported by firm size. In contrast, large firms-especially those with 1,000 or more workers-have the greatest influence on statistics related to covered workers. Even with the large firm category (those with 200 or more workers), 84% of the employer weight is driven by firms with 200-999 employees.

Statistics for small firms and employer-weighted measures tend to exhibit greater variability.

Figure M.5: Distribution of Employers, Workers, and Workers Covered by Health Benefits, by Firm Size, 2026

The survey asks firms what percentage of their employees earn more or less than a specified amount in order to identify the portion of the workforce that has relatively lower or higher wages. This year, the income threshold is $38,000 or less per year for lower-wage workers and $82,000 or more for higher-wage workers. These thresholds are based on the 25th and 75th percentile of workers’ earnings as reported by the Bureau of Labor Statistics using data from the Occupational Employment Statistics (OES) (2024).⁵ The cutoffs were inflation-adjusted and rounded to the nearest thousand.

Annual inflation estimates are calculated as an average of the first three months of the year. The 12 month percentage change for this period was 2.7%.⁶ Data presented is nominal unless indicated specifically otherwise.

ROUNDING AND IMPUTATION

Some figures may not sum to totals due to rounding. While overall totals and totals by firm size and industry are statistically valid, some breakdowns are not reported due to limited sample sizes or high relative standard errors. Where the unweighted sample size is fewer than 30 observations, figures are labeled “NSD” (Not Sufficient Data). Estimates with high relative standard errors are reviewed and, in some cases, suppressed. Many subset estimates may have large standard errors, meaning that even large differences between groups may not be statistically significant.

To improve readability, values below 3% are not shown in graphical figures. The underlying data for all estimates presented in graphs are available in Excel files accompanying each section at http://ehbs.kff.org.

To control for item nonresponse bias, we impute missing values for most variables. On average, 10% of observations are imputed. All variables-except single coverage premiums-are imputed using a hotdeck method, which replaces missing values with observed values from a similar firm (based on size and industry).

When both single and family coverage premiums are missing for a firm, the single coverage premium is first predicted using a random forest algorithm based on other known plan and firm characteristics. This predicted value is then used to impute related variables, such as family premiums and worker contributions, using the hotdeck approach. Some variables are hotdecked based on their relationship to another variable. For example, if a firm reports a family worker contribution but not a family premium, we impute a ratio between the two and then calculate the missing premium.

In 2026, there were thirty-two variables where the imputation rate exceeded 20%, most of which were related to plan-level statistics. When constructing aggregate estimates across all plans, the imputation rate is typically much lower. A few variables are not imputed-these are usually cases where a “don’t know” response is considered valid.

To ensure data quality, we conduct multiple reviews of outliers and illogical responses. Each year, several hundred firms are recontacted to verify or correct their responses. In some cases, responses are edited based on open-ended comments or established logic rules.

Figure M.6: Imputation Rates of Premiums, Worker Contributions, and Deductibles, by Plan Type, 2022-2026

WEIGHTING

Because we select firms randomly, it is possible through the use of weights to extrapolate results to national (as well as firm size, regional, and industry) averages. These weights allow us to present findings based on the number of workers covered by health plans, the number of workers, and the number of firms. In general, findings in dollar amounts (such as premiums, worker contributions, and cost sharing) are weighted by covered workers. Other estimates, such as the offer rate, are weighted by firms.

The employer weight was determined by calculating the firm’s probability of selection. This weight was trimmed of overly influential weights and calibrated to U.S. Census Bureau’s 2022 Statistics of U.S. Businesses for firms in the private sector, and the 2022 Census of Governments totals. The worker weight was calculated by multiplying the employer weight by the number of workers at the firm and then following the same weight adjustment process described above. The covered-worker weight and the plan-specific weights were calculated by multiplying the percentage of workers enrolled in each of the plan types by the firm’s worker weight. These weights allow analyses of workers covered by health benefits and of workers in a particular type of health plan.

The trimming procedure follows the following steps: First, we grouped firms into size and offer categories of observations. Within each strata, we calculated the trimming cut point as the median plus six times the interquartile range (M + [6 * IQR]). Weight values larger than this cut point are trimmed. In all instances, very few weight values were trimmed.

To account for design effects, the statistical computing package R version 4.6.1 (2026-06-24 ucrt) and the library “survey” version 4.5 were used to calculate standard errors.

STATISTICAL SIGNIFICANCE AND LIMITATIONS

All statistical tests are performed at the 0.05 confidence level. For figures spanning multiple years, comparisons are made between each year and the previous year shown, unless otherwise noted. No statistical tests are conducted for years prior to 1999.

Subgroup comparisons are made against all other firm sizes not included in the specified group. For example, firms in the Northeast are compared to an aggregate of firms in the Midwest, South, and West. For plan type comparisons (e.g., average premiums in PPOs), results are tested against the “All Plans” estimate. In some cases, plan-specific estimates are also compared to similar estimates for other plan types (e.g., single and family premiums in HSAs vs. HMO, PPO, and POS plans); such comparisons are noted in the text.

Two statistical tests are used: the t-test and the Wald test. A small number of observations for certain variables can result in large variability around point estimates. Readers should be cautious of these when interpreting year-to-year changes, as large shifts may not be statistically significant. Standard errors for selected estimates are available in a technical supplement at http://ehbs.kff.org.

Due to the complexity of many employer health benefit programs, the survey may not capture all elements of any given plan. For instance, employers may offer intricate and varying prescription drug benefits, premium contributions, or wellness incentives. Interviews were conducted with the individual most knowledgeable about the firm’s health benefits, though some respondents may not have complete information on all aspects of the plan. While the survey collects data on the number of workers enrolled in coverage, it does not capture the characteristics of those offered or enrolled in specific plans.

DATA COLLECTION AND SURVEY MODE

Starting in 2022, we expanded the use of computer assisted web interview (CAWI), offering most respondents the opportunity to complete the survey using an online questionnaire rather a telephone interview. In 2026, fifty-five percent of survey responses were completed via telephone interview, and the remainder were completed online. Previous analysis has found that survey mode had little impact on major statistics such as annual premiums, contributions, and deductibles.

EMPLOYER SURVEY LANDSCAPE

Given the complexity of the private health insurance system, estimating changes in health insurance costs is challenging and depends on both what is being measured and how it is measured. The KFF Employer Health Benefits Survey provides a comprehensive snapshot of current-year premiums and uses methods designed to produce estimates representative of workers and employers with 10 or more workers.

Actuarial and consulting firms often produce prospective estimates of employer health benefit cost growth. These forecasts often include assumptions about changes in health care prices, utilization, and the mix of services. Prospective estimates of cost growth may be higher than the premium increases ultimately observed, in part because employers can mitigate anticipated cost increases by changing plan designs, provider networks, vendors, or other aspects of their plans.

By contrast, the KFF Employer Health Benefits Survey measures observed health insurance premiums or premium equivalents, that is the cost of the plans actually offered to workers in the current year. Other annual employer surveys, including AHRQ’s MEPS-Insurance Component and Mercer’s National Survey of Employer-Sponsored Health Plans, use probability samples to measure employer health benefit costs. While these surveys use different methods and cover somewhat different populations, over time they have documented a similar rate of premium growth.

PREFERRED REPORTING ITEMS FOR COMPLEX SAMPLE SURVEY ANALYSIS (PRICSSA)

In their Journal of Survey Statistics and Methodology article, Seidenberg, Moser, and West (2023) propose a checklist for survey administrators and sponsoring organizations to help external researchers quickly understand the methods used to create a complex sample dataset.⁷ The Preferred Reporting Items for Complex Sample Survey Analysis (PRICSSA) recommends a standard format to enumerate data collection and analysis techniques across a variety of different surveys. KFF has adopted this checklist to increase transparency for our readership and also to promote reproducibility among external researchers granted access to our public use files.

• 1.1 Data collection dates: January 05, 2026-July 13, 2026.
• 1.2 Data collection mode(s): fifty-five percent computer-assisted telephone interviewing (CATI), and the remainder completed with computer assisted web interview (CAWI).
• 1.3 Target population: Private firms as well as state and local government employers with ten or more employees in 50 US states and Washington DC.
• 1.4 Sample design: A sample stratified by ten industry categories and six size categories drawn from a Dynata list (based on a census assembled by Dun and Bradstreet) of the nation’s private employers and the Census of Governments for public employers.
• 1.5 Full Survey response rate: 11 percent (CASRO method).
• 2.1 Missingness rates: On average, 10% of observations are imputed.
• 2.2 Observation deletion: Observations found to be duplicated firms, out of business, or no longer exisiting in the sample universe.
• 2.3 Sample sizes: 1,937 firms completed the entire survey, 3,653 completed at least the offer question, out of 35,781 initially sampled firms, generalizing to a total of about one million firms.
• 2.4 Confidence intervals / standard errors: All statistical tests are performed at the .05 confidence level.
• 2.5 Weighting: empwt (firms), empwt_a6 (firms, including those answering only the offer question), wkrwt (workers), covwt (policyholders), hmowt, ppowt, poswt, and hsawt (plan weights)
• 2.6 Variance estimation: Taylor Series Linearization with newcell used as the stratum variable but no PSU variable.
• 2.7 Subpopulation analysis: The R survey package toolkit such as svyby and a complex sample design’s subset method allowed for most analysis of subdomains.
• 2.8 Suppression rules: Where the unweighted sample size is fewer than 30 observations, figures include the notation “NSD” (Not Sufficient Data). Estimates with high relative standard errors are reviewed and in some cases not published.
• 2.9 Software and code: All design-based analyses were performed using R version 4.6.1 (2026-06-24 ucrt) and survey library version 4.5.

2026 SURVEY

The 2026 survey includes new questions on substance use disorder services, transparency, and prior authorization, among other topics. As in previous years, modifications were also made to existing questions to improve clarity and reflect changes in the health care marketplace.

Previous surveys combined high deductible plans paired with HSAs or HRAs into a single plan type referred to as high deductible health plans with savings options (“HDHP/SOs”). Over time, the prevalence of HSA-qualified plans has grown while that of high deductible plans paired with HRAs has waned. The different types and uses of HRAs also has made it more difficult to make generalizations about these plans. So, beginning this year, the survey no longer tracks the HDHP/SOs as a plan type and instead focuses on HSA-qualified plans as a plan type. The survey will continue to ask employers whether they offer HRAs and what the HRA funds may be used for, but will no longer ask about the amounts made available in these arrangements.

Due to data availability changes starting with the 2022 SUSB, we revised the firm size categories used for weighting. Prior surveys calibrated nationwide totals based on each firm’s employment using the categories 10-24, 25-49, 50-199, 200-999, 1,000-4,999, and 5,000+. For this year’s survey, firm sizes were grouped into 10-19, 20-99, 100-499, 500-999, 1,000-4,999, and 5,000+ employment categories. When analyzing the impact with the 2021 SUSB, the most recent year with both categorizations available, we did not find any changes to our main findings weighted separately based on the two distinct sets of firm sizes. We also adjusted how our weighting accounts for California. Statistics of US Businesses (SUSB) public tables include nationwide counts for firms with 500 or more and 5,000 or more employees, and these tables also contain California statewide counts for firms with 500 or more employees, but not for California firms with 5,000 or more employees. From special tabulations received from the US Census Bureau, we know the distribution of the largest firms in California to be stable over time. Among California firms with at least 500 employees in both the 2016 and 2021 SUSB, the share of firms with 500-999 employees was 34%, the share of firms with 1,000-4,999 employees was 44%, and the remaining share of firms with 5,000+ employees was 22%. We retained this distribution to estimate the weighting cell for firms with 5,000+ employees with any presence in California based on the 2022 count of firms with 500+ employees.

OTHER RESOURCES

Additional information about the Employer Health Benefits Survey is available at http://ehbs.kff.org, including an interactive graphic and historical reports. Researchers may also request access to a public use dataset at https://www.kff.org/contact-us/.

The Survey Design and Methods section on our website includes an extended methodology document that is not available in the PDF or printed versions of this report. Readers interested in more detailed information on survey methods should consult the online edition.

Published: October 22, 2026. Last Updated: October 16, 2026.

HISTORICAL DATA

Data in this report focus primarily on findings from surveys conducted and authored by KFF since 1999. Between 1999 and 2017, the Health Research & Educational Trust (HRET) co-authored this survey. HRET’s divestiture had no impact on our survey methods, which remain the same as years past. Prior to 1999, the survey was conducted by the Health Insurance Association of America (HIAA) and KPMG using a similar survey instrument, but data are not available for all the intervening years. Following the survey’s introduction in 1987, the HIAA conducted the survey through 1990, but some data are not available for analysis. KPMG conducted the survey from 1991-1998. However, in 1991, 1992, 1994, and 1997, only larger firms were sampled. In 1993, 1995, 1996, and 1998, KPMG interviewed both large and small firms. In 1998, KPMG divested itself of its Compensation and Benefits Practice, and part of that divestiture included donating the annual survey of health benefits to HRET.

This report uses historical data from the 1993, 1996, and 1998 KPMG Surveys of Employer-Sponsored Health Benefits and the 1999-2017 Kaiser/HRET Survey of Employer-Sponsored Health Benefits. For a longer-term perspective, we also use the 1988 survey of the nation’s employers conducted by the HIAA, on which the KPMG and KFF surveys are based. The survey designs for the three surveys are similar.

[Figure M.7] displays the historic sample sizes and weights of firms, workers, and covered workers (employees receiving coverage from their employer).

Figure M.7: Historic Firm Sample Sizes and Weights, 1999-2026

[Figure M.8] displays the historic sample frames and weighting universes.

Figure M.8: Sampling and Weighting Targets, 1999-2026

1999

The Kaiser Family Foundation and The Health Research and Educational Trust (Kaiser/HRET) began sponsoring the survey of employer-sponsored health benefits supported for many years by KPMG Peat Marwick LLP, an international consulting and accounting firm. In 1998, KPMG divested itself of its Compensation and Benefits Practice, and donated the annual survey of health benefits to HRET, a non-profit research organization affiliated with the American Hospital Association. From 1999 until 2017, the survey was conducted under a partnership between HRET and The Kaiser Family Foundation, a health care philanthropy and policy research organization that is not affiliated with Kaiser Permanente or Kaiser Industries. Starting in 1999, survey continued a core set of questions from prior KPMG surveys, but was expanded to include small employers and a variety of policy-oriented questions. Some reports include data from the 1993, 1996 and 1998 KPMG Surveys of Employer-Sponsored Health Benefits. For a longer-term perspective, we also use the 1988 survey of the nation’s employers conducted by the Health Insurance Association of America (HIAA), on which the KPMG, Kaiser/HRET, and Kaiser Family Foundation surveys were based. Many of the questions in the HIAA, KPMG, Kaiser/HRET, and Kaiser Family Foundation surveys are identical, as is the sample design. Since Point-of-Service (POS) plans did not exist in 1988, reports do not include statistics for this plan type in that year. Starting in 1999, Kaiser/HRET drew its sample from a Dun & Bradstreet list of the nation’s private and public employers with three or more workers. To increase precision, Kaiser/HRET stratified the sample by industry and the number of workers in the firm. Kaiser/HRET attempted to repeat interviews with many of the 2,759 firms interviewed in 1998 and replaced non-responding firms with another firm from the same industry and firm size. As a result, 1,377 firms in the 1999 total sample of 1,939 firms participated in both the 1998 and 1999 surveys.

For more detail about the 1999 survey, see the Survey Methodology section of that year’s report.

2000

Kaiser/HRET attempted to repeat interviews with many of the 1,939 firms interviewed in 1999 and replaced non-responding firms with other firms of the same industry and firm size. As a result, 982 firms in the 2000 survey’s total sample of 1,887 firms participated in both the 1999 and 2000 surveys. The overall response rate was 45% down from 60% in 1999. Contributing to the declining response rate was the decision not to re-interview any firms with 3-9 workers who participated in the 1999 survey. In 1999, the survey weights had instead been adjusted to control for the fact that firms with 3-9 workers that are in the panel (responded in either 1998 or 1999) are biased in favor of offering a health plan. The response rate in 2000 for firms with 3-9 workers was 30%.

For more detail about the 2000 survey, see the Survey Methodology section of that year’s report.

2001

For more detail about the 2001 survey, see the Survey Methodology section of that year’s report.

2002

The list of imputed variables was greatly expanded in 2002 to also include self-insurance status, level of benefits, prescription drug cost-sharing, copay and coinsurance amounts for prescription drugs, and firm workforce characteristics such as average income, age and part-time status. On average, 2% of these observations are imputed for any given variable. The imputed values are determined based on the distribution of the reported values within stratum defined by firm size and region.

For more detail about the 2002 survey, see the Survey Methodology section of that year’s report.

2003

The calculation of the weights followed a similar approach to previous years, but with several notable changes in 2003. First, as in years past, the basic weight was determined, followed by a nonresponse adjustment added this year to reflect the fact that small firms that do not participate in the full survey are less likely to offer health benefits and, consequently, are unlikely to answer the single offer rate question. To make this adjustment, Kaiser/HRET conducted a follow-up survey of all firms with 3-49 workers that did not participate in the full survey. Each of these 1,744 firms was asked the single question, “Does your company offer or contribute to a health insurance program as a benefit to its employees?” The main difference between this follow-up survey and the original survey is that in the follow-up survey the first person who answered the telephone was asked whether the firm offered health benefits, whereas in the original survey the question was asked of the person who was identified as most knowledgeable about the firm’s health benefits. Conducting the follow-up survey accomplished two objectives. First, statistical techniques (a McNemar analysis which was confirmed by a chi-squared test) demonstrated that the change in method-speaking with the person answering the phone rather than a benefits manager-did not bias the results of the follow-up survey. Analyzing firms who responded to the offer question twice, in both the original and follow-up survey, proved that there was no difference in the likelihood that a firm offers coverage based on which employee answered the question about whether a firm offers health benefits. Second, the follow-up survey demonstrated that very small firms not offering health benefits to their workers are less likely to answer the one survey question about coverage. Kaiser/HRET analyzed the group of firms that only responded to the follow-up survey and performed a t-test between the firms who had responded to the initial survey as well as the follow-up, and those who only responded to the follow-up. Tests confirmed the hypothesis that the firms that did not answer the single offer rate question in the original survey were less likely to offer health benefits. To adjust the offer rate data for this finding an additional non-response adjustment was applied to increase the weight of firms in the sample that do not offer coverage. The second change to the weighting method in 2003 was to trim the weights in order to reduce the influence of weight outliers. On occasion one or two firms will, through the weighting process, represent a highly disproportionate number of firms or covered workers. Rather than excluding these observations from the sample, a set cut point that would minimize the variances of several key variables (such as premium change and offer rate) was determined. The additional weight represented by outliers is then spread among the other firms in the same sampling cell. Finally, a post-stratification adjustment was applied. In the past, Kaiser/HRET was poststratified back to the Dun & Bradstreet frequency counts. Concern over volatility of counts in recent years led to the use of an alternate source for information on firm and industry data. This year the survey uses the recently released Statistics of U.S. Businesses conducted by the U.S. Census as the basis for the post-stratification adjustment. These Census data indicate the percentage of the nation’s firms with 3-9 workers is 59% rather than the higher percentages (e.g., 76% in 2002) derived from Dun & Bradstreet’s national database. This change has little impact on worker-based estimates, since firms with 3-9 workers accounted for less than 10% of the nation’s workforce. The impact on estimates expressed as a percentage of employers (e.g., the percent of firms offering coverage), however, may be significant. Due to these changes, Kaiser/HRET recalculated the weights for survey years 1999-2002 and modified estimates published in the survey where appropriate. The vast majority of these estimates are not statistically different. However, please note that the survey data published starting in 2003 varies slightly from previously published reports.

For more detail about the 2003 survey, see the Survey Methodology section of that year’s report.

2004

For more detail about the 2004 survey, see the Survey Methodology section of that year’s report.

2005

In 2005, the Kaiser/HRET survey added two additional sections to the questionnaire to collect information about high-deductible health plans (HDHP) that are offered along with a health reimbursement account (HRA) or are health savings account (HSA) qualified. Questions in these sections were asked of all firms offering these plan types, regardless of enrollment. Specific weights were also created to analyze the HDHP plans that are offered along with HRAs or are HSA qualified. These weights represent the proportion of employees enrolled in each of these arrangements.

We updated our data to reflect the 2002 Census of Governments. We also removed federal government employee counts from our post-stratification.

For more detail about the 2005 survey, see the Survey Methodology section of that year’s report.

2006

For the first time in 2006, Kaiser/HRET asked questions about the highest enrollment HDHP/SO as a separate plan type, equal to the other plan types. In prior years, data on HDHP/SO plans were collected as part of one of the other types of plans. Therefore, the removal of HDHP/SOs from the other plan types may affect the year to year comparisons for the other plan types. Given the decline in conventional health plan enrollment and the addition of HDHP/SO as a plan type option, Kaiser/HRET eliminated nearly all questions pertaining to conventional coverage from the survey instrument. We continue to ask firms whether or not they offer a conventional health plan and, if so, how much their premium for conventional coverage increased in the last year, but respondents are not asked additional questions about the attributes of the conventional plans they offer. Because we have limited information about conventional health plans, we must make adjustments in calculating all plan averages or distributions. In cases where a firm offers only conventional health plans, no information from that respondent is included in all plan averages. The exception is for the rate of premium growth, for which we have information. If a firm offers a conventional health plan and at least one other plan type, for categorical variables we assign the values from the health plan with the largest enrollment (other than the conventional plan) to the workers in the conventional plan. In the case of continuous variables, covered workers in conventional plans are assigned the weighted average value of the other plan types in the firm.

The survey newly distinguished between plans that have an aggregate deductible amount in which all family members’ out-of-pocket expenses count toward the deductible and plans that have a separate amount for each family member, typically with a limit on the number of family members required to reach that amount.

In 2006, Kaiser/HRET began asking employers if they had a health plan that was an exclusive provider organization (EPO). We treat EPOs and HMOs together as one plan type and report the information under the banner of “HMO”; if an employer sponsors both an HMO and an EPO, they are asked about the attributes of the plan with the larger enrollment.

Kaiser/HRET made a slight change to one of the industry groups: we removed Wholesale from the group that also included Agriculture, Mining and Construction. The nine industry categories now reported are: Agriculture/Mining/Construction, Manufacturing, Transportation/Communications/Utilities, Wholesale, Retail, Finance, Service, State/Local Government, and Health Care.

Starting in 2006, we made an important change to the way we test the subgroups of data within a year. Statistical tests for a given subgroup (firms with 25-49 workers, for instance) are tested against all other firm sizes not included in that subgroup (all firm sizes NOT including firms with 25-49 workers in this example). Tests are done similarly for region and industry: Northeast is compared to all firms NOT in the Northeast (an aggregate of firms in the Midwest, South, and West). Statistical tests for estimates compared across plan types (for example, average premiums in PPOs) are tested against the “All Plans” estimate. In some cases, we also test plan specific estimates against similar estimates for other plan types (for example, single and family premiums for HDHP/SOs against single and family premiums in HMO, PPO, and POS plans). Those are noted specifically in the text. This year, we also changed the type of Chi-square test from the Chi-square test for goodness-of-fit to the Pearson Chi-square test. Therefore, in 2006, the two types of statistical tests performed are the t-test and the Pearson Chi-square test.

For more detail about the 2006 survey, see the Survey Methodology section of that year’s report.

2007

Kaiser/HRET drew its sample from a Survey Sampling Incorporated list (based on an original Dun and Bradstreet list) of the nation’s private and public employers with three or more workers.

In prior years, many variables were imputed following a hotdeck approach, while others followed a distributional approach (where values were randomly determined from the variable’s distribution, assuming a normal distribution). This year, all variables are imputed following a hotdeck approach. This imputation method does not rely on a normal distribution assumption and replaces missing values with observed values from a firm with similar characteristics, in this case, size and industry. Due to the low imputation rate for most variables, the change in methodology is not expected to have a major impact on the results. In some cases, due to small sample size, imputed outliers are excluded. There are a few variables that Kaiser/HRET has decided should not be imputed; these are typically variables where “don’t know” is considered a valid response option (for example, firms’ opinions about effectiveness of various strategies to control health insurance costs).

The survey now contains a few questions on employee cost sharing that are asked only of firms that indicate in a previous question that they have a certain cost-sharing provision. For example, the copayment amount for prescription drugs is asked only of those that report they have copayments for prescription drugs. Because the composite variables are reflective of only those plans with the provision, separate weights for the relevant variables were created in order to account for the fact that not all covered workers have such provisions.

For more detail about the 2007 survey, see the Survey Methodology section of that year’s report.

2008

National Research, LLC (NR), our Washington, D.C.-based survey research firm, introduced a new CATI (Computer Assisted Telephone Interview) system at the end of 2007, and, due to several delays in the field, obtained fewer responses than expected. As a result, an incentive of $50 was offered during the final two and a half weeks the survey was in the field. Kaiser/HRET compared the distribution of key variables between firms receiving the incentive and firms not receiving the incentive to determine any potential bias. Chi-square test results were not significant, suggesting minimal to no bias.

In 2008, we changed the method used to report the annual percentage premium increase. In prior years, the reported percentage was based on a series of questions that asked responding firms the percentage increase or decrease in premiums from the previous year to the current year for a family of four in the largest plan of each plan type (e.g., HMO, PPO). The reported premium increase was the average of the reported percentage changes (i.e., 6.1% for 2007) weighted by covered workers. This year, we calculate the overall percentage increase in premiums from year to year for family coverage using the average of the premium dollar amounts for a family of four in the largest plan of each plan type reported by respondents and weighted by covered workers (i.e., $12,106 for 2007 and $12,680 for 2008, an increase of 5%). A principal advantage of using the premium dollar amounts to calculate the annual change in premiums is that we are better able to capture changes in the cost of health insurance for those firms that are newly in the market or that change plan types, especially those that move to plans with very different premium levels. For example, in the first year that a firm offers a plan of a new plan type, such as a consumer-directed plan, the firm can report the level of the premium they paid, but using the previous method would be unable to report the rate of change from the previous year since the plan was not previously offered. If the premium for the new plan is relatively low compared to other premiums in the market, the relatively low premium amount that the firm reports will tend to lower the weighted average premium dollar amount reported in the survey, but the firm responses would not provide any information to the percentage premium increase question. Another advantage of using premium dollar amounts to examine trends is that these data directly relate to the other findings in the survey and better address a principal public policy issue (i.e., what was the change in the cost of insurance over some past period). Many users noted, for example, that the percentage change calculated from the reported premium dollar amounts between two years did not directly match the reported average premium increase for the same period. There are several reasons why we would not expect these questions to produce identical results: 1) they are separate questions subject to varying degrees of reporting error, 2) firms could report a premium dollar amount for a plan type they might not have offered in the previous year, therefore, contributing information to one measure but not the other, or 3) firms could report a premium dollar amount for a plan that was not the largest plan of that type in the previous year. Although the two approaches have generated similar results in terms of the long-term growth rate of overall family premiums, there are greater discrepancies in trends for subgroups like small employers and self-funded firms. Focusing on the dollar amount changes over time will provide a more reliable and consistent measure of premium change that also is more sensitive to firms offering new plan options.

As we have in past years, this year we collected information on the cost-sharing provisions for hospital admissions and outpatient surgery that is in addition to any general annual plan deductible. However, for the 2008 survey, we changed the structure of the question and now include “separate annual deductible or hospital admissions” as a response option rather than collecting the information through a separate question. We continue to examine and sometimes modify the questions on hospital and outpatient surgery cost sharing because this can be a complex component of health benefit plans. For example, for some plans it is difficult to distinguish a separate hospital deductible from one categorized as a general annual deductible, where office visits and preventive care are covered and the deductible only applies to hospital use. Because this continues to be a point of confusion, we continue to refine the series of questions in order to clearly convey the information we are attempting to collect from respondents.

As in 2007, we asked firms if they offer health benefits to opposite-sex or same-sex domestic partners. However, this year, we changed the response options because during early tests of the 2008 survey, several firms noted that they had not encountered the issue yet, indicating that the responses of “yes,” “no,” and “don’t know” were insufficient. Therefore, this year we added the response option “not applicable/not encountered” to better capture the number of firms that report not having a policy on the issue.

For more detail about the 2008 survey, see the Survey Methodology section of that year’s report.

2009

In the fall of 2008, with guidance from experts in survey methods and design from NORC, we reviewed the methods used for the survey. As a result of this review, several important modifications were made to the 2009 survey, including the sample design and questionnaire. For the first time, this year we determined the sample requirements based on the universe of firms obtained from the U.S. Census rather than Dun and Bradstreet. Prior to the 2009 survey, the sample requirements were based on the total counts provided by Survey Sampling Incorporated (SSI) (which obtains data from Dun and Bradstreet). Over the years, we have found the Dun and Bradstreet frequency counts to be volatile because of duplicate listings of firms, or firms that are no longer in business. These inaccuracies vary by firm size and industry. In 2003, we began using the more consistent and accurate counts provided by the Census Bureau’s Statistics of U.S. Businesses and the Census of Governments as the basis for post-stratification, although the sample was still drawn from a Dun and Bradstreet list. In order to further address this concern at the time of sampling, we now also use Census data as the basis for the sample. This change resulted in shifts in the sample of firms required in some size and industry categories.

This year, we also defined Education as a separate sampling category, rather than as a subgroup of the Service category. In the past, Education firms were a disproportionately large share of Service firms. Education is controlled for during post-stratification, and adjusting the sampling frame to also control for Education allows for a more accurate representation of both Education and Service industries.

In past years, both private and government firms were sampled from the Dun and Bradstreet database. For the 2009 sample, Government firms were sampled in-house from the 2007 Census of Governments. This change was made to eliminate the overlap of state agencies that were frequently sampled from the Dun and Bradstreet database. Each year the survey attempts to repeat interviews with respondents from past years (see “Response Rate” section below), and in order to maintain government firms that had completed the survey in the past (firms that have completed the survey in the past are known as panel firms), government firms from the 2008 survey were matched to the Census of Governments to identify phone numbers. All panel government firms were included in the sample (resulting in an oversample). In addition, the sample of private firms is screened for firms that are related to state/ local governments, and if these firms are identified in the Census of Governments, they are reclassified as government firms and a private firm is randomly drawn to replace the reclassified firm. These changes to the sample frame resulted in an expected slight reduction in the overall response rate, since there were shifts in the number of firms needed by size and industry. Therefore, the data used to determine the 2009 Employer Health Benefits sample frame include the U.S. Census’ 2005 Statistics of U.S. Businesses and the 2007 Census of Governments. At the time of the sample design (December 2008), these data represented the most current information on the number of public and private firms nationwide with three or more workers. As in the past, the post- stratification is based on the most up-to-date Census data available (the 2006 update to the Census of U.S. Businesses was purchased during the survey field period) and the 2007 Census of Governments. The Census of Governments is conducted every five years, and this is the first year the data from the 2007 Census of Governments have been available for use.

Based on recommendations from cognitive researchers at NORC and internal analysis of the survey instrument, a number of questions were revised to improve the clarity and flow of the survey in order to minimize survey burden. For example, in order to better capture the prevalence of combinations of inpatient and outpatient surgery cost sharing, the survey was changed to ask a series of yes or no questions. Previously, the question asked respondents to select one response from a list of types of cost sharing, such as separate deductibles, copayments, coinsurance, and per diem payments (for hospitalization only). We have also expanded the number of questions for which respondents can provide either the number of workers or the percentage of workers. Previously, after obtaining the total number of employees, the majority of questions asked about the percentage of workers with certain characteristics. Now, for questions such as the percentage of workers making $23,000 a year or less or the enrollment of workers in each plan type, respondents are able to respond with either the number or the percentage of workers. Few of these changes have had any noticeable impact on responses.

For more detail about the 2009 survey, see the Survey Methodology section of that year’s report.

2010

New topics in the 2010 survey include questions on eligibility for dependent coverage, coverage for care received at retail clinics, health plan changes as a result of the Mental Health Parity and Addiction Equity Act of 2008, and disease management. As in past years, this year’s survey included questions on the cost of health insurance, offer rates, coverage, eligibility, enrollment patterns, premiums, employee cost sharing, prescription drug benefits, retiree health benefits, wellness benefits, and employer opinions.

Firms in the sample with 3-49 workers that did not complete the full survey are contacted and asked (or re-asked in the case of firms that previously responded to only one question about offering benefits) whether or not the firm offers health benefits. As part of the process, we conduct a McNemar test to verify that the results of the follow-up survey are comparable to the results from the original survey. If the test indicates that the results are comparable, a nonresponse adjustment is applied to the weights used when calculating firm offer rates. This year, for the first time since we began conducting the follow-up survey, the test indicated that the results from those answering the one question about offering health benefits in the original survey and those answering the follow-up survey were different (statistically significant difference at the p<0.05 level between the two surveys), suggesting the results are not comparable. Therefore, we did not use the results of this follow-up survey to adjust the weights as we have in the past. In the past, the nonresponse adjustment lowered the offer rate for smaller firms by one to three percentage points, so not making the adjustment this year makes the offer rate look somewhat higher when making comparisons to prior years. For 2010, we saw a very large and unexpected increase in the offer rate (from 60 percent in 2009 to 69 percent in 2010) overall and particularly for firms with 3 to 9 workers (from 46 percent in 2009 to 59 percent in 2010). While not making the adjustment this year added to the size of the change, there would have been a large and difficult to explain change even if a nonresponse adjustment comparable to previous years had been made.

For more detail about the 2010 survey, see the Survey Methodology section of that year’s report.

2011

New topics in the 2011 survey include questions on stoploss coverage for self-funded plans, cost sharing for preventive care, plan grandfathering resulting from the Affordable Care Act (ACA), and employer awareness of tax credits authorized under the ACA.

This year, we became aware that the way we have been using the data from the Census Bureau for calibration was incorrect and resulted in an over-count of the actual number of firms in the nation. Specifically, firms operating in more than one industry were counted more than once in computing the total firm count by industry, and firms with establishments were counted more than once in computing the total firm count by state (which affects the regional count). Because smaller firms are less likely to operate in more than one industry or state, the miscounts occurred largely for larger from sizes. The error affects only statistics that are weighted by the number of firms (such as the percent of firms offering health benefits or sponsoring a disease management plan). Statistics that are weighted by the number of workers or covered workers (such as average premiums, contributions, or deductibles) were not affected. We addressed this issue by proportionally distributing the correct national total count of firms within each firm size as provided by the U.S. Census Bureau across industry and state based on the observed distribution of workers. This effectively weights each firm within each category (industry or state) in proportion to its share of workers in that category. The end result is a synthetic count of firms across industry and state that sums to the national totals. Firm-weighted estimates resulting from this change show only small changes from previous estimates, because smaller firms have much more influence on national estimates. For example, the estimate of the percentage of firms offering coverage was reduced by about .05 percentage points in each year (in some years no change is evident due to rounding). Estimates of the percentage of large firms offering retiree benefits were reduced by a somewhat larger amount (about 2 percentage points). Historical estimates used in the 2011 survey release have been updated following this same process. As noted above, worker-weighted estimates from prior years were not affected by the miscount and remain the same.

For more detail about the 2011 survey, see the Survey Methodology section of that year’s report.

2012

New topics in the 2012 survey include the use of biometric screening, domestic partner benefits, and emergency room cost sharing. In addition, many of the questions on health reform included in the 2011 survey were retained, including stoploss coverage for self-funded plans, cost sharing for preventive care, and plan grandfathering resulting from the Affordable Care Act (ACA).

There are several variables in which missing data is calculated based on respondents’ answers to other questions (for example, when missing employer contributions to premiums is calculated from the respondent’s premium and the ratio of contributions to premiums). In 2012 the method to calculate missing premiums and contributions was revised; if a firm provides a premium for single coverage or family coverage, or a worker contribution for single coverage or family coverage, that information was used in the imputation. For example, if a firm provided a worker contribution for family coverage but no premium information, a ratio between the family premium and family contribution was imputed and then the family premium was calculated. In addition, in cases where premiums or contributions for both family and single coverage were missing, the hotdeck procedure was revised to draw all four responses from a single firm. The change in the imputation method did not make a significant impact on the premium or contribution estimates.

In 2012, the method for calculating the size of the sample was adjusted. Rather than using a combined response rate for panel and non-panel firms, separate response rates were used to calculate the number of firms to be selected in each strata. In addition, the mining stratum was collapsed into the agriculture and construction industry grouping. In sum, changes to the sampling method required more firms to be included and may have reduced the response rate in order to provide more balanced power within each strata.

To account for design effects, the statistical computing package R and the library package “survey” were used to calculate standard errors. All statistical tests are performed at the .05 level, unless otherwise noted. For figures with multiple years, statistical tests are conducted for each year against the previous year shown, unless otherwise noted. No statistical tests are conducted for years prior to 1999. In 2012 the method to test the difference between distributions across years was changed to use a Wald test which accounts for the complex survey design. In general this method was more conservative than the approach used in prior years.

In 2012, average coinsurance rates for prescription drugs, primary care office visits, specialty office visits, and emergency room visits include firms that have a minimum and/or maximum attached to the rate. In years prior to 2012 we did not ask firms the structure of their coinsurance rate. For most prescription drug tiers, and most services, the average coinsurance rate is not statically different depending on whether the plan has a minimum or maximum.

In 2012 the calculation of the response rates was adjusted to be slightly more conservative than previous years.

For more detail about the 2012 survey, see the Survey Methodology section of that year’s report.

2013

Starting in 2013, information on conventional plans was collected under the PPO section and therefore the covered worker weight was representative of all plan types.

For more detail about the 2013 survey, see the Survey Methodology section of that year’s report.

2014

Starting in 2014, we elected to estimate separate single and family coverage premiums for firms that provided premium amounts as the average cost for all covered workers, instead of differentiating between single and family coverage. This method more accurately accounted for the portion that each type of coverage contributes to the total cost for the 1 percent of covered workers who are enrolled at firms affected by this adjustment.

Several provisions of the ACA took effect on January 1, 2014 which impacted non-grandfathered plans as well as plans renewing in calendar year 2014, such as the requirement to have an out of pocket limit and a waiting period of not more than three months. As a result, firms with non-grandfathered plans that reported that they did not have out-of-pocket limits, or waiting periods exceeding three months, were contacted during our data-confirmation calls. We did not have information on the month in which a firm’s plan or plans was renewed. Many of these firms indicated that they had a plan year starting prior to January 2014, so these ACA provision were not yet in effect for these plans.

Firms with 200 or more workers were asked: “Does your firm offer health benefits for current employees through a private or corporate exchange? A private exchange is one created by a consulting firm or an insurance company, not by either a federal or state government. Private exchanges allow employees to choose from several health benefit options offered on the exchange.” Employers were still asked for plan information about their HMO, PPO, POS and HDHP/SO plan regardless of whether they purchased health benefits through a private exchange or not.

Beginning in 2014, we collected whether firms with a non-final disposition code (such as a firm that requested a callback at a later time or date) offered health benefits. By doing so we attempt to mitigate any potential non-response bias of firms either offering or not offering health benefits on the overall offer rate statistic.

For more detail about the 2014 survey, see the Survey Methodology section of that year’s report.

2015

To increase response rates, firms with 3-9 employees were offered an incentive of $75 in cash or as a donation to a charity of their choice to complete the full survey.

In 2015, weights were not adjusted using the nonresponse adjustment process described in previous years’ methods. As in past years, Kaiser/HRET conducted a small follow-up survey of those firms with 3 to 49 workers that refused to participate in the full survey. Based on the results of a McNemar test, we were not able to verify that the results of the follow-up survey were comparable to the results from the original survey. In 2010, the results of the McNemar test were also significant and we did not conduct a nonresponse adjustment.

The 2015 survey contains new information in several areas, including on wellness and biometric screening. In most cases, information reported in this section is not comparable with previous years’ findings. Data presented in the 2015 report reflect the firm’s benefits at the time they completed the interview. Some firms may report on a plan which took effect in the prior calendar year. Starting in 2015, firms were able to have a contribution and deductible in compliance with HSA requirements for the plan year.

Starting in 2015, employers were asked how many full-time equivalents they employed. In cases in which the number of full-time equivalents was relevant to the question, interviewer skip patterns may have depended on the number of FTEs.

In cases where a firm had multiple plans, they were asked about their strategies for containing the cost of specialty drugs for the plan with the largest enrollment.

Under the Affordable Care Act, non-grandfathered plans are required to have an out-of- pocket maximum. Non-grandfathered plans who indicated that they did not have an out of pocket maximum were asked to confirm whether their plan was grandfathered and whether that plan had an out-of-pocket maximum.

For more detail about the 2015 survey, see the Survey Methodology section of that year’s report.

2016

Between 2015 and 2016, we conducted a series of focus groups that led us to the conclusion that human resource and benefit managers at firms with between 20 and 49 employees think about health insurance premiums more similarly to benefit managers at smaller firms than larger firms. Therefore, starting in 2016, we altered the health insurance premium question pathway for firms with between 20-49 employees to match that of firms with 3-19 employees rather than firms with 50 or more employees. This change affected firms representing 8% of the total covered worker weight. We believe that these questions produce comparable responses and that this edit does not create a break in trend.

Starting in 2016, we made significant revisions to how the survey asks employers about their prescription drug coverage. In most cases, information reported in the Prescription Drug Benefits section is not comparable with previous years’ findings. First, in addition to the four standard tiers of drugs (generics, preferred, non-preferred, and lifestyle), we began asking firms about cost sharing for a drug tier that covers only specialty drugs. This new tier pathway in the questionnaire has an effect on the trend of the four standard tiers, since respondents to the 2015 survey might have previously categorized their specialty drug tier as one of the other four standard tiers. We did not modify the question about the number of tiers a firm’s cost-sharing structure has, but in cases in which the highest tier covered exclusively specialty drugs we reported it separately. For example, a firm with three tiers may only have copays or coinsurances for two tiers because their third tier copay or coinsurance is being reported as a specialty tier. Furthermore, in order to reduce survey burden, firms were asked about the plan attributes of only their plan type with the most enrollment. Therefore, in most cases, we no longer make comparisons between plan types. Lastly, prior to 2016, we required firms’ cost sharing tiers to be sequential, meaning that the second tier copay was higher than the first tier, the third tier was higher than the second, and the fourth was higher than the third. As drug formularies have become more intricate, many firms have minimum and maximums attached to their copays and coinsurances, leading us to believe it was no longer appropriate to assume that a firm’s cost sharing followed this sequential logic.

In cases where a firm had multiple plans, they were asked about their strategies for containing the cost of specialty drugs for the plan type with the largest enrollment. Between 2015 and 2016, we modified the series of ‘Select All That Apply’ questions regarding cost containment strategies for specialty drugs. In 2016, we elected to impute firms’ responses to these questions. We removed the option “Separate cost sharing tier for specialty drugs” and added specialty drugs as their own drug tier questionnaire pathway. We added question options on mail order drugs and prior authorization.

In 2016, we modified our questions about telemedicine to clarify that we were interested in the provision of health care services, and not merely the exchange of information, through telecommunication. We also added dependent and spousal questions to our health risk assessment question pathway.

For more detail about the 2016 survey, see the Survey Methodology section of that year’s report.

2017

While the Kaiser/HRET survey similar to other employer and household surveys has seen a general decrease in response rates over time, the decrease between the 2016 and 2017 response rates is not solely explained by this trend. In order to improve statistical power among sub-groups, including small firms and those with a high share of low income workers, the size of the sample was expanded from 5,732 in 2016 to 7,895 in 2017. As a result, the 2017 survey includes 204 more completes than the 2016 survey. While this generally increases the precision of estimates (for example, a reduction in the standard error for the offer rate from 2.2% to 1.8%), it has the effect of reducing the response rate. In 2017, non-panel firms had a response rate of 17%, compared to 62% for firms that had participated in one of the last two years.

To increase response rates, firms with 3-9 employees were offered an incentive for participating in the survey. A third of these firms were sent a $5 Starbucks gift card in the advance letter, a third were offered an incentive of $50 in cash or as a donation to a charity of their choice after completing the full survey, and a third of firms were offered no incentive at all. Our analysis does not show significant differences in responses to key variables among these incentive groups.

In 2017, weights were not adjusted using the nonresponse adjustment process described in previous years’ methods. As in past years, Kaiser/HRET conducted a small follow-up survey of those firms with 3-49 workers that refused to participate in the full survey. Based on the results of a McNemar test, we were not able to verify that the results of the follow-up survey were comparable to the results from the original survey. In 2010 and 2015, the results of the McNemar test were also significant and we did not conduct a nonresponse adjustment.

To reduce the length of survey, in several areas, including stoploss coverage for self-funded firms and cost sharing for hospital admissions, outpatient surgery, and emergency room visits, we revised the questionnaire to ask respondents about the attributes of their largest health plan rather than each plan type they may offer. This expands on the method we used for prescription drug coverage in 2016. Therefore, for these topics, aggregate variables represent the attributes of the firm’s largest plan type, and are not a weighted average of all of the firms plan types. In previous surveys, if a firm had two plan types, one with a copayment and one with a coinsurance for hospital admissions, the covered worker weight was allotted proportionally toward the average copayment and coinsurance based on the number of covered workers with either feature. With of this change, comparison among plans types is now a comparison of firms where any given plan type is the largest. The change only affects firms that have multiple plan types (58% of covered workers). After reviewing the responses and comparing them to prior years where we asked about each plan type, we find that the information we are receiving is similar to responses from previous years. For this reason, we will continue to report our results for these questions weighted by the number of covered workers in responding firms.

Starting in 2017, respondents were allowed to volunteer that their plans did not cover outpatient surgery or hospital admissions. Less than 1% of respondents indicated that their plan did not include coverage for these services. Cost sharing for hospital admissions, outpatient surgery and emergency room visits was imputed by drawing a firm similar in size and industry within the same plan type.

For more detail about the 2017 survey, see the Survey Methodology section of that year’s report.

2018

As in past years, we conducted a small follow-up survey of those firms with 3-49 workers that refused to participate in the full survey. Based on the results of a McNemar test, we were not able to verify that the results of the follow-up survey were comparable to the results from the original survey, and weights were not adjusted using the nonresponse adjustment process described in previous years’ methods. In 2010, 2015, and 2017, the results of the McNemar test were also significant and we did not conduct a nonresponse adjustment.

In light of a number of regulatory changes and policy proposals, we included new questions on the anticipated effects of the ACA’s individual mandate penalty repeal on the firm’s health benefits offerings, and the impact of the delay of the high cost plan tax, also known as the Cadillac tax, on the firm’s health benefits decisions. Also new in 2018 are questions asking about smaller firms’ use of level-funded premium plans, an alternative self-funding method with integrated stop loss coverage and a fixed monthly premium.

In 2018, we moved the battery of worker demographics questions from near the beginning of the survey to the end of the survey in an effort to improve the flow. There is no evidence that this move has impacted our survey findings and we will continue to monitor any suspected impacts.

The 2018 survey also expands on retiree health benefits questions, asking firms about cost reduction strategies, whether they contribute to the cost of coverage, and how retiree benefits are offered (e.g., through a Medicare Advantage contract, a traditional employer plan, private exchange, etc.).

Starting in 2018, we allowed respondents who did not know the combined maximum incentive or penalty an employee could receive for health screening and/or wellness and health promotion to answer a categorical question with specified ranges. This method is consistent with how we handle the percent of low-wage and high-wage workers at a firm. In 2018, 18% of respondents did not know the dollar value of the their incentive or penalty and 39% were able to estimate a range.

Starting in 2018, the survey began asking small firms who indicated that their plan was fully-insured whether the plan was level-funded. In a level-funded plan, employers make a set payment each month to an insurer or third party administrator which funds a reserve account for claims, administrative costs, and premiums for stop-loss coverage. These plans are often integrated and firms may not understand the complexities of the self-funded mechanisms underlying them. Some small employers who indicate that their plan is self-funded may also offer a plan that meets this definition. Respondents offering level funded plans were asked about any attachment points applying to enrollees. These firms were not less likely to answer this question, and including them doesn’t not substantially change the average. Prior to 2018, all firms reporting coverage as underwritten by an insurer were excluded from the stop-loss calculations.

The response option choices for the type of incentive or penalty for completing biometric screening or a health risk assessment changed from 2017 to 2018.

For more detail about the 2018 survey, see the Survey Methodology section of that year’s report.

2019

Starting in 2019, we discontinued a weighting adjustment informed by a follow-back survey of firms with 3-49 workers that refused to participate in the full survey. This adjustment was intended to reduce non-response bias in the offer rate statistic, under the assumption that firms that did not complete the survey were less likely to offer health benefits. The adjustment involves comparing the distribution of offering to non-offering firms in the full survey and the follow-back sample in the three smallest size categories (3-9, 10-24, 25-49). The adjustment is based on the differences between the two groups of firms and generally operates to adjust the weights of offering firms and non-offering firms to bring the counts closer together. However, if the distributions of the two groups differ to a statistically significant extent, we consider the follow-back survey to be a different population from the full survey and do not make any adjustment to the weights.

Although we cannot be sure of the reason, we are no longer witnessing the systematic upward bias on estimates for the offer rates of small firms that gave rise to the adjustment. Looking at the decade from 2010 to 2019, offer rates among firms responding to the follow-up survey have been higher for five of ten surveys. Firms with 3-49 employees responding to this follow-up survey have reported a higher offer rate than the full EHBS survey during the 2014, 2016, 2017, 2018, and 2019 surveys. An alternative way to measure non-response bias is to compare estimates throughout the fielding period.

In 2019, the percent of firms offering health benefit was similar in the last month of fielding to offer rates throughout the entire fielding period. Changes in both the survey methodology and the health insurance market have led us to become increasingly cautious about assuming that the follow back survey is a suitable proxy for the true population. Since 2014, we have collected offer rate information from firms before a final disposition is assigned. This method was introduced to reduce a bias in which firms who offer health benefits face a longer average survey than non-offering firms. This had the effect of increasing the percentage of firms for whom contact was made from whom we collected offer rate information. Additionally, we have also attempted to reduce non-response bias by increasing our data collection.

Recent changes in the marketplace also raise some concerns about the validity of the follow-back survey to be the basis for a weight adjustment. We have in recent years seen an increase in non-offering firms reporting that they are providing funds to employees to purchase non-group health insurance. We do not consider this to be an offer of health insurance by the firm, but we are concerned that the person who responds to the follow-back survey may not be able to make that distinction. The follow-back survey is a very simple set of questions asked to whoever answers the phone at a firm that refused to participate in the survey. In contrast, during the full-survey, we attempt to talk to the person most knowledgeable about health benefits, and the interviewers are trained to distinguish between types of benefit programs.

For 2019, making the weight adjustment would change offer rate statistic for all firms from 57% to 60%. Neither estimate is different than the 57% we reported last year (when the weight adjustment was not made because the statistical test indicated that the follow-back group was significantly different than the full survey group).

Starting in 2019, all presented calculations of out-of-pocket maximums strictly relied on an arithmetic average across all plans weighted by covered worker plan enrollment. In prior surveys, some figures (for example Figures 7.43, 7.45, and 7.46 in the 2018 report) were calculated based on the out-of-pocket maximum of the largest plan. This change did not meaningfully change any findings and ensured consistency within the out-of-pocket maximum section of the Employee Cost Sharing section.

For prescription drug coverage, similar to years past, if the firm reports that the worker pays the full cost for drugs on a particular tier and/or that the plan only offers access to a discount program, we do not consider this as offering covering for that drug tier. Starting this year, firms with multiple tiers that cover exclusively specialty drugs, were asked about the cost-sharing of the tier that is used most often. Cost-sharing for prescription drugs does not typically include mail order. Hospital, outpatient surgery and prescription drug cost-sharing was only asked of a firm’s largest plan type.

For 2019, we clarified the question that we use to ask firms whether or not they provide retiree health benefits; particularly, we added language that explicitly stated that firms that had terminated retiree health benefits but still has some retirees currently getting coverage, or that had current employees who will get retiree health coverage in the future, should answer yes to the question. We made this clarification in response to a large decline in the 2018 survey in the prevalence of retiree coverage (from 25% in 2017 to 18% in 2018). In the 2018 survey, we expressed concern that the then current public focus on public entities eliminating retiree benefits for future (not existing) retirees may be influencing the responses we were getting and said that we were going to add clarifying language to the survey question in future years.

For 2019, two open-ended questions were added to the survey in order to examine employer responses to the opioid crisis and obstacles preventing firms from adopting narrow network health plans. All responses to these questions were reviewed in a consistent manner by KFF staff to determine whether they could be recoded as an earlier multiple choice item, or if they could be sorted into new categories.

To increase participation in the final two weeks of the survey, a financial incentive was offered to firms with 3-9 employees, but only 6 firms that completed the survey within that time period qualified for the incentive. All respondents received a printed copy of the survey findings.

For more detail about the 2019 survey, see the Survey Methodology section of that year’s report.

2020

2020 was a challenging year both in administering the survey, as well as for many of our respondents who were scrambling to respond to the pandemic and the ensuing economic downturn. Our questionnaire was developed before the extent of the pandemic became apparent and the fielding period included response from both before and after. We asked respondents about their plans at the time of the interview, with approximately half of the responses (composing 50% of the covered worker weight) collected between January and March. The remaining interviews were completed before the middle of July. The survey is designed to track changes in benefit and cost between years and is not well suited to answer many of the important questions that emerged this year for a couple of reasons. Firstly, employers make decisions about their plans before the plan year begins. Premiums for self-funded employers are usually reported as the cost for a former worker to enroll in COBRA (deflated by an administrative fee) and do not reflect real-time spending. Many other plan features, including provider networks and cost-sharing, are set before a plan’s open enrollment period. We expect to learn more about how changes in benefits and utilization affected cost in the 2021 survey. Secondly, the month in which a respondent completes the survey is not random, the data collection firm completes interviews with larger panel firms first. We do not believe that these firms are similar to the non-panel firms that complete the survey later in the year. We believe these firms differ in ways which are not corrected for by weighting, which means we cannot look at how responses changed over the period to detect patterns of change. Thirdly, our sample is not sufficient to make many comparisons across fielding period. We plan to ask employers about changes to their plans and the impact of COVID-19 on their decision making in the 2021 survey.

In the summer of 2019, National Research LLC, which had conducted the Employer Health Benefit Survey since its inception, ceased operation. We engaged in a search to identify a new firm to conduct the 2020 survey and selected Davis Research LLC, based on their extensive experience in research on firms and establishments. While we believe that the sampling methodology, questionnaire and survey procedures were consistent between years, readers are strongly encouraged to consider “total survey error” when drawing conclusions about differences between statistics. Survey-adjusted standard errors (and statistical testing) measure uncertainty in estimates based on the sampling strategy, but do not measure biases that may be introduced through the data collection process such as interviewer or house effects. House effects refer to the impact of a data collection firm’s management and workflow processes on final statistics. We do not know how, or if at all, changing the data collection firm from National Research to Davis impacted estimates. Empirical studies of house effects vary greatly, with some reporting almost no impact and others observing significant differences in point estimates.

In order to minimize house effect impacts, we conducted extensive interview training with managers and interviewers at Davis, including sessions lead by interviewers with prior experience on the project. In addition, KFF pretested and observed interviews to verify that Davis’ quality assurance process was consistent with our understanding of how the survey had been conducted historically.

Starting in 2020, we limited the number of margins used to calibrate weights and adjust for non-response. Until 2019, our weighting procedure incorporated offer status, firm size, geographic region, and metropolitan status to adjust for unit nonresponse. Our 2020 weighting algorithm no longer relies on metropolitan vs. non-metropolitan as part of the non-response calculation. Separately, earlier surveys post-stratified each firm’s set of weights to industry, firm size, census division, and panel versus non-panel margins. Starting in 2020, we reduced this weight calibration to only industry and firm size controls. Finally, we collapsed industries in our 5,000+ employee firm size category, owing to the fact that many large businesses operate across multiple industries. All three of these changes were prompted by an increase in the number of calibration cells with low sample, which can result in individual firms with highly influential weights if not revised. Without this revision, some 2020 statistics would had been driven by a small number of firms with overly influential weights. Reducing the number of variables in these improves the stability of some published estimates. This issue arose in part due to the smaller number of completed interviews in 2020 relative to 2019.

Historically we measured the annual changes in workers’ wages and in inflation by comparing the values for April of the previous year and April of the current year. This year the labor market underwent significant disruptions in March and April as employers laid off and furloughed large numbers of workers in response to the COVID-19 pandemic. A relatively high share of lower-wage workers were furloughed and laid off during these months, resulting in a high change in wages as measured from April to April. In response to this unprecedented change in the labor market, we have elected to change how we calculate workers wages and inflation. Beginning with our 2020 publication, we are now calculating the change in workers wages and inflation based on an average of the first quarter of each year. Using this method, workers wages increased 3.4% compared to 7.7% between April and April. And similarly inflation increased 2.1% compared to 0.3%. Prior to 2020, both methods produced very similar estimates.

For more detail about the 2020 survey, see the Survey Methodology section of that year’s report.

2021

This year we made several changes to the survey questionnaire in order to reduce the length and burden of the survey; rather than asking benefit managers about the characteristics of up to four plan types, we asked for the premiums and deductibles of the largest two plan types and other cost information for only the largest. We now only ask about cost-sharing for prescription drugs, hospitalizations, outpatient surgery and office visits for the plan type with the most enrollment. This change mostly impacts the largest firms which are more likely to sponsor multiple plan types. As in prior years, if a firm sponsors multiple plans, of the same plan type, for example, several PPOs across the country, we ask about only the one with the most enrollment. In 2021, 13% of respondents offered three or more plan types – in total the largest plan type accounts for 82% of workers covered by health benefits and the largest two plan types represents 98%. For this reason, this change will only have a minimal impact on most estimates. Furthermore, in prior years we observed no systematic bias in key metrics across the plan type rank at each firm. For example, in 2020, among firms with three or more plan types, the third-largest plan had statistically similar premiums and deductibles to the larger plan types on average. This change did not require a change in how many of the the all firm variables are calculated. To determine the all plan value for categorical variables describing plans, we continue to use the largest type as a proxy. To do so, we identify the plan type that has the largest enrollment within the observation and use data from that plan as a proxy for the all-plan aggregate for that firm. For example, in previous years, we would ask an employer whether their HMO, PPO, POS and HDHP/SO were self-funded, and then report the response from largest plan type as the all firm response.

For the first time, a subset of employers were invited to complete the survey online, though in total 99% of the interviews were completed through computer-assisted telephone interviewing.

For more detail about the 2021 survey, see the Survey Methodology section of that year’s report.

2022

In 2022, we incorporated the California Employer Health Benefits Survey (CHBS) from the California Health Care Foundation (CHCF) into EHBS by oversampling firms with any presence in California and including new questions into the main EHBS instrument to determine firms with any employment in the state of California. Unlike other years, the 2022 EHBS used as its panel both respondents to either of the prior two years of EHBS (2020 and 2021) and also respondents to either of the prior two years of CHBS (2018 and 2020). Since many larger firms operate across state lines, the integration of CHBS with EHBS aimed to reduce survey burden among firms that had previously responded to both surveys. Among the N=1,140 large firms responding to the 2022 EHBS, 419 of those responding firms (37%) had any presence in California, highlighting the overlap across these two projects. Given the size of the California oversample needed to assure statistical reliability both nationally and within California, firm weights were calibrated to California-specific targets from the SUSB.

In 2022, Davis extended computer assisted web interview (CAWI) capacity, offering most respondents the opportunity to complete the survey using an online questionnaire rather a telephone interview. Although only 1% of respondents used this survey mode during the initial 2021 attempt, 43% of 2022 survey respondents answered EHBS via CAWI.

Survey mode did not impact the survey results in a systematic or obvious manner. The effects of mode and firm size on major firm characteristics such as annual premiums, contributions, and deductibles was modeled using standard linear regression. For certain plan types, survey implementation through telephone interview had a negative effect on the reported value. However, the plan types affected were random, so this effect is more likely due to confounding variables. When examining demographic characteristics between the two modes, there were small differences in the distribution of categorical variables such as region and age. However, without multiple years of data utilizing the two modes, it is impossible to determine if these are systematic biases. The imputation rate between the two modes was almost identical.

For more detail about the 2022 survey, see the Survey Methodology section of that year’s report.

2023

The 2023 survey features questions which have not been asked for several years including questions on spousal benefits, voluntary benefits, such as dental and vision coverage, waiting periods and emergency room cost-sharing. In addition, the survey includes new questions, on abortion coverage, prior authorization, coverage limits and coverage for gender-affirming care.

In 2022, the Employer Health Benefit Survey over-sampled California based firms in order to provide estimates for the California Health Care Foundation’s Health Benefit Survey. For more information please see: https://www.chcf.org/publication/2023-edition-california-employer-health-benefits/. As a result, both our weighting and sampling in 2022 took into account whether a firm was located in California. In 2023, we sampled non-panel firms based on whether they were located in California. Our 2023 sampling method is similar to the methods used prior to 2022, and is based on a firms size and industry.

As in previous years, modification were made to existing survey questions, both to improve clarity or respond to changes in the marketplace.

• Starting in 2023, respondents are able to provide either monthly or annual HSA contribution amounts.
• The interview notes for the question on level-funding was editing to clarify that employing a third-party administrator does not necessarily mean a plan is level-funded.
• The question on whether a firm or plan gives workers the opportunity to complete biometeric screening was edited to include take-home kits, which collect biometetric data, not just in-person exams.
• The distribution of cost-sharing for hospital admission and outpatient surgery was edited, to make the categories “copay”, “coninsurance”, and “both copay and coinsurance”, mutually exclusive. The both category may include covered workers who face either both cost-sharing requirements or which ever is greater.

Based on interview debriefs, we elected not to report the share of employers who believe that telehealth will be important for enrollees in remote settings. We continue to revise our data cleaning and editing procedures.

For more detail about the 2023 survey, see the Survey Methodology section of that year’s report.

2024

The 2024 survey features new questions, on prescription drug policy, mental health and substance use, GLP-1 drug coverage, family-building services, transparency, and affordability issues for lower-wage workers.

As in previous years, modification were made to existing survey questions, both to improve clarity or respond to changes in the marketplace. Starting in 2024, the introductory text for web-based interviews was condensed. In an effort to reduce respondent burden, we removed questions on waiting periods, emergency room cost sharing, wellness program incentives, disease management, sites of care, and prior authorization. We also restricted clarification follow-up calls (or callbacks) to only firms with at least one premium or cost sharing-related item: observations for firms with outliers only in the drug tier section of the questionnaire were imputed based on logic rules.

In some cases respondents report they offer coverage, but do not offer a comprehensive major medical plan. This year we added additional questions to clarify whether plans with low premiums were major medical plans. We dropped fewer than five firms where the respondent told us they did not cover most physician services and hospital admissions other than preventative care from the premium average.

9.8 percent of respondents in 2024 were either unable to provide their firm’s single coverage premium, or provided a response which was logically inconsistent with other values. In these cases, in order to minimize non-response bias, missing responses were imputed. In prior years, if a firm was missing a single premium value, this value was imputed using a ‘hot deck’ approach in which a single premium was selected among firms with similar demographic characteristics. This year we revised this method. In cases in which both the single and family premiums were missing, the single premium was estimated based on other known characteristics of the plan and firm. This method is advantageous because it predicts single premiums based on specific firm characteristics related to the premium, such as cost-sharing and deductibles, as well as demographics. Then, the family premium, as well as single and family worker contributions (if missing), were subsequently hot decked based on their relationship to the single premium. In cases in which a firm provides a response to the family premium, the single premium is imputed based on a ratio of the premiums. Therefore, in total, 8% of responses were affected by this change.

The updated imputation process uses a random forest machine learning model. The model was trained on EHBS data from 2021-2023. Features were selected using step wise regression. The hyper-parameters of the model were tuned using the grid search algorithm. Compared to hot-decking, this method is significantly better at explaining the variation in the observed data (R-squared of 0.2071 versus 0.00018540). This methodological change has a relatively minor impact on the overall premium; the 2024 premium would be 0.8% different if we did not implement the new method. However, this change meaningfully impacts the precision of premium estimates for demographic subgroups.

For more detail about the 2024 survey, see the Survey Methodology section of that year’s report.

2025

The 2025 survey includes new questions on primary care, menopause benefits, direct contracting, specialty networks, and transparency, among other topics. As in previous years, modifications were also made to existing questions to improve clarity and reflect changes in the health care marketplace.

In 2025, we fielded an oversample of California-based employers to generate separate state-level estimates for the CHCF/KFF California Employer Health Benefits Survey (CHBS). KFF and the California Health Care Foundation (CHCF) have previously included California-specific questions and an oversample of firms located in the state. The 2025 California Employer Health Benefits Survey will produce estimates comparable to those in the 2022 CHBS. Firms with workers in California are included in both the 2025 EHBS and CHBS. To ensure statistical reliability at both the national and state levels, firm weights for the California sample were calibrated to state-specific targets from the U.S. Census Bureau’s Statistics of U.S. Businesses (SUSB). All firms were asked about the characteristics of their workforce nationwide and if applicable in California.

Firms with 70,000 or more employees account for 14% of workers in the United States. As a result, the accuracy of estimates depends heavily on the participation of these large employers. In recent years, however, participation among the largest firms has declined. In 2014, survey respondents included firms of this size employing about 9% of the nation’s covered workforce; by 2024, this share had fallen to 4%. While the total number of responding firms has remained relatively stable, the survey now includes fewer firms that have large workforces. Although there are likely multiple reasons for the decline in participation among large firms, one potential concern is that these firms may be underrepresented in the sample frame.

To address this issue, beginning in 2025, we implemented an augmented sample drawn from the Forbes America’s Largest Private Companies list, which includes U.S.-based firms with annual revenues of $2 billion or more. This supplemental sample was designed to enhance representation of the largest employers and complement the primary Dynata sample frame. For this augmented sample, Davis Research conducted outreach to multiple individuals at each firm, targeting staff with human resources-related titles.

Beginning in 2025, the survey will no longer include firms with 3 to 9 employees. This change reflects longstanding challenges in surveying the smallest firms and their limited influence on national estimates. Although there are 1.95 million such firms in the U.S., they employ a very small share of the workforce and present significant methodological difficulties.

In 2024, only 151 firms in this size range responded to the survey, and just 29 reported offering health benefits. Due to their small numbers, each responding firm carried substantial weight in employer-level estimates—on average, offering firms with 3-9 employees were weighted 58 times more heavily than larger firms. As a result, a small number of responses have disproportionate influence on employer-weighted estimates, even though these firms often had more limited knowledge of their health plans. The response rate for offering firms in this group was also significantly lower than the overall rate (6.5% vs. 14%).

At the same time, these firms have minimal impact on most covered worker-weighted estimates, such as premiums, contributions, deductibles and other cost-sharing. For example, the average family premium when including versus excluding 3-9 employee firms in 2024 differed by only $13 because they account for just 3.7% of all covered workers. For more information on the sample distribution and responses rates including firms with 3 to 9 employees see the 2024 methods section.

Given these factors — low response rates, high variability, and limited influence on key national estimates — firms with fewer than 10 employees were removed from the sample universe starting in 2025.

This change most directly affects the firm offer rate. In 2024, the offer rate among firms with 10 or more employees was 65% compared to 54% among firms with 3 or more employees. While this adjustment reduces insight into the smallest firms, it improves the precision and reliability of estimates for the remaining sample universe.

After fielding the 2025 survey, we discovered a skip pattern mistake that led to a sharp reduction in the number of firms refusing the full survey but responding to the question “Does your company offer a health insurance program as a benefit to any of your employees?” In the past few years, more than 2,000 firms have answered only this question but not the full survey; however, the error reduced this segment’s 2025 unweighted sample to only about 700 firms. Although this oversight decreased the precision of our 2025 offer rate estimates, we reviewed the questionnaire pathways and do not believe to have introduced bias in the manner of data collection. Both including and excluding these additional firms yielded the same percentage point estimates both last year and this year: 65% in 2024 and 61% in 2025. This oversight also reduced our 2025 combined response rate to 17% compared to 30% last year, since fewer eligible firms were given an opportunity to answer this standalone question. (The 2024 Table M.1 shows 31% including firms with 3-9 employees.) We expect to remedy this issue in the 2026 setup and hope to collect single-question information from a larger pool of firms as consistent with recent years.

For more detail about the 2025 survey, see the Survey Methodology section of that year’s report.

---

5. May 2024 Data from the Occupational Employment and Wage Statistics (OEWS) Survey. Bureau of Labor Statistics. Occupational Employment and Wage Statistics (OEWS) Tables [Internet]. Washington (DC): BLS; [cited 2026 Sep 24]. Available from: https://www.bls.gov/oes/tables.htm↩︎
6. Bureau of Labor Statistics, Mid-Atlantic Information Office. Consumer Price Index historical tables for, U.S. City Average (1967 = 100) of Annual Inflation [Internet]. Washington (DC): BLS; [cited 2026 Sep 24]. Available from: https://www.bls.gov/regions/mid-atlantic/data/consumerpriceindexhistorical1967base_us_table.htm↩︎
7. Seidenberg, Andrew B, Richard P Moser, and Brady T West. 2023. “Preferred Reporting Items for Complex Sample Survey Analysis (PRICSSA).” Journal of Survey Statistics and Methodology 11 (4): 743-57. https://doi.org/10.1093/jssam/smac040.↩︎

The average annual health insurance premiums in 2026 are $9,804 for single coverage and $28,303 for family coverage. The average single coverage premium increased 5% in 2026, the same as the average family premium increased (5%). The average family premium has increased 28% since 2021 and 55% since 2016.

As part of this report, KFF publishes an online tool which allows users to look at changes in premiums and worker contributions for covered workers at different types of firms over time: https://www.kff.org/interactive/premiums-and-worker-contributions/

PREMIUMS FOR SINGLE AND FAMILY COVERAGE

The average premium for single coverage in 2026 is $9,804 per year. The average premium for family coverage is $28,303 per year [Figure 1.1].

• The average annual premiums for single coverage are similar for covered workers at firms with 10 to 199 workers ($9,593) and at larger firms ($9,865) [Figure 1.3].
• The average annual premiums for family coverage are lower for covered workers at firms with 10 to 199 workers ($27,288) than for those at larger firms ($28,592) [Figure 1.3].
• The average annual premiums for covered workers in HSA-qualified plans are lower than the average premiums for coverage overall for both single coverage ($8,989 vs. $9,804) and family coverage ($26,450 vs. $28,303). The average premiums for covered workers in PPOs are higher than the overall average premiums for both single coverage ($10,272 vs. $9,804) and family coverage ($29,522 vs. $28,303) [Figure 1.1].
• The average premium for covered workers with both single and family coverage is higher in the Northeast and lower in the South [Figure 1.4].
• The average premium for family coverage for covered workers at firms with relatively large shares of lower-wage workers (where at least 35% of workers earn $38,000 a year or less) is lower than the average premium for covered workers at firms with smaller shares of lower-wage workers ($26,533 vs. $28,524). The average premium for covered workers at firms with relatively large shares of higher-wage workers (where at least 35% of workers earn $82,000 a year or more) is higher than the average premium for covered workers at firms with smaller shares of higher-wage workers for family coverage ($29,139 vs. $27,664) [Figure 1.6] and [Figure 1.7].
• The average premium for family coverage for covered workers at firms with relatively large shares of older workers (firms where at least 35% of the workers are age 50 or older) is similar to the average premium for covered workers at firms with smaller shares of older workers ($28,689 and $27,889) [Figure 1.7].
• The average premiums for single coverage and family coverage are relatively lower for covered workers at private for-profit firms and relatively higher for covered workers at private not-for-profit firms [Figure 1.6] and [Figure 1.7].
• The average premiums for single coverage are relatively higher for covered workers at firms with at least some union workers than firms without any union workers [Figure 1.6].

Figure 1.1: Average Annual Premiums for Covered Workers, Single and Family Coverage, by Plan Type, 2026

Figure 1.2: Average Annual Premiums for Covered Workers, Single and Family Coverage, by Firm Size, 2026

Figure 1.3: Average Monthly and Annual Premiums for Covered Workers, by Plan Type and Firm Size, 2026

Figure 1.4: Average Monthly and Annual Premiums for Covered Workers, by Plan Type and Region, 2026

Figure 1.5: Average Monthly and Annual Premiums for Covered Workers, by Plan Type and Industry, 2026

Figure 1.6: Average Annual Premiums for Covered Workers With Single Coverage, by Firm Characteristics, 2026

Figure 1.7: Average Annual Premiums for Covered Workers With Family Coverage, by Firm Characteristics, 2026

Figure 1.8: Average Annual Premiums for Covered Workers, by Firm Characteristics and Firm Size, 2026

PREMIUM DISTRIBUTION

There is considerable variation in premiums for both single and family coverage.

• Eighteen percent of covered workers are employed at firms where the single premium is at least 20% higher than the average single premium, while 23% of covered workers are at firms with a single premium less than 80% of the average single premium [Figure 1.9].
• For family coverage, 17% of covered workers are employed at a firm with a family premium at least 20% higher than the average family premium, while 21% of covered workers are at firms with a family premium less than 80% of the average family premium [Figure 1.9].
• Thirteen percent of covered workers are employed at a firm with an average annual premium of at least $12,500 for single coverage [Figure 1.10]. Twenty-one percent of covered workers are employed at a firm with an average annual premium of at least $33,000 for family coverage [Figure 1.11].

Figure 1.9: Distribution of Annual Premiums for Single and Family Coverage Relative to the Average Annual Single or Family Premium, 2026

Figure 1.10: Distribution of Annual Premiums for Covered Workers With Single Coverage, 2026

Figure 1.11: Distribution of Annual Premiums for Covered Workers With Family Coverage, 2026

PREMIUM CHANGES OVER TIME

The average premiums for covered workers for both single and family coverage increased 5% from last year [Figure 1.12].

• The average premium for single coverage grew 27% over the past five years.
• The $28,303 average family premium in 2026 is 28% higher than the average family premium in 2021 and 55% higher than the average family premium in 2016. [Figure 1.15].
• The average family premiums for covered workers at smaller firms (firms with 10 to 199 workers) and at larger firms have grown at similar rates since 2021 (26% at smaller firms and 28% at larger firms). For smaller firms, the average family premium rose from $21,598 in 2021 to $27,288 in 2026. For larger firms, the average family premium rose from $22,389 in 2021 to $28,592 in 2026 [Figure 1.14].
• The average family premiums for covered workers at smaller firms (firms with 10 to 199 workers) and at larger firms have grown at similar rates since 2016 (54% at smaller firms and 55% at larger firms). For smaller firms, the average family premium rose from $17,753 in 2016 to $27,288 in 2026. For larger firms, the average family premium rose from $18,395 in 2016 to $28,592 in 2026 [Figure 1.13].
• Over the past five years, the average family premium for covered workers at large firms that are fully insured has grown at a similar rate to the average family premium for covered workers in fully or partially self-funded plans (33% for fully-insured plans and 27% for self-funded plans) [Figure 1.14].
• The average family premium grew 5% in 2026 while inflation was 2.7%. Over the last 5 years, family premiums grew 28%, while inflation during this period was 24.4%. Over the last ten years, the growth in the average premium for family coverage far outpaced inflation (55% vs. 37.9%) [Figure 1.15].
• The average family premium grew 5% in 2026 while wages grew 3.7%. Over the last 5 years, family premiums grew 28%, similar to the 26.9% growth in wages. Over the last ten years, the average family premium and average wages grew at roughly comparable rates (55% vs. 50.1%) [Figure 1.15].

Figure 1.12: Average Annual Premiums for Single and Family Coverage, 1999-2026

Figure 1.13: Average Annual Premiums for Covered Workers With Family Coverage, by Firm Size, 1999-2026

Figure 1.14: Among Workers in Large Firms, Average Annual Premiums for Family Coverage, by Funding Arrangement, 1999-2026

Figure 1.15: Cumulative Premium Increases, Inflation, and Earnings for Covered Workers With Family Coverage, 2001-2026

Nearly all (98%) firms with 200 or more workers offer health benefits to at least some workers, while two in three (66%) smaller firms do. Ninety-five percent of firms that offer health benefits offer both single and family coverage, similar to the percentage last year.

Firms with fewer than 200 workers that do not offer health benefits say the most important reason they do not offer coverage is that the “cost of insurance is too high.”

Beginning with the 2025 survey, the sample frame changed from firms with 3 or more employees to firms with 10 or more employees. Because firms with 3 to 9 employees historically have lower offer rates, excluding them increases overall offer rates and affects estimates for firms that do not offer coverage. Historical offer-rate tables have been adjusted to reflect this change. For more information, see the Methods section.

FIRM OFFER RATES

• In 2026, 67% of firms with 10 or more workers offer health benefits, higher than the percentage last year (61%) but similar to the percentage two years ago (65%) and lower than the percentage five years ago (73%) [Figure 2.1].
  • Among smaller firms (10 to 199 workers), the likelihood of offering health benefits increases with firm size: 59% of firms with 10 to 24 workers, 66% of firms with 25 to 49 workers, and 87% of firms with 50 to 199 workers offer health benefits to at least some of their workers [Figure 2.2].
  • The percentage of smaller firms that offer health benefits (66%) is higher than the percentage last year (59%) but lower than the percentage (72%) five years ago [Figure 2.1].
• A large majority of firms are small, and the survey sees considerable year-to-year variation in the offer rates for these firms, which results in fluctuations in the overall offer rate. Most workers, however, work for larger firms, where offer rates are much higher.
• + Eighty-nine percent of firms with 50 or more workers offer health benefits in 2026; this percentage has remained at or near ninety percent for each of the past 10 years [Figure 2.3].
  • Among larger firms, 98% of firms with 200 to 999 workers and over 99% of firms with 1,000 or more workers offer health benefits to at least some of their workers. These percentages are similar to those last year.
• Because most workers are employed by larger firms, most workers work at a firm that offers health benefits to at least some of its employees. In 2026, 92% of all workers are employed by a firm that offers health benefits to at least some of its workers. This percentage is similar to the percentage last year (91%) but lower than the percentage five years ago (94%) [Figure 2.4].

Figure 2.1: Percentage of Firms Offering Health Benefits, by Firm Size, 1999-2026

Figure 2.2: Percentage of Firms Offering Health Benefits, by Firm Size, Region, and Industry, 2026

Figure 2.3: Percentage of Firms and Workers at Firms Offering Health Benefits,

Figure 2.4: Percentage of Workers at Firms That Offer Health Benefits to at Least Some Workers, by Firm Size, 1999-2026

OFFERS TO SPOUSES AND DEPENDENTS

• Almost all firms that offer health benefits offer family coverage. In 2026, nearly all firms with 200 or more workers and 94% of smaller firms that offer health benefits offer family coverage to their workers [Figure 2.5].
• The vast majority of firms with 10 or more workers that offer health benefits offer them to spouses and dependents, such as children.
  • Ninety-four percent of smaller firms and virtually all larger firms that offer health benefits offer coverage to spouses. These percentages are similar to the percentages in 2025 [Figure 2.6].
  • Ninety-three percent of smaller firms and virtually all larger firms that offer health benefits offer coverage to dependents other than spouses, such as children. These percentages are similar to the percentages in 2025 [Figure 2.6].
  • Seven percent of firms with 10 to 49 workers offering health benefits offer only single coverage to their workers, similar to the percentage last year.

Figure 2.5: Percentage of Firms Offering Health Benefits Which Offer Family Coverage, by Firm Size, 2026

Figure 2.6: Among Firms Offering Health Benefits, Availability of Coverage for Spouses and Other Dependents, by Firm Size, 2026

PROVISIONS TO ENCOURAGE ENROLLMENT IN OTHER COVERAGE

Some firms have provisions to encourage workers or their spouses to forgo enrolling in coverage, or to choose other sources of coverage when available.

• Among firms with 10 or more workers offering coverage, 7% provide additional compensation or benefits to workers if they choose not to enroll in the firm’s health plan and 8% provide additional compensation or benefits to workers who choose to enroll in a spouses health plan [Figure 2.7].

SPOUSAL ELIGIBILITY AND SURCHARGES

Some employers place conditions on the ability of dependent spouses to enroll in a health plan if the spouse is offered health insurance from another source, such as the spouse’s own employer.

• Among firms offering health benefits to spouses, 81% say that an employee’s spouse is able to enroll in the employee’s health plan even if the spouse is offered coverage from another source, 6% say the spouse can enroll subject to some conditions (for example, the type of coverage offered), and 13% say that the spouse is not eligible to enroll if they have access to another source of coverage [Figure 2.8].
  • Firms with 1,000 or more workers are more likely than smaller firms to allow these spouses to enroll with conditions (17% vs. 6%).
• Among firms offering coverage (with or without conditions) to spouses with access to other coverage, 8% require the spouses to pay more than spouses without access to other coverage if they decide to enroll. This may be implemented through higher premium contributions or higher cost sharing. Firms with 1,000 or more workers are more likely than smaller firms to have restrictions or assess higher costs to spouses with access to other coverage (17% vs. 8%).
• Overall, 24% of firms offering spousal coverage restrict eligibility or require a surcharge for spouses who have an offer of coverage from another source. Among large firms (200 or more workers) offering spousal coverage, this share is 29%, up from 22% in 2022 [Figure 2.9].

Figure 2.7: Percentage of Firms That Provide Workers Additional Incentives for Various Enrollment Decisions, by Firm Size, 2026

Figure 2.8: Among Firms Offering Spousal Coverage, Spouses’ Eligibility If They Have an Offer From Another Source, by Firm Size, 2026

Figure 2.9: Among Large Firms That Offer Spousal Coverage, Spouses’ Eligibility If They Have an Offer From Another Source, by Firm Size, 2026

PART-TIME WORKERS

Among firms that offer health benefits, relatively few offer benefits to part-time workers.

The Affordable Care Act (ACA) defines “full-time” workers as those who work an average of at least 30 hours per week, and “part-time” workers as those who work fewer than 30 hours. The employer shared responsibility provision of the ACA requires that firms with at least 50 full-time equivalent employees offer most of their full-time employees coverage that meets minimum standards or be assessed a penalty.⁸

• Twenty-nine percent of firms with 200 or more workers that offer health benefits in 2026 offer health benefits to part-time workers, similar to the percentage (27%) that did so in 2025. Firms with 200 or more workers are more likely than smaller firms to offer health benefits to part-time workers [Figure 2.11].

Figure 2.10: Among Firms Offering Health Benefits, Percentage That Offer to Part-Time Workers, by Firm Size, 1999-2026

Figure 2.11: Among Firms Offering Health Benefits, Percentage That Offer to Part-Time Workers, by Firm Size, 2026

CHOICE/ICHRA AND ASSISTING EMPLOYEES WITH PURCHASING COVERAGE IN THE NON-GROUP MARKET

Some employers provide funds to some or all of their employees to help them purchase coverage in the individual (“non-group”) market. Employers that do not otherwise offer health benefits may provide these funds as an alternative to offering a group plan. Employers that offer a group plan to some employees may also use this approach for other types or classes of workers, such as those working part-time or remotely.

One way employers can provide tax-preferred assistance for employees to purchase non-group coverage is through a Custom Health Option and Individual Care Expense Arrangement (CHOICE). Prior to 2026, these arrangements were called Individual Coverage Health Reimbursement Arrangements (ICHRAs). Small employers may also contribute toward employees’ health coverage through a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). Both employers that offer health benefits and those that do not were asked whether they provide funds to any employees to purchase non-group coverage.

• Four percent of firms that offer health benefits and 11% of firms that do not offer health benefits provided funds to one or more of their employees to purchase non-group coverage in 2026 [Figure 2.12].
• Among firms with 10 to 199 workers that do not offer health benefits, 11% offer funds to one or more of their employees to purchase non-group coverage, a similar percentage as last year (9%) [Figure 2.14].
• Firms that do not offer funds to any employees to purchase non-group coverage in 2026 were asked if they were likely to do so in the next two years.
  • Among firms with 10 or more workers that offer health benefits, 6% say they are “somewhat likely” to offer a CHOICE/ICHRA to at least some employees in the next two years [Figure 2.13].
  • • Among firms with 10 to 199 workers that do not offer health benefits, 2% say they are “very likely” and an additional 13% say they are “somewhat likely” to offer a CHOICE/ICHRA to at least some employees in the next two years [Figure 2.15].

Figure 2.12: Among Firms Offering Health Benefits, Percentage of Firms That Provide Workers Funds to Purchase Non-Group Insurance, Such As Through an ICHRA, by Firm Size, 2026

Figure 2.13: Likelihood of Offering an ICHRA in the Next Two Years Among Firms That Offer Health Benefits But Do Not Currently Offer an ICHRA, by Firm Size, 2026

Figure 2.14: Among Small Firms Not Offering Health Benefits, Percentage Providing Funds for Employees to Purchase Non-Group Insurance, 2012-2026

Figure 2.15: Likelihood of Offering an ICHRA in the Next Two Years Among Small Firms Not Offering Health Benefits, 2021-2026

FIRMS NOT OFFERING HEALTH BENEFITS

Firms that do not offer health benefits were asked several questions, including whether they have offered insurance or shopped for insurance in the recent past, what their most important reasons for not offering coverage are, and their opinion on whether their employees would prefer an increase in wages or health insurance if additional funds were available to increase their compensation. Because very few larger firms report not offering health benefits, we present responses only for firms with 10 to 199 workers.

• The “cost of insurance is too high” is the most common reason these firms cite for not offering health benefits. When firms were asked the most important reason for not offering coverage, 46% say the “cost of insurance is too high,” 13% say the “firm is too small,” 10% say that their “employees are covered under another plan, including coverage on a spouse’s plan,” 7% say that “their employees will get a better deal on the health insurance exchanges,” 10% say that “most employees are part-time or temporary workers”, and 8% say their “employees are not interested.” [Figure 2.16]
• Some firms not offering health benefits have either offered health insurance in the past five years or shopped for health insurance in the past year [Figure 2.17].
  • Sixteen percent of firms not offering health benefits have offered health benefits in the past five years [Figure 2.17].
  • Among these firms, 10% stopped offering coverage within the past year.Among firms that stopped offering coverage within the past five years, 31% say the firm stopped offering health insurance coverage after receiving a high renewal quote following high claims from a small number of enrollees.
  • Among firms that stopped offering coverage within the past five years, 34% say the cost of coverage was too high, 3% say premium increases were unpredictable or unsustainable, 28% say too few employees wanted to enroll, and 12% say employees obtained coverage elsewhere. Other reasons include transitioning to a stipend or other benefit instead of group coverage (9%), and downsizing, merging, or changing ownership (5%) [Figure 2.19].
  • Seventeen percent of firms not offering health benefits have shopped for coverage in the past year, similar to the percentage last year (16%) [Figure 2.17].
• Eighty-one percent of firms not offering health benefits agreed with the statement that their employees would prefer a two-dollar-per-hour increase. increase in wages rather than health insurance [Figure 2.18].

Figure 2.16: Among Small Firms Not Offering Health Benefits, Most Important Reason for Not Offering, 2026

Figure 2.17: Among Small Firms Not Offering Health Benefits, Percentage of Firms That Report the Following Actions, 2009-2026

Figure 2.18: Among Small Firms Not Offering Health Benefits, Firms’ View of Employees’ Preference for Higher Wages or Health Insurance Benefits, 2008-2026

Figure 2.19: Main Reasons Small Firms That Previously Offered Health Benefits Stopped Offering Coverage in the Past Five Years, 2026

---

8. Employer Responsibility Under the Affordable Care Act. KFF. https://www.kff.org/infographic/employer-responsibility-under-the-affordable-care-act/.↩︎

Employers are the principal source of health insurance in the United States, providing health benefits for 157 million nonelderly people.⁹ Most workers are offered health coverage at work, and most of the workers who are offered coverage take it. Workers may not be covered by their own employer for several reasons: their employer may not offer coverage, they may not be eligible for the benefits offered by their firm, they may elect to receive coverage from another source (such as through their spouse’s employer), or they may decline the offer from their firm. In 2026, 59% of workers in firms offering health benefits are covered by their own firm, similar to the percentages last year, five years ago, and ten years ago.

ELIGIBILITY

• Some workers employed at firms that offer health benefits may not be eligible to participate. Many firms, for example, do not offer coverage to part-time or temporary workers. Among workers in firms offering health benefits in 2026, 80% are eligible to enroll in the benefits offered by their firm, similar to the percentages last year, five years ago, and ten years ago [Figure 3.1].
  • Eligibility varies considerably with firm wage level. Workers in firms with a relatively large share of lower-wage workers (where at least 35% of workers earn $38,000 a year or less) have a lower average eligibility rate than workers in firms with a smaller share of lower-wage workers (73% vs. 81%) [Figure 3.6].
  • Workers in firms with a relatively large share of higher-wage workers (where at least 35% earn $82,000 or more annually) have a higher average eligibility rate than workers in firms with a smaller share of higher-wage workers (86% vs. 77%) [Figure 3.6].
  • Eligibility also varies by the age of the workforce within firms. Workers in firms with a relatively small share of younger workers (where fewer than 35% of the workers are age 26 or younger) have a higher average eligibility rate than those in firms with a larger share of younger workers (82% vs. 70%) [Figure 3.6].Eligibility rates vary considerably for workers in different industries. The average eligibility rate remains particularly low for workers in retail firms (61%) [Figure 3.3].

Figure 3.1: Eligibility, Take-Up, and Coverage Rates for Workers in Firms Offering Health Benefits, by Firm Size, 1999-2026

Figure 3.2: Eligibility and Coverage Rates for Workers in Firms Offering Health Benefits, 1999-2026

Figure 3.3: Eligibility, Take-Up, and Coverage Rates in Firms Offering Health Benefits, by Firm Size, Region, and Industry, 2026

Figure 3.4: Eligibility, Take-Up, and Coverage Rates in Firms Offering Health Benefits, by Firm Size, 2026

Figure 3.5: Among Workers at Small Firms, Eligibility for Workers at Their Own Firms, 1999-2026

TAKE-UP RATE

• On average, 74% of eligible workers take up coverage when it is offered to them, the similar to the percentage last year.
  • Eligible workers in firms with 10 to 199 workers have a lower average take-up rate than those in larger firms (70% vs. 75%) [Figure 3.8].
  • • Eligible workers in firms with a relatively large share of lower-wage workers have a lower average take-up rate than those in firms with a smaller share of lower-wage workers (64% vs. 76%) [Figure 3.7].
  • • Eligible workers in firms with a relatively large share of higher-wage workers have a higher average take-up rate than those in firms with a smaller share of higher-wage workers (79% vs. 70%) [Figure 3.7].
  • • Eligible workers in private, for-profit firms have a lower average take-up rate (71%) and eligible workers in public firms have a higher average take-up rate (87%) than workers in other firm types [Figure 3.7].Eligible workers in firms with some union workers have a higher average take-up rate (80%) than eligible workers in firms with no union workers (71%) [Figure 3.7].
• The average percentages of eligible workers taking up benefits in offering firms also vary across industries [Figure 3.3].
• The share of eligible workers taking up benefits in offering firms (74%) is similar to the share in 2021 (77%) but lower than the share in 2016 (79%) [Figure 3.1].

Figure 3.6: Among Workers in Firms Offering Health Benefits, Percentage of Workers Eligible for Health Benefits Offered by Their Firm, by Firm Characteristics, 2026

Figure 3.7: Among Workers in Firms Offering Health Benefits, Percentage of Eligible Workers Who Take Up Health Benefits Offered by Their Firm, by Firm Characteristics, 2026

COVERAGE

• In 2026, the percentage of workers at firms offering health benefits covered by their firm’s health plan is 59%, the same as last year [Figure 3.10].
  • The coverage rate at firms offering health benefits is similar for smaller firms (10 to 199 workers) and larger firms in 2026. Rates for both groups are similar to last year. [Figure 3.1].
• There is significant variation by industry in the coverage rate among workers in firms offering health benefits. The average coverage rate is particularly low in the retail industry (32%) [Figure 3.3].
• The coverage rate also varies with firm wage levels. Among workers in firms offering health benefits, those in firms with a relatively large share of lower-wage workers are less likely to be covered by their own firm than workers in firms with a smaller share of lower-wage workers (47% vs. 61%). A similar pattern exists in firms with a relatively large share of higher-wage workers, with workers in higher-wage firms being more likely to be covered by their employer’s health benefits than those in firms with a smaller share of higher-wage workers (68% vs. 54%) [Figure 3.9].
• The age distribution of workers is also related to variation in coverage rates. Among workers in firms offering health benefits, those in firms with a relatively small share of younger workers are more likely to be covered by their own firm than those in firms with a larger share of younger workers (62% vs. 44%). Similarly, workers in offering firms with a relatively large share of older workers are more likely to be covered by their own firm than those in firms with a smaller share of older workers (65% vs. 54%) [Figure 3.9].
• Among workers in firms offering health benefits, those working in firms with some union workers are more likely than workers in firms with no union workers to be covered by their own firm [Figure 3.9].
• Among workers in firms offering health benefits, those working in public firms are more likely than workers in other firm types to be covered by their own firm [Figure 3.9].

Figure 3.8: Among Workers in Firms Offering Health Benefits, Percentage of Eligible Workers Who Take Up Health Benefits Offered by Their Firm, by Firm Size, 1999-2026

Figure 3.9: Among Workers in Firms Offering Health Benefits, Percentage of Workers Covered by Health Benefits Offered by Their Firm, by Firm Characteristics, 2026

COVERAGE AMONG ALL FIRMS

• Among workers in all firms, including those that offer and those that do not offer health benefits, 55% are covered by health benefits offered by their employer, similar to the percentages last year (55%) and ten years ago (57%) but lower than five years ago (58%) [Figure 3.10].

Figure 3.10: Percentage of Workers Covered by Their Firm’s Health Benefits, 1999-2026

---

9. KFF. Health Insurance Coverage of the Non elderly [Internet]. San Francisco (CA): KFF; 2024 [cited 2026 Aug 5. Available from: https://www.kff.org/other/state-indicator/nonelderly-0-64/.↩︎

Most firms (68%) that offer health benefits offer only one type of health plan. Firms with 200 or more workers are more likely than smaller firms to offer more than one plan type.

NUMBER OF PLAN TYPES OFFERED

• Among firms that offer health benefits, 68% offer only one type of health plan in 2026. Firms with 200 or more workers are more likely than smaller firms to offer more than one plan type (58% vs. 30%) [Figure 4.1].
• While most firms are small, most workers are employed by larger firms, which are more likely to offer more than one type of health plan. Sixty-eight percent of covered workers in 2026 are employed in a firm that offers more than one type of health plan. Seventy-six percent of covered workers in firms with 200 or more workers are employed by a firm that offers more than one plan type, compared to 40% of covered workers in smaller firms [Figure 4.2].
• Seventy-five percent of covered workers in firms that offer health benefits work in firms that offer a PPO, 56% work in firms that offer an HSA-qualified plan, 19% work in firms that offer an HMO, 11% work in firms that offer a POS plan, and 1% work in firms that offer one or more conventional plans [Figure 4.4].
• Among covered workers in firms offering only one type of health plan, 60% are in firms that offer only PPOs and 19% are in firms that offer only HSA-qualified plans [Figure 4.5].

Figure 4.1: Among Firms Offering Health Benefits, Percentage of Firms That Offer One, Two, or Three or More Plan Types, by Firm Size, 2026

Figure 4.2: Among Firms Offering Health Benefits, Percentage of Covered Workers in Firms Offering One, Two, or Three or More Plan Types, by Firm Size, 2026

Figure 4.3: Among Firms Offering Health Benefits, Percentage of Firms That Offer the Following Plan Types, by Firm Size, 2026

Figure 4.4: Among Firms Offering Health Benefits, Percentage of Covered Workers in Firms That Offer the Following Plan Types, by Firm Size, 2026

Figure 4.5: Among Firms Offering Only One Type of Health Plan, Percentage of Covered Workers in Firms That Offer Each Plan Type, by Firm Size, 2026

PERCENTAGE OF FIRMS OFFERING HSA-QUALIFIED PLANS

Thirty-nine percent of firms with 10 or more workers offering health benefits offer an HSA-qualified plan [Figure 4.6]. This percentage is more than last year (31%) and five years ago (31%).

• Firms with 200 or more workers are more likely than smaller firms to offer an HSA-qualified plan to at least some workers (54% vs. 38%). The percentage of larger firms offering an HSA-qualified plan is similar to five years ago. Among smaller firms, the percentage offering an HSA-qualified plan increased from 29% to 38% over the last five years.

Figure 4.6: Among Firms Offering Health Benefits, Percentage That Offer an HSA-Qualified Plan, by Firm Size, 2011-2026

---

The survey collects information on the plan with the largest enrollment for each plan type a firm offers. While we know the number of plan types a firm offers, we do not know the total number of plans. In addition, firms may offer different types of plans to different workers. For example, workers at one location may be offered one type of plan, while workers at another location are offered a different type.

Health plans are often categorized into plan types based on their coverage of out-of-network services and whether they require primary care referrals. This survey classifies plans into five plan types:

• Conventional/Indemnity: A plan with no preferred provider network and the same cost sharing regardless of physician or hospital.
• HMO (Health Maintenance Organization): A plan that does not cover non-emergency services provided by out-of-network providers.
• PPO (Preferred Provider Organization): A plan that covers services from both in-network and out-of-network providers, generally with lower cost sharing for in-network services, and does not require a primary care referral for specialist care.
• POS (Point-of-Service): A plan that covers services from both in-network and out-of-network providers, generally with lower cost sharing for in-network services, but requires a primary care referral for specialist care.
• HSA-qualified plan: A high-deductible health plan that meets federal requirements allowing an enrollee to contribute to a Health Savings Account (HSA). In 2026, an HSA-qualified plan must have a deductible of at least $1,650 for single coverage and $3,300 for family coverage.

Beginning in 2026, this survey changed how it classifies high-deductible health plans associated with a Health Reimbursement Arrangement (HRA). In previous years, these plans were grouped with HSA-qualified plans in a broader HDHP/SO category. HRA plans are now classified as conventional, PPOs, POS plans, or HMOs based on their plan characteristics. HSA-qualified plans are now reported as a separate plan type.

Health plans are often characterized into plan types based on their coverage of out-of-network services and their use of primary care gatekeeping. In 2026, PPOs remain the most common plan type.

As described previously, high-deductible health plans (HDHPs) associated with a health reimbursement arrangement (HRA) are no longer classified as an HDHP/SO plan type. As a result, covered workers who were classified as enrolled in an HDHP/HRA in previous versions of this survey are now included in the HMO, PPO, POS, or conventional plan categories. In 2025, 4% of covered workers were enrolled in an HDHP/HRA, compared with 7% in 2021. Historical comparisons should be interpreted in light of this change in methods.

• Fifty percent of covered workers are enrolled in PPOs in 2026, followed by HSA-qualified plans (29%), HMOs (12%), POS plans (8%), and conventional plans (less than one percent). All of these percentages are similar to the enrollment percentages in 2025 [Figure 5.1].
• The percentage of covered workers enrolled in HSA-qualified plans is similar to the percentage last year (29%), but higher than the percentages five years ago (22%) and 10 years ago (19%) [Figure 5.1].
• The percentage of covered workers enrolled in HMOs (12%) is the same percentage as last year and similar to the percentage five years ago (16%) [Figure 5.1].
• A larger share of covered workers are enrolled in HSA-qualified plans than in HMOs in both smaller firms (10 to 199 workers) and larger firms (200 or more workers) [Figure 5.2].
• Plan enrollment patterns differ between firms with 10 to 199 workers and larger firms.
  • The share of covered workers enrolled in a PPO is larger in larger firms than in smaller firms (52% vs. 44%) [Figure 5.2]. This is different than last year and may reflect the change in methods around classifying plans associated with a health reimbursement arrangement.
  • The share of covered workers enrolled in a POS plan is larger in smaller firms than in larger firms (16% vs. 6%) [Figure 5.2].
  • The shares of covered workers enrolled in an HSA-qualified plan are similar in smaller firms (27%) and in larger firms (30%). The shares of covered workers enrolled in an HMO are similar in firms with 10 to 199 workers (11%) and in larger firms (12%) [Figure 5.2].
• Plan enrollment patterns also differ across regions.
  • Covered workers in the West are more likely (23%) to be enrolled in an HMO than workers in other regions, while covered workers in the Midwest are less likely (5%) to be enrolled in an HMO [Figure 5.3].
  • Covered workers in the Midwest are more likely (41%) to be enrolled in an HSA-qualified plan than workers in other regions, while covered workers in the South and West are less likely to be enrolled in an HSA-qualified plan (24%) [Figure 5.3].
  • Covered workers in the West are less likely (37%) to be enrolled in a PPO than workers in other regions [Figure 5.3].

Figure 5.1: Distribution of Health Plan Enrollment for Covered Workers, by Plan Type, 1988-2026

Figure 5.2: Distribution of Health Plan Enrollment for Covered Workers, by Plan Type and Firm Size, 2026

Figure 5.3: Distribution of Health Plan Enrollment for Covered Workers, by Firm Size, Region, and Industry, 2026

COVERAGE IN HSA-QUALIFIED PLANS

The share of covered workers enrolled in HSA-qualified plans varies with firm characteristics.

• Covered workers in firms with a relatively large share of younger workers (firms where at least 35% of the workers are age 26 or younger) are less likely to be enrolled in an HSA-qualified plan than covered workers in firms with smaller shares of younger workers (22% vs. 30%) [Figure 5.4].
• Covered workers in firms with a relatively large share of higher-wage workers (firms where at least 35% of workers earn $82,000 a year or more) are more likely to be enrolled in an HSA-qualified plan than covered workers in firms with smaller shares of higher-wage workers (36% vs. 24%) [Figure 5.4].
• Covered workers in private, for-profit firms are more likely (35%) to be enrolled in an HSA-qualified plan than covered workers in public firms (19%) or in private, not-for-profit firms (22%). [Figure 5.4].

Figure 5.4: Percentage of Covered Workers Enrolled in HSA-Qualified Plans, by Firm Characteristics, 2026

The vast majority of covered workers make contributions toward the cost of their coverage.

• In 2026, the average contribution percentages for covered workers are 18% of the premium for single coverage and 27% of the premium for family coverage, similar to the levels last year [Figure 6.1].¹⁰
  • The average contribution percentage for single coverage is similar for covered workers in smaller firms (firms with 10 to 199 workers) and for those in larger firms [Figure 6.2].
    • Covered workers in smaller firms contribute, on average, a much higher percentage of the premium for family coverage than covered workers in larger firms (37% vs. 25%) [Figure 6.2].
• The average contribution amount for covered workers for single coverage is $139 per month ($1,672 annually), higher than last year ($1,440) [Figure 6.3]. The average contribution amount for covered workers for family coverage is $623 per month ($7,471 annually), higher than the amount ($6,850 annually) last year [Figure 6.3].
  • The average contribution amount for covered workers for single coverage in smaller firms is lower than the average contribution amount for covered workers in larger firms ($1,451 vs. $1,736) [Figure 6.7].
  • The average contribution amount for covered workers for family coverage in smaller firms is higher than the average contribution amount for covered workers in larger firms ($9,687 vs. $6,840) [Figure 6.7].
    • The average contribution amount for family coverage among workers enrolled in HSA-qualified plans is lower than the overall average contribution amount for covered workers ($6,211 vs. $7,471) [Figure 6.6].

Figure 6.1: Average Percentage of Premium Paid by Covered Workers for Single and Family Coverage, 1999-2026

Figure 6.2: Average Percentage of Premium Paid by Covered Workers for Single and Family Coverage, by Firm Characteristics, 2026

Figure 6.3: Average Monthly Worker Premium Contributions for Single and Family Coverage, 1999-2026

Figure 6.4: Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Single Coverage, 1999-2026

Figure 6.5: Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Family Coverage, 1999-2026

Figure 6.6: Average Annual Worker and Employer Premium Contributions and Total Premiums for Single and Family Coverage, by Plan Type, 2026

Figure 6.7: Average Annual Worker and Employer Premium Contributions and Total Premiums for Single and Family Coverage, by Firm Size, 2026

Figure 6.8: Average Annual Worker and Employer Premium Contributions and Total Premiums for Single Coverage, by Plan Type and Firm Size, 2026

Figure 6.9: Average Annual Employer and Worker Premium Contributions and Total Premiums for Family Coverage, by Plan Type and Firm Size, 2026

DISTRIBUTIONS OF WORKER CONTRIBUTIONS TO THE PREMIUM

Almost nine in ten covered workers (88%) are in a plan where the employer contributes at least half of the premium for both single and family coverage [Figure 6.10].

• Ten percent of covered workers are in a plan where the employer pays the entire premium for single coverage, while only 3% of covered workers are in a plan where the employer pays the entire premium for family coverage [Figure 6.10].
• Covered workers in smaller firms (firms with 10 to 199 workers) are much more likely than covered workers in larger firms to be in a plan where the employer pays the entire premium for single coverage.
  • Twenty-nine percent of covered workers in smaller firms are in a firm where their employer pays the full premium for single coverage, compared to 5% of covered workers in larger firms [Figure 6.10].
  • For family coverage, 9% of covered workers in smaller firms have an employer that pays the full premium, compared to 2% of covered workers in larger firms [Figure 6.10].
• Twelve percent of covered workers are in a plan where the worker contributes more than half of the premium for family coverage [Figure 6.10].
  • This percentage differs significantly by firm size. Thirty-two percent of covered workers in smaller firms are in a plan where the worker contribution for family coverage is more than half of the premium, compared to 6% of covered workers in larger firms [Figure 6.10].
  • Small shares of covered workers in smaller firms (4%) or in larger firms (1%) are in a plan where the worker must contribute more than 50% of the premium for single coverage [Figure 6.10].
• There is substantial variation in the dollar amounts that covered workers must contribute toward health coverage.
  • Among covered workers in firms with 10 to 199 workers, 34% have a contribution for single coverage of less than $500 a year, while 29% have a contribution of $2,000 or more [Figure 6.13]. For family coverage, 16% have a contribution of less than $3,000, while 37% have a contribution of $10,500 or more [Figure 6.14].
  • Among covered workers in firms with 200 or more workers, 9% contribute less than $500 a year for single coverage, while 31% have a contribution of $2,000 or more [Figure 6.13]. For family coverage, only 11% contribute less than $3,000 a year, while 11% have a contribution of $10,500 or more [Figure 6.14].

Figure 6.10: Distribution of Percentage of Premium Paid by Covered Workers for Single and Family Coverage, by Firm Size, 2026

Figure 6.11: Distribution of Percentage of Premium Paid by Covered Workers for Single Coverage, 2002-2026

Figure 6.12: Distribution of Percentage of Premium Paid by Covered Workers for Family Coverage, 2002-2026

Figure 6.13: Distribution of Worker Contributions for Single Coverage, by Firm Size, 2026

Figure 6.14: Distribution of Worker Contributions for Family Coverage, by Firm Size, 2026

DIFFERENCES BY FIRM CHARACTERISTICS

The average share of the premium paid by covered workers varies with firm characteristics.

• For single coverage, covered workers in private, for-profit firms have a relatively high average contribution rate (20%) while, those in private, not-for-profit firms have a relatively low average contribution rate (20%).
• The average contribution rate for family coverage is higher for covered workers at firms with few older workers (where at least 35% are 50 years or older) than those in firms with many older workers (29% vs. 26%) [Figure 6.17].
• The average contribution rate for family coverage is higher for covered workers in firms with relatively large shares of lower-wage workers (where at least 35% earn $38,000 or less annually) than those in firms with smaller shares of lower-wage workers (31% vs. 27%) [Figure 6.17].
• The average contribution rate for family coverage is lower for covered workers in firms with relatively large shares of higher-wage workers (where at least 35% earn $82,000 or more annually) than those in firms with smaller shares of higher-wage workers (25% vs. 29%) [Figure 6.17].
• Covered workers in firms that have at least some union workers have a lower average contribution rate for family coverage than those in firms without any union workers (22% vs. 31%) [Figure 6.17].
• Covered workers in large firms that are fully insured have a higher average contribution rate for family coverage than those in firms with self-funded plans (28% vs. 24%) [Figure 6.17].

Figure 6.15: Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Single and Family Coverage, by Firm Wage Level, 2026

Figure 6.16: Average Annual Premium Contributions Paid by Covered Workers for Single and Family Coverage, by Firm Characteristics, 2026

Figure 6.17: Average Percentage of Family Premium Paid by Covered Workers, by Firm Characteristics, 2026

Figure 6.18: Average Percentage of Premium Paid by Covered Workers, by Firm Characteristics and Size, 2026

Figure 6.19: Average Annual Premium Paid by Covered Workers for Single and Family Coverage, by Plan Type and Region, 2026

DIFFERENCES BY REGION AND INDUSTRY

• The average worker contribution rate for single coverage is relatively low in the West (15%) [Figure 6.19].

• The average worker contribution rate for family coverage is relatively low in the Northeast (24%) and the Midwest (25%) and relatively high in the South (30%) [Figure 6.19].

• Average worker contribution rates vary significantly across industries for single and family coverage [Figure 6.20].

Figure 6.20: Average Percentage of Premium Paid by Covered Workers, by Industry, 2026

CHANGES OVER TIME

The average worker contribution amounts in 2026 are higher than the amounts last year for single coverage ($1,672 vs. $1,440) and for family coverage ($7,471 vs. $6,850) [Figure 6.21].

• Over the last five years, the average worker contribution amount for single coverage has increased 29% and the average worker contribution for family coverage increased 26%. For comparison, during the same period inflation increased 24.4% and workers’ wages increased 26.9%.
• Over the last 10 years, the average worker contribution amount for single coverage has increased 45% and the average worker contribution amount for family coverage has increased 42% [Figure 6.4] and [Figure 6.5].
• The average worker contribution amount for family coverage increased 42% at private for-profit firms, 46% at public firms and 41% at private not-for-profit firms over the last ten years.

Figure 6.21: Average Annual Worker Contributions for Covered Workers With Single Coverage, by Firm Size, 1999-2026

Figure 6.22: Average Annual Worker Contributions for Covered Workers With Family Coverage, by Firm Size, 1999-2026

Figure 6.23: Average Percentage of Premium Paid by Covered Workers for Single and Family Coverage, by Firm Size, 1999-2026

Figure 6.24: Among Large Firms, Average Annual Worker Contributions for Covered Workers With Family Coverage, by Firm Wage Level, 1999-2026

Figure 6.25

---

10. The average percentage contribution is calculated as a weighted average of all a firm’s plan types and may not necessarily equal the average worker contribution divided by the average premium.↩︎

In addition to any required premium contributions, most covered workers must pay a share of the cost for the medical services they use. The most common forms of cost-sharing are deductibles (an amount that must be paid before most services are covered by the plan), copayments (fixed dollar amounts), and coinsurance (a percentage of the charge for services). Some plans combine forms of cost-sharing, such as requiring coinsurance for a service up to a maximum amount, or assessing either coinsurance or a copayment for a service, whichever results in the higher payment. The type and level of cost-sharing may vary by the type of plan in which the worker is enrolled. Cost-sharing may also vary by the type of service, with with different requirements for office visits, hospitalizations, and prescription drugs.

The cost-sharing amounts reported here are for covered workers using in-network services. Plan enrollees receiving services from out-of-network providers often face higher cost-sharing and may be responsible for charges that exceed the plan’s allowable amounts. This survey does not allow us to capture all of the complex cost-sharing requirements in modern plans, including ancillary services (such as durable medical equipment or physical therapy) or cost-sharing arrangements that vary across different settings (such as tiered networks). Therefore, we do not collect information on all plan provisions and limits that affect the out-of-pocket liability of plan enrollees.

GENERAL ANNUAL DEDUCTIBLES FOR WORKERS IN PLANS WITH DEDUCTIBLES

We consider a general annual deductible to be an amount that must be paid by enrollees before most services are covered by their health plan. Non-grandfathered health plans are required to cover some services, such as preventive care, without cost-sharing. Some plans require enrollees to meet a specific deductible for certain services, such as prescription drugs or hospital admissions, in lieu of or in addition to a general annual deductible. As discussed below, some plans with a general annual deductible for most services exclude specified classes of care from the deductible, such as prescriptions or physician office visits.

• Eighty-eight percent of covered workers in 2026 are enrolled in a plan with a general annual deductible for single coverage, the same percentage as last year and similar to the percentage five years ago (85%), but higher than the percentage ten years ago (83%) [Figure 7.2].
• The percentage of covered workers enrolled in a plan with a general annual deductible for single coverage is similar for covered workers in smaller firms (firms with 10 to 199 workers) (88%) and for those in larger firms (88%) [Figure 7.5].
• The likelihood of a plan having a general annual deductible varies by plan type. Forty-nine percent of covered workers in HMOs do not have a general annual deductible for single coverage, compared to 23% of workers in POS plans and 9% of workers in PPOs [Figure 7.1].
• For workers with single coverage in a plan with a general annual deductible, the average annual deductible is $1,955, similar to the average deductible last year ($1,886) [Figure 7.3] and [Figure 7.8].
• For covered workers in plans with a general annual deductible, the average deductibles for single coverage are $1,562 in HMOs, $1,446 in PPOs, $1,902 in POS plans, and $2,912 in HSA-qualified plans [Figure 7.5].
• Among covered workers in plans with a general annual deductible, average deductibles for single coverage are higher at smaller firms (firms with 10 to 199 workers) than at larger firms across plan types. For covered workers in PPOs, the most common plan type, the average deductibles for single coverage are $2,097 in smaller firms and $1,282 in firms with 200 or more workers [Figure 7.5]. Overall, for covered workers in plans with a general annual deductible, the average deductible for single coverage at smaller firms ($2,624) is higher than the average deductible at larger firms ($1,772) [Figure 7.3].
• The average general annual deductible for single coverage ($1,955) for workers in plans with a deductible is higher than five years ago ($1,658) and ten years ago ($1,464) [Figure 7.9].

Figure 7.1: Percentage of Covered Workers With No General Annual Deductible for Single Coverage, by Plan Type and Firm Size, 2026

Figure 7.2: Percentage of Covered Workers in a Plan That Includes a General Annual Deductible for Single Coverage, by Plan Type and Firm Size, 2006-2026

Figure 7.3: Percentage of Covered Workers in a Plan That Includes a General Annual Deductible and Average Deductible for Single Coverage, by Firm Size and Region, 2026

Figure 7.4: Percentage of Covered Workers in a Plan That Includes a General Annual Deductible and Average Deductibles for Single Coverage, by Firm Characteristics, 2026

Figure 7.5: Among Covered Workers With a General Annual Deductible for Single Coverage, Average Deductible, by Plan Type and Firm Size, 2026

Figure 7.6: Percentage of Covered Workers With a General Annual Deductible for Single Coverage, 2006-2026

Figure 7.7: Among Covered Workers With a General Annual Deductible, Average Single and Family Coverage Deductible, by Plan Type, 2006-2026

Figure 7.8: Prevalence and Value of General Annual Deductibles for Single Coverage, by Firm Size, 2006-2026

GENERAL ANNUAL DEDUCTIBLES AMONG ALL COVERED WORKERS

As discussed above, the share of covered workers in plans with a general annual deductible has increased over time, from 83% in 2016 to 88% this year [Figure 7.6]. The average deductible amount for covered workers in plans with a deductible has also increased over the same period, from $1,464 in 2016 to $1,955 in 2026 [Figure 7.9]. Neither trend by itself, however, captures the full impact that changes in deductibles have had on all covered workers. We can look at the average impact of both trends together by assigning a zero deductible to covered workers in plans with no deductible and examining how the resulting average changes over time. These averages are lower than the averages among only workers in plans with deductibles, but the changes over time reflect both workers facing higher monetary deductible amounts and a greater number of workers facing deductibles.

• Using this approach, the average general annual deductible for all covered workers with single coverage (with or without a deductible) in 2026 is $1,733, similar to the amount last year ($1,663) [Figure 7.9].
• The 2026 value is 21% higher than the average general annual deductible in 2021 ($1,431) and 43% higher than in 2016 ($1,210) [Figure 7.9].
• Another way to assess deductibles on covered workers is to look at the percent of all covered workers who are in a plan with a deductible that exceeds a certain amount. Thirty-eight percent of covered workers are in plans with a general annual deductible of $2,000 or more for single coverage, similar to the percentage last year (34%) but higher than the percentage five years ago (29%) [Figure 7.12].
  • Workers at smaller firms are more likely to have a general annual deductible of $2,000 or more for single coverage than workers at larger firms (55% vs. 33%) [Figure 7.11].

Figure 7.9: Average General Annual Deductibles for Single Coverage, 2006-2026

Figure 7.10: Among Covered Workers Who Face a Deductible for Single Coverage, Average General Annual Deductible for Single Coverage, by Firm Size, 2006-2026

Figure 7.11: Percentage of Covered Workers Enrolled in a Plan With a High General Annual Deductible for Single Coverage, by Firm Size, 2026

Figure 7.12: Percentage of Covered Workers Enrolled in a Plan With a General Annual Deductible of $2,000 or More for Single Coverage, by Firm Size, 2009-2026

GENERAL ANNUAL DEDUCTIBLES AND ACCOUNT CONTRIBUTIONS

HSA-qualified plans are subject to a minimum deductible, have an important impact on the average deductible amounts across the market. The higher deductibles in these plans, however, are often paired with employer contributions to an HSA, offsetting some or all of the higher cost-sharing.

• Among covered workers enrolled in an HSA-qualified plan, 3% receive an employer HSA contribution for single coverage that is at least equal to their deductible, and another 10% receive a contribution that would reduce their deductible to $1,000 or less. [Figure 7.14].
• If employer HSA contributions are subtracted from general annual deductibles, the percentage of covered workers with a deductible of $2,000 or more would be reduced from 38% to 29% [Figure 7.13].

Some employers also make funds available to employees through health reimbursement arrangements (HRAs), which in many cases can also be used by employees to reduce their cost-sharing liability. The survey this year did not collect information on the amounts that employers make available in HRAs, so we cannot estimate their potential impact on cost-sharing liability. Additional information on the ways that workers can use funds made available by employers in HRAs is provided in Chapter 8.

Figure 7.13: Percentage of Covered Workers Enrolled in a Plan With a High General Annual Deductible for Single Coverage, Reduced by Any HSA Contributions, by Firm Size, 2026

Figure 7.14: Among Covered Workers With a General Annual Deductible, Distribution of General Annual Deductibles for Single Coverage, Reduced by Any HSA Contributions, by Plan Type and Firm Size, 2026

Figure 7.15: Among Covered Workers With a General Annual Deductible, Distribution of General Annual Deductible for Single Coverage, 2007-2026

Figure 7.16: Among Covered Workers With a General Annual Deductible, Distribution of General Annual Deductibles for Single Coverage, by Plan Type, 2026

GENERAL ANNUAL DEDUCTIBLES FOR WORKERS ENROLLED IN FAMILY COVERAGE

General annual deductibles for family coverage are structured in two primary ways: (1) an aggregate family deductible, where the out-of-pocket expenses of all family members count against a specified family deductible amount and where the deductible is considered met when the combined family expenses exceed the deductible amount, or (2) a separate per-person family deductible, where each family member is subject to a specified deductible amount before the plan covers expenses for that member. Many plans with a per-person deductible, however, consider the deductible for all family members met once a certain number of family members (such as two or three) meet their specified deductible amount.¹¹

• Forty-nine percent of covered workers in HMOs are in plans without a general annual deductible for family coverage, much higher than the percentage of covered workers in plans without a family deductible in PPOs (8%) and POS plans (23%). As defined, all covered workers in HSA-qualified plans have a general annual deductible for family coverage [Figure 7.17].
• Among covered workers enrolled in family coverage, 42% of those in HMOs have an aggregate general annual deductible, compared with 56% of those in PPOs, 55% of those in POS plans, and 72% of those in HSA-qualified plans [Figure 7.17].
  • The average deductible for covered workers in plans with an aggregate annual deductible for family coverage are $3,207 for HMOs, $3,320 for PPOs, $3,875 for POS plans, and $5,380 for HSA-qualified plans [Figure 7.18]. The average deductible for HSA-qualified plans is higher than last year ($4,936). The average deductible amounts for the other plan types are similar to the amounts last year.
• For covered workers in HMOs, PPOs, and HSA-qualified plans with an aggregate deductible for family coverage, average annual deductibles are higher at firms with 10 to 199 workers than at larger firms [Figure 7.21].
• Among covered workers enrolled in family coverage, 10% of those in HMOs have a separate per-person annual deductible, compared with 36% of those in PPOs, 21% of those in POS plans, and 28% of those in HSA-qualified plans.
  • The average deductible amounts for covered workers in plans with separate per-person annual deductibles for family coverage are $1,693 for PPOs, and $4,614 for HSA-qualified plans [Figure 7.18].
• Twenty-eight percent of covered workers in plans with a separate per-person annual deductible for family coverage have a limit on the number of family members required to meet separate deductible amounts [Figure 7.21]. Among these covered workers, the most common number of family members required to meet the separate per-person deductible is two [Figure 7.22].

Figure 7.17: Distribution of Type of General Annual Deductible for Covered Workers With Family Coverage, by Plan Type, 2026

Figure 7.18: Among Covered Workers With a General Annual Deductible, Average Deductibles for Family Coverage, by Deductible Type, Plan Type, and Firm Size, 2026

Figure 7.19: Among Covered Workers With a Separate Per-Person General Annual Deductible for Family Coverage, Distribution of Deductibles, by Plan Type, 2026

Figure 7.20: Among Covered Workers With an Aggregate General Annual Deductible for Family Coverage, Distribution of Deductibles, by Plan Type, 2026

Figure 7.21: Among Covered Workers With a Separate Per-Person General Annual Deductible for Family Coverage, Structure of Deductible Limits, by Plan Type, 2026

Figure 7.22: Among Covered Workers With a Separate Per-Person General Annual Deductible for Family Coverage and a Per-Person Limit, Distribution of Maximum Number of Family Members Required to Meet the Deductible, by Plan Type, 2026

Figure 7.23: Among Covered Workers With an Aggregate General Annual Deductible for Family Coverage, Distribution of Aggregate Deductibles, by Plan Type, 2021 and 2026

COVERAGE OF SERVICES AND PRODUCTS BEFORE MEETING THE GENERAL ANNUAL DEDUCTIBLE

A majority of covered workers with a general annual deductible are enrolled in plans in which the deductible does not have to be met before certain services, such as physician office visits or prescription drugs, are covered. Covered workers in HSA-qualified plans are not included in these estimates, because different deductible requirements apply to HSA-qualified plans.

• Among covered workers enrolled in a plan with a general annual deductible, 80% in HMOs, 80% in PPOs, and 58% in POS plans are enrolled in plans where the deductible does not have to be met before primary care office visits are covered [Figure 7.24].
• Similarly, among covered workers enrolled in a plan with a general annual deductible, 92% in HMOs, 82% in PPOs, and 78% in POS plans are enrolled in plans where the deductible does not have to be met before prescription drugs are covered [Figure 7.24].

Figure 7.24: Among Covered Workers With a General Annual Deductible, Percentage With Coverage for the Following Services Without Having to First Meet the Deductible, by Plan Type, 2026

HOSPITAL ADMISSIONS AND OUTPATIENT SURGERY

Whether or not a covered worker is in a plan with a general annual deductible, most covered workers face additional types of cost-sharing (such as a copayment, coinsurance, or a per diem charge) when admitted to a hospital or undergoing outpatient surgery. The distribution of workers with cost-sharing for hospital admissions or outpatient surgery does not equal 100%, as workers may face a complex combination of types of cost-sharing. For this reason, the average copayment and coinsurance rates include workers who may have a combination of these cost-sharing methods. Coinsurance, in particular, may include minimums or maximums which affect the liability of enrollees. We report the distribution of cost-sharing for covered workers enrolled in a plan which covers hospital admissions and outpatient surgery, respectively. A small share of firms indicate that they have some “other” type of cost-sharing arrangement.

• In addition to any general annual deductible that may apply, 60% of covered workers have coinsurance and 11% have a copayment that apply to an inpatient hospital admission. A lower percentage of covered workers have per-day (per diem) payments (4%), a separate hospital deductible (3%), or both a copayment and coinsurance (10%). Seventeen percent of covered workers have no additional cost-sharing for hospital admissions after any general annual deductible has been met [Figure 7.27]. Covered workers with both a copay and coinsurance may be required to pay both, or to pay the greater or lesser amount.
  • Covered workers in HMOs are more likely than workers in other plan types to have a copayment for hospital admissions, while those in PPOs and HSA-qualified plans are less likely to have a copayment [Figure 7.28].
  • Covered workers in PPOs are more likely and those in HMOs and POS plans are less likely than those in other plan types to have a coinsurance requirement for hospital admissions [Figure 7.28].In 2026, the average coinsurance rate for a hospital admission is 20%, the average copayment is $317, and the average per diem charge is $337 [Figure 7.31]. Eighty percent of workers enrolled in a plan with a per diem for hospital admissions have a limit on the number of days for which the per diem charge applies [Figure 7.32].
• The cost-sharing provisions for outpatient surgery are similar to those for hospital admissions, as most workers have coinsurance or copayments. In 2026, 12% of covered workers have a copayment and 64% have a coinsurance requirement for outpatient surgery. In addition, 5% have both a copayment and a coinsurance requirement, while 19% have no additional cost-sharing after any general annual deductible has been met [Figure 7.29] and [Figure 7.30].
  • For covered workers with cost-sharing for outpatient surgery, the average coinsurance rate is 20% and the average copayment is $205 [Figure 7.31].

Figure 7.25: Distribution of Covered Workers’ Cost Sharing for Hospital Admissions, by Plan Type, 2026

Figure 7.26: Distribution of Covered Workers’ Cost Sharing for Outpatient Surgery, by Plan Type, 2026

Figure 7.27: Percentage of Covered Workers With the Following Types of Cost Sharing for Hospital Admissions and Outpatient Surgery, in Addition to Any General Annual Deductible, 2026

Figure 7.28: Among Covered Workers With Separate Cost Sharing for Hospital Admissions or Outpatient Surgery, Average Cost Sharing, by Type, 2026

Figure 7.29: Among Covered Workers With a Charge Per Day for Hospital Admissions, Average Cost Sharing Features, 2026

Figure 7.30: Among Covered Workers With a Copayment for Hospital Admissions or Outpatient Surgery, Distribution of Copayments, 2026

Figure 7.31: Among Covered Workers With Coinsurance for Hospital Admissions or Outpatient Surgery, Distribution of Coinsurance Rates, 2026

COST-SHARING FOR PHYSICIAN OFFICE VISITS

The majority of covered workers are enrolled in health plans that require cost-sharing for an in-network physician office visit, in addition to any general annual deductible.¹² The amounts shown below are for visits to in-network providers.

• The most common form of cost-sharing for a physician office visit is a copayment. Sixty-six percent of covered workers have a copayment for a primary care office visit and 19% have coinsurance. For specialist office visit, 67% of covered workers have a copayment and 21% have coinsurance [Figure 7.32].
  • Covered workers at firms with 10 to 199 workers are less likely to have coinsurance than workers at larger firms for a primary care office visit (8% vs. 22%) or an office visit with a specialist. (9% vs. 24%) [Figure 7.37].
  • Covered workers in HSA-qualified plans are less likely to have a copayment for a primary care office visit than workers in other plan types. For covered workers in HSA-qualified plans, 11% have a copayment for a primary care office visit, 55% have coinsurance, and 28% have no cost-sharing after the general annual deductible is met [Figure 7.35].
  • Covered workers in HSA-qualified plans also are less likely to have a copayment for office visits to specialists than workers in other plan types. For covered workers in HSA-qualified plans, 14% have a copayment for an office visit to a specialist, 57% have coinsurance, and 24% have no cost-sharing after the general annual plan deductible is met [Figure 7.35].
• Among covered workers with a copayment for physician office visits, the average copayments are $27 for a primary care office visit and $46 for a specialist. Both amounts are similar to last year. [Figure 7.36].
• Among covered workers with coinsurance for physician office visits, the average coinsurance rates are 20% for a primary care office visit and 21% for a specialist. Each of these is similar to the rates last year [Figure 7.36].

Figure 7.32: Percentage of Covered Workers With the Following Types of Cost Sharing for Physician Office Visits, by Plan Type, 2026

Figure 7.33: Among Covered Workers With Copayments And/Or Coinsurance for Physician Office Visits, Average Copayments and Coinsurance, by Plan Type, 2026

Figure 7.34: Percentage of Covered Workers With the Following Types of Cost Sharing for Physician Office Visits, by Firm Size, 2026

Figure 7.35: Among Covered Workers With a Copayment for a Primary Care Physician Office Visit, Distribution of Copayments, by Plan Type, 2026

Figure 7.36: Among Covered Workers With a Copayment for a Specialist Physician Office Visit, Distribution of Copayments, by Plan Type, 2026

Figure 7.37: Among Covered Workers With a Copayment for a Primary Care Physician Office Visit, Distribution of Copayments, 2007-2026

Figure 7.38: Among Covered Workers With a Copayment for a Specialist Physician Office Visit, Distribution of Copayments, 2007-2026

Figure 7.39: Among Covered Workers With a Copayment And/Or Coinsurance for Physician Office Visits, Average Copayment and Coinsurance, 2006-2026

OUT-OF-POCKET MAXIMUMS

Virtually all covered workers are in a plan that either partially or fully limits the amount of cost-sharing that enrollees must pay in a year. This limit is generally referred to as an out-of-pocket maximum. The Affordable Care Act (ACA) requires requires non-grandfathered health plans to have an annual out-of-pocket maximum of no more than $10,600 for single coverage and $21,200 for family coverage in 2026. HSA-qualified plans are subject to lower out-of-pocket limits.¹³ Many plans have complex out-of-pocket cost-sharing structures, which makes it difficult to accurately collect information on this element of plan design.

• In 2026, more than 99% of covered workers are in a plan with an out-of-pocket maximum for single coverage [Figure 7.40].
• Among covered workers in plans with an out-of-pocket maximum for single coverage, 14% have a maximum of $2,000 or less, while 24% have a maximum above $6,000 [Figure 7.41].

Figure 7.40: Among Covered Workers With an Out-Of-Pocket Maximum for Single Coverage, Distribution of Out-Of-Pocket Maximums, by Plan Type, 2026

Figure 7.41: Average Out-Of-Pocket Maximum for Single Coverage, by Firm Size, 2026

---

11. Some workers with separate per-person deductibles or out-of-pocket maximums for family coverage do not have a specific number of family members that are required to meet the deductible amount and instead have another type of limit, such as a per-person amount with a total dollar amount limit. These responses are included in the averages and distributions for separate family deductibles and out-of-pocket maximums.↩︎
12. Starting in 2010, the survey asked about the prevalence and cost of physician office visits separately for primary care and specialty care. Prior to the 2010 survey, if the respondent indicated the plan had a copayment for office visits, we assumed the plan had a copayment for both primary and specialty care visits. The survey did not allow for a respondent to report that a plan had a copayment for primary care visits and coinsurance for visits with a specialist physician. The changes made in 2010 allow for variations in the type of cost-sharing for primary care and specialty care visits. The survey includes cost-sharing for in-network services only.↩︎
13. For those enrolled in an HDHP/HSA, the out-of-pocket maximum may be no more than $8,500 for an individual plan and $17,000 for a family plan in 2026.↩︎

Health plans can be paired with account options that workers can use to help pay for expenses not covered by the plan. The two most common account options are health savings accounts (HSAs) and health reimbursement arrangements (HRAs). HSAs and HRAs both allow workers to pay for health care expenses on a tax-preferred basis. Workers enrolled in an HSA-qualified plan can establish an HSA, into which employers and workers may make pre-tax contributions up to specified limits. Employer contributions to HSAs belong to workers once they are made, and workers may use their HSA funds to pay for health care expenses permitted by law.

In contrast, HRAs are employer-funded arrangements, and employers can determine how the funds may be used. For example, an employer could establish an HRA that workers could use only for a specific service, such as in-vitro fertilization, or it could establish an HRA that could be used for a broader range of services, or for plan cost-sharing. HRAs are nominal accounts, meaning that the employer promises to provide funds if an employee has eligible expenses, but the funds remain with the employer if the employee does not use them.

These savings arrangements are often (or, in the case of HSAs, always) paired with health plans with high deductibles. Since 2004, the survey has combined high deductible plans paired with HSAs or HRAs into a single plan type referred to as high deductible health plans with savings options (“HDHP/SOs”). Since that time, the prevalence of HSA-qualified plans has grown while that of high deductible plans paired with HRAs has waned. The different types and uses of HRAs has also made it more difficult to make generalizations about these plans. So, beginning this year, the survey will no longer track the HDHP/SOs as a plan type and instead focus on HSA-qualified plans as a plan type. The survey will continue to ask employers whether they offer HRAs and what the HRA funds may be used for, but will no longer ask about the amounts made available in these arrangements.

AVAILABILITY OF AND ENROLLMENT IN HSA-QUALIFIED PLANS

• Among firms with 10 or more workers offering health benefits, 39% offer an HSA-qualified plan to at least some of their workers, higher than the percentages last year (31%) and two years ago (28%).
• Firms with 200 or more workers are more likely than smaller firms to offer an HSA-qualified plan to at least some workers (54% vs. 38%) [Figure 4.6].
• As discussed in Section 5, 29% of covered workers are enrolled in an HSA-qualified plan in 2026, similar to the percentage last year (29%), but higher than the percentages five years ago (22%) and 10 years ago (19%) [Figure 5.1].

EMPLOYER CONTRIBUTIONS TO HSA ACCOUNTS

Employers may, but are not required to, make contributions to the HSAs of employees enrolled in HSA-qualified plans.

• Covered workers enrolled in HSA-qualified plans in 2026 receive an average annual employer HSA contribution of $713 for single coverage and $1,346 for family coverage [Figure 8.1].
• In many cases, employers that sponsor HSA-qualified plans do not make any contributions to HSAs established by their employees. Thirty-nine percent of employers offering single coverage and 40% of employers offering family coverage through HSA-qualified plans do not make HSA contributions. Among covered workers enrolled in HSA-qualified plans, 16% with single coverage and 16% with family coverage do not receive an employer HSA contribution, similar to the percentages last year [Figure 8.1] and [Figure 8.2].
• The average HSA contributions number reported above include covered workers whose employer contribution is zero. Excluding workers with no employer contribution, the average employer HSA contribution is $853 for single coverage and $1,615 for family coverage.
• The amounts that employers contribute to HSAs can vary considerably. Twenty-seven percent of covered workers in an HSA-qualified plan receive an annual employer HSA contribution of less than $400 for single coverage, including 16% who receive no employer contribution [Figure 8.3]. In contrast, 16% receive an annual employer HSA contribution of $1,200 or more. Two percent of covered workers have an employer that matches worker HSA contributions for single coverage.

Figure 8.1: Average Annual Employer Contributions to HSA Accounts for Covered Workers Enrolled in HSA-Qualified Plans, 2026

Figure 8.2: Average Annual Employer Contributions to HSA Accounts for Covered Workers Enrolled in HSA-Qualified Plans, 2011-2026

Figure 8.3: Distribution of Covered Workers With the Following Annual Employer Contributions to Their HSA Accounts, for Single Coverage, 2026

Figure 8.4: Distribution of Covered Workers With the Following Annual Employer Contributions to Their HSA Accounts, for Family Coverage, 2026

WORKER AND EMPLOYER CONTRIBUTIONS TO HSA-QUALIFIED PLAN PREMIUMS

• The average worker premium contribution for covered workers enrolled in HSA-qualified plans are $1,497 for single coverage and $6,211 for family coverage, similar to the amounts last year [Figure 8.6].
• The average worker premium contribution for covered workers enrolled in HSA-qualified plans is similar to the average for covered workers overall for single coverage ($1,497 and $1,672), but lower for family coverage ($6,211 vs. $7,471).

Employers contribute to HSA-qualified plans in two ways: through contributions toward the cost of the health plan premiums and through contributions, if any, to workers’ HSAs.

• The average annual employer contributions toward premiums for covered workers in HSA-qualified plans are $7,492 for single coverage and $20,239 for family coverage. These amounts are similar to last year [Figure 8.7].
• For single coverage, the average employer contribution toward premiums for covered workers in HSA-qualified plans ($7,492) is lower than the average employer contribution for workers in plans that are not HSA-qualified ($8,392) [Figure 8.7].

Employer contributions toward premiums for HSA-qualified plans can be combined with employer contributions, if any, to workers’ HSAs to calculate the total employer contribution for workers enrolled in these plans.

• The average total annual employer contribution for covered workers enrolled in HSA-qualified plans is $8,242 for single coverage and $21,742 for family coverage.

These amounts are similar to the average employer contributions for single and family coverage in plans that are not HSA-qualified [Figure 8.7].

Figure 8.5: Average Annual Premiums and Account Contributions for Covered Workers in HSA-Qualified Plans, Compared to Other Plan Types, 2026

Figure 8.6: Average Annual Premiums and Contributions for Covered Workers in HSA-Qualified Plans and Other Plan Types, for Family Coverage, 2026

Figure 8.7: Total Annual Costs (Premiums and Account Contributions) for Covered Workers in HSA-Qualified Plans, for Family Coverage, by Firm Characteristics, 2026

COST-SHARING

For covered workers in HSA-qualified plans the the average deductibles for single coverage is $3,595 at small firms and $2,734 at large firms. Overall, the average deductible for single coverage is $2,912 [Figure 8.9].

• Forty-eight percent of covered workers in HSA-qualified plans have a deductible of $3,000 or more for single coverage.

While HSA-qualified plans often have higher deductibles, they are often paired with employer account contributions, which can offset some costs. If employer HSA contributions are subtracted from general annual deductibles, the average deductible for single coverage is $2,222.

Among covered workers enrolled in family coverage, 72% of those in HSA-qualified plans have an aggregate general annual deductible. The average deductible for covered workers in HSA-qualified plans with an aggregate annual deductible for family coverage is $5,380 for HSA-qualified plans.

• Nineteen percent of covered workers in HSA-qualified plans with an aggregate annual deductible for family coverage have a deductible of $7,000 or more.

Figure 8.8: Distribution of Covered Workers in HSA-Qualified Plans With the Following General Annual Deductibles for Single Coverage, by Firm Size, 2026

Figure 8.9: General Annual Deductible for Workers in HSA-Qualified Plans After Any Employer Account Contributions for Single Coverage, by Firm Size, 2026

Figure 8.10: Distribution of Covered Workers in HSA-Qualified Plans With the Following Aggregate Family Deductibles, 2026

Figure 8.11: Distribution of Covered Workers in HSA-Qualified Plans and Other Plan Types With the Following Types of Cost Sharing in Addition to the General Annual Deductible, 2026

HEALTH REIMBURSEMENT ARRANGEMENTS

Some employers offering health benefits make funds available to covered workers through an HRA.

• In 2026, 8% of covered workers are in a plan that is offered along with a health reimbursement arrangement [Figure 8.12].
• Among covered workers in a plan offered with an HRA, 61% are in a plan where HRA funds can be used to offset workers’ cost-sharing expenses [Figure 9.13].

Figure 8.12: Among Firms Offering Health Benefits, Percentage of Covered Workers Enrolled in a Plan That Is Paired With an HRA, by Firm Size, 2026

Figure 8.13: Among Covered Workers in a Plan Paired With an HRA, Function of the HSA, by Firm Size, 2026

---

Health Reimbursement Arrangements (HRAs) are employer-funded arrangements that reimburse employees for eligible health care expenses. Employers may make a specified amount of money available through an HRA for premiums and medical expenses incurred by employees or their dependents. HRAs are accounting devices, and employers are not required to expend funds until an employee incurs an expense that is eligible for reimbursement. Unspent HRA funds can usually be carried over to the next year, sometimes subject to a limit. Employees generally cannot take their HRA balances with them if they leave their job, although an employer can choose to make the remaining balance available to former employees to pay for health care. HRAs are often offered along with health plans with high deductibles. In such cases, employees may use HRA funds to pay eligible health care expenses and then pay out of pocket until the health plan deductible is met. Certain preventive services or other services, such as prescription drugs, may be covered by the plan before the employee meets the deductible.

Health Savings Accounts (HSAs) are savings accounts established by individuals to pay for health care expenses. An individual may establish an HSA if they are covered by an HSA-qualified plan that meets federal requirements, including a minimum deductible of $1,650 for single coverage and $3,300 for family coverage in 2026, compared with $1,600 and $3,200, respectively, in 2025. Employers can facilitate employees’ access to HSAs by offering an HSA-qualified plan and may also assist employees by identifying HSA options, facilitating applications, or negotiating favorable fees from HSA vendors.

Both employers and employees can contribute to an HSA, up to the statutory contribution limit of $4,400 for single coverage and $8,650 for family coverage in 2026. Employee contributions to an HSA may be made on a pre-tax basis, and some employers arrange for employees to fund their HSAs through payroll deductions. Employers are not required to contribute to HSAs established by their employees, but employer contributions are not taxable to the employee. Interest and other earnings on amounts in an HSA are not taxable, and withdrawals used to pay for qualified medical expenses are not taxed. The account is owned by the individual, so employees retain their HSA balances if they leave their job.

Nearly all (98%) covered workers are in a firm that provides prescription drug coverage to enrollees in its largest health plan. Over time, employer plans have incorporated more complex prescription drug benefit designs as employers and insurers have expanded the use of formularies with multiple cost-sharing tiers and other management approaches. To reduce the burden on respondents, we ask firms offering health benefits about the attributes of prescription drug coverage only for their largest health plan. We collect information on cost-sharing in up to four tiers, and, if applicable, a separate tier exclusively for specialty drugs. Some plans may have more than one tier for specialty drugs, or other variations in their formularies that are not captured by the survey.

Figure 9.1: Distribution of Covered Workers Facing Different Cost-Sharing Formulas for Prescription Drug Benefits, 2017-2026

Figure 9.2: Distribution of Covered Workers Facing Different Cost-Sharing Formulas for Prescription Drug Benefits, by Plan Type and Firm Size, 2026

TIERS NOT EXCLUSIVELY FOR SPECIALTY DRUGS

Excluding formulary tiers that cover only specialty drugs, a large share (82%) of covered workers are in a plan with three or more tiers of cost sharing for prescription drugs. The cost-sharing statistics presented in this section do not include tiers that cover only specialty drugs. When specialty drugs are covered on a tier with other drugs, those drugs are included in these averages. Cost-sharing statistics for tiers covering only specialty drugs are presented separately below.

• For covered workers in a plan with three or more tiers of cost-sharing for prescription drugs, copayments are the most common form of cost-sharing in the first three tiers, and coinsurance is the second-most common [Figure 9.3].
  • Among covered workers in plans with three or more tiers of cost-sharing for prescription drugs, the average copayment is $12 for first-tier drugs, $36 for second-tier drugs, $66 for third-tier drugs, and $136 for fourth-tier drugs [Figure 9.6].
  • Among covered workers in plans with three or more tiers of cost-sharing for prescription drugs, the average coinsurance rate is 21% for first-tier drugs, 26% for second-tier drugs, 35% for third-tier drugs, and 30% for fourth-tier drugs [Figure 9.6].
• Six percent of covered workers are in a plan with two tiers of prescription drug cost-sharing, excluding tiers that cover only specialty drugs.
  • For these workers, copayments are more common than coinsurance in both tiers [Figure 9.3]. The average copayment is $13 for the first tier and $37 for the second tier. The average coinsurance rate is 19% for the first tier and 27% for the second tier [Figure 9.6].
• Six percent of covered workers are in a plan with the same cost-sharing for all prescription drugs, excluding tiers that cover only specialty drugs [Figure 9.2].
  • Among these workers, 22% have copayments and 78% have coinsurance [Figure 9.3].

Figure 9.3: Among Covered Workers With Prescription Drug Coverage, Distribution With the Following Types of Cost Sharing for Prescription Drugs, 2026

Figure 9.4: Among Covered Workers With Three or More Tiers of Prescription Drug Cost Sharing, Distribution With the Following Types of Cost Sharing, by Firm Size, 2026

Figure 9.5: Among Covered Workers With Three or More Tiers of Prescription Drug Cost Sharing, Distribution With the Following Types of Cost Sharing, by Plan Type, 2026

Figure 9.6: Among Covered Workers With Prescription Drug Coverage, Average Copayments and Coinsurance, 2026

COINSURANCE MAXIMUMS

Coinsurance rates for prescription drugs often include maximum and/or minimum dollar amounts. Depending on the plan design, coinsurance maximums can significantly limit the amount an enrollee must spend out-of-pocket for higher-cost drugs. Even in plans without explicit coinsurance maximum amounts, the overall plan out-of-pocket maximum limits enrollee cost-sharing on covered services, including prescription drugs.

Coinsurance minimum and maximum amounts vary across tiers and plan designs.

• For example, among covered workers in a plan with coinsurance for the third cost-sharing tier, 38% have only a maximum dollar amount attached to the coinsurance rate, 9% have only a minimum dollar amount, 27% have both a minimum and maximum dollar amount, and 27% have neither.
• For those in a plan with coinsurance for the fourth cost-sharing tier, 76% have only a maximum dollar amount attached to the coinsurance rate, <1% have only a minimum dollar amount, 6% have both a minimum and maximum dollar amount, and 16% have neither [Figure 9.7].

Figure 9.7: Distribution of Coinsurance Structures for Covered Workers Facing Coinsurance for Prescription Drugs, 2026

SEPARATE TIERS FOR SPECIALTY DRUGS

Specialty drugs are generally high-cost medications used to treat complex or chronic conditions, such as cancer, rheumatoid arthritis, or multiple sclerosis. They may be biologics or other drugs and often require special handling, administration, or monitoring. Given the high cost of these drugs, we ask separately about formulary tiers that cover only specialty drugs.

• In 2026, 89% of covered workers at firms with 10 or more workers are in a plan with coverage for specialty drugs, similar to the percentage as last year.
  • Covered workers in larger firms (firms with 200 or more workers) are more likely than workers in smaller firms to be in a plan with coverage for specialty drugs (93% vs. 76%).
  • Covered workers in smaller firms are more likely than workers in larger firms to work for a firm that did not know whether its largest plan covers specialty drugs (17% vs. 3%).
• Among covered workers in larger firms in a plan with coverage for specialty drugs, 62% are in a plan with at least one cost-sharing tier exclusively for specialty drugs [Figure 9.8].
  • Among covered workers in larger firms whose plan has at least one separate tier for specialty drugs, 41% have a copayment for specialty drugs and 54% have coinsurance [Figure 9.10]. The average copayment is $110 and the average coinsurance rate is 27% [Figure 9.11]. Seventy percent of those with coinsurance have a maximum dollar limit on the amount of coinsurance they must pay.

Figure 9.8: Among Large Firms With Prescription Drug Coverage, Percentage of Workers With Coverage for Specialty Drugs, 2016-2026

Figure 9.9: Among Large Firms Whose Prescription Drug Coverage Includes Specialty Drugs, Percentage of Covered Workers Enrolled in a Plan That Has a Separate Tier for Specialty Drugs, by Firm Size, 2026

Figure 9.10: Among Covered Workers at Large Firms Enrolled in a Plan With a Separate Tier for Specialty Drugs, Distribution of the Following Types of Cost Sharing, by Firm Size, 2026

Figure 9.11: Among Covered Workers at Large Firms Enrolled in a Plan With a Separate Tier for Specialty Drugs, Average Copayments and Coinsurance, by Firm Size, 2017 and 2026

PRESCRIPTION DRUG POLICY

Firms with 50 or more workers offering prescription drug coverage were asked about several strategies to reduce prescription drug costs.

• Thirty-three percent of these firms offer enrollees access to lower-cost mail-order generic drugs through a third-party vendor, such as Mark Cuban Cost Plus, SingleCare, or GoodRx. Firms with 50 to 199 workers are less likely than larger firms to offer access to lower-cost mail-order generic drugs through a third-party vendor (31% vs. 40%) [Figure 9.12].
  • The share of firms with 200 or more workers offering access to lower-cost mail-order generic drugs through a third-party vendor increased from 32% in 2024 to 40% in 2026.
• Eleven percent of firms limit coverage for certain prescription drugs exclusively to mail-order pharmacies. In these cases, the plan does not pay for those prescriptions if an enrollee uses an in-person pharmacy.
  • Firms with 5,000 or more workers are more likely than smaller firms to limit coverage for certain prescription drugs exclusively to mail-order pharmacies (20%) [Figure 9.13].
• Nine percent of firms participate in an international prescription drug purchasing service, such as ScriptSourcing or CanaRx, which provides access to discounted maintenance medications purchased outside the United States [Figure 9.14].
  • Firms with 5,000 or more workers are less likely than smaller firms to participate in an international prescription drug purchasing service (1%).

Figure 9.12: Percentage of Firms That Offer Coverage for Lower-Cost Mail-Order Generics, by Firm Size, 2026

Figure 9.13: Percentage of Firms That Cover Some Drugs Only Through Mail-Order Pharmacies, by Firm Size, 2026

Figure 9.14: Percentage of Firms That Buy Prescription Drugs From Outside the USA Through International Sourcing, by Firm Size, 2026

---

Generic drugs

• Drugs that are no longer protected by a patent and may be produced or distributed by multiple drug companies.

Preferred drugs

• Drugs included on a formulary or preferred drug list; for example, a brand-name drug without a generic substitute.

Non-preferred drugs

• Drugs not included on a formulary or preferred drug list; for example, a brand-name drug for which a generic substitute is available.

Fourth-tier drugs

• Drugs placed on an additional cost-sharing tier that typically requires higher copayments or coinsurance than the first three tiers. This tier may include specialty or other high-cost drugs.

Specialty drugs

• Generally high-cost medications used to treat complex or chronic conditions, such as cancer, rheumatoid arthritis, or multiple sclerosis. They may be biologic or other drugs and often require special handling, administration, or monitoring.

Many firms, particularly larger firms, choose to pay for some or all of the health services of their workers directly from their own funds rather than by purchasing health insurance to cover them. This is called self-funding. Both public and private employers can use self-funding to provide health benefits. Federal law (the Employee Retirement Income Security Act of 1974, or ERISA) exempts self-funded plans established by private employers (but not public employers) from most state insurance laws, including reserve requirements, mandated benefits, premium taxes, and some consumer protection regulations. In 2026, 71% of covered workers are in a self-funded health plan. Some employers who sponsor self-funded plans purchase stoploss coverage to limit their liabilities.

In recent years, a complex funding option, often called level-funding, has become more widely available to small employers. Level-funded arrangements are nominally self-funded options that package together a self-funded plan with extensive stoploss coverage that significantly reduces the risk retained by the employer. Thirty-eight percent of covered workers in firms with 10 to 199 workers are in a level-funded plan in 2026.

SELF-FUNDED PLANS

• Seventy-one percent of covered workers are in a plan that is self-funded, similar to the percentage (67%) last year [Figure 10.2].
  • The percentage of covered workers enrolled in self-funded plans is higher than the percentages two years ago (65%), five years ago (66%) and ten years ago (63%) [Figure 10.2].
  • Covered workers in firms with 200 or more workers are significantly more likely to be in a self-funded plan than covered workers in smaller firms (85% vs. 25%) [Figure 10.1] and [Figure 10.1].

Figure 10.1: Percentage of Covered Workers Enrolled in a Self-Funded Plan, by Firm Size, 2026

Figure 10.2: Percentage of Covered Workers Enrolled in a Self-Funded Plan, by Firm Size, 1999-2026

Figure 10.3: Percentage of Covered Workers Enrolled in a Self-Funded Plan, by Firm Size, Region, and Industry, 2026

Figure 10.4: Percentage of Covered Workers Enrolled in a Self-Funded Plan, by Plan Type and Firm Size, 2026

Figure 10.5: Percentage of Covered Workers Enrolled in a Self-Funded Plan, by Firm Ownership Type, 2026

LEVEL-FUNDED PLANS

In recent years, insurers have been offering health plans that provide a nominally self-funded option for small and mid-sized employers that incorporates stoploss insurance with relatively low attachment points. In these arrangements, the insurer calculates an expected monthly expense for the employer, which includes a share of estimated annual claims costs, premiums for the stoploss protection, and an administrative fee. The employer pays this “level premium” amount, with the possibility of reconciliation between the employer and insurer at the end of the year, although small employers are often protected from any meaningful additional liability. These policies are sold as self-funded plans, so they generally are not subject to state requirements for insured plans and, for those sold to employers with fewer than 50 employees, are not subject to the rating and benefit standards in the ACA for small firms.

Due to the complexity of the funding (and regulatory status) of these plans, and because employers often pay a monthly amount that resembles a premium, respondents may be confused as to whether or not their health plan is self-funded or insured. There also may be confusion because different plan administrators (generally insurers) use different labels to refer to these arrangements. We asked employers with fewer than 200 workers whether or not they have a level-funded plan.

• Thirty-seven percent of firms with 10 to 199 workers that offer health benefits offer a level-funded plan in 2026, the same percentage as last year [Figure 10.8].
• Thirty-eight percent of covered workers in firms with 10 to 199 workers are enrolled in a level-funded plan in 2026, similar to the percentage last year [Figure 10.6] . Fifty percent of covered workers in firms with 10 to 199 workers are enrolled in either a level-funded plan or a self-insured plan, similar to the percentage last year [Figure 10.7] and [Figure 10.8].

Figure 10.6: Among Covered Workers at Small Firms, Percentage Enrolled in a Level-Funded or Self-Funded Plan, by Firm Size, 2026

Figure 10.7: Among Covered Workers at Small Firms, Percentage Enrolled in a Level-Funded or Self-Insured Plan, by Firm Size, 2026

Figure 10.8: Among Covered Workers at Small Firms, Percentage Enrolled in a Level-Funded or Self-Funded Plan, 2018-2026

STOPLOSS COVERAGE

Employers purchase insurance, often referred to as “stoploss” coverage, to protect themselves from unexpected losses for claims incurred by a self-funded plan. There are different types of stoploss coverage. For example, a policy may cover any amount that the plan sponsor must pay over a specified amount for each worker or enrollee (referred to as specific stoploss coverage) or it may limit the total amount the plan sponsor must pay for all claims in the plan over the plan year (referred to as aggregate stoploss coverage). Stoploss coverage may also be focused on particular types of claims (e.g., organ transplants). A firm may have more than one type of stoploss coverage.

• Among covered workers in self-funded plans at firms with 200 or more workers, 75% of covered workers are in plans that have stoploss insurance, similar to the percentage last year (75%) [Figure 10.9]. Covered workers in firms with 5,000 or more workers are less likely than covered workers in smaller firms to be in a plan with stoploss insurance [Figure 10.10].

Figure 10.9: Among Covered Workers Enrolled in a Self-Funded Plan, Percentage Covered by Stoploss Insurance (At Firms With 50 or More Workers), by Firm Size, 2011-2026

Figure 10.10: Among Covered Workers Enrolled in a Self-Funded Plan, Percentage Covered by Stoploss Insurance (At Firms With 50 or More Workers), by Firm Size, 2026

---

Retiree health benefits are an important consideration for older workers making decisions about retirement, and can be a crucial source of coverage for people retiring before they are eligible for Medicare. For retirees with Medicare coverage, retiree health benefits can provide important supplementary coverage by helping them pay for cost sharing and benefits that Medicare does not cover.

Twenty-five percent of large firms offering health benefits offer retiree health benefits in 2026, similar to the percentage in 2025 (27%).

This survey asks questions about retiree health benefits only of firms with 200 or more workers that offer health benefits.

EMPLOYER RETIREE BENEFITS

In 2026, 25% of firms with 200 or more workers that offer health benefits offer retiree health benefits for at least some current workers or retirees [Figure 11.1]. Starting in 2019, we instructed firms to respond “yes” if they were providing coverage to retirees but were not offering these benefits to current employees, or if they were planning to provide retiree health benefits to current employees in the future.

• Retiree health benefit offer rates vary with firm characteristics.
• Firms with 5,000 or more workers are more likely than smaller firms to offer retiree health benefits (35% vs. 24%) [Figure 11.2].
• The share of firms that offer retiree health benefits varies considerably by industry [Figure 11.2].
• Public employers are far more likely than other types of firms to offer retiree health benefits (61% vs. 11%) [Figure 11.3].
• Firms that have at least some union workers are more likely to offer retiree health benefits than firms without any union workers (48% vs. 15%) [Figure 11.3].

Figure 11.1: Among Large Firms Offering Health Benefits to Active Workers, Percentage of Firms Offering Retiree Health Benefits, 1988-2026

Figure 11.2: Among Large Firms Offering Health Benefits to Active Workers, Percentage of Firms Offering Retiree Health Benefits, by Firm Size, Region, and Industry, 2026

Figure 11.3: Among Large Firms Offering Health Benefits to Active Workers, Percentage of Firms Offering Retiree Health Benefits, by Firm Characteristics, 2026

BENEFIT ELIGIBILITY

Among firms with 200 or more workers that offer retiree health benefits:

• Ninety-three percent offer benefits to early retirees under age 65 [Figure 11.4].
• Fifty-seven percent offer benefits to Medicare-age retirees [Figure 11.4].
• Fifty-one percent offer benefits to both early and Medicare-age retirees.

Among firms that offer retiree health benefits, three in four (88%) offer health benefits to retirees’ spouses [Figure 11.5].

Figure 11.4: Among Large Firms Offering Health Benefits to Active Workers and Retirees, Percentage of Firms Offering Health Benefits to Early and Medicare-Age Retirees, 2000-2026

Figure 11.5: Among Large Firms Offering Health Benefits to Active Workers and Retirees, Percentage of Firms Offering Health Benefits to Retirees’ Spouses, by Firm Size, 2026

MEDICARE ADVANTAGE

Fifty-nine percent of firms that offer retiree health benefits to Medicare-age retirees offer coverage to at least some Medicare-age retirees through a contract with a Medicare Advantage plan, similar to the share last year (47%) [Figure 11.7].

• Among firms that offer retiree health benefits through a Medicare Advantage plan:
  • Sixty-one percent offer retiree health benefits only through Medicare Advantage plans, while 39% offer a choice of Medicare Advantage and other types of plans for retiree health benefits [Figure 11.8]. Both shares are similar to last year.
  • Sixty-one percent say, to the best of their knowledge, that the shift to offering Medicare Advantage plans lowered their per-retiree costs; 16% say the shift did not lower their per-retiree costs; and 23% say they do not know [Figure 11.9].
• Among firms that offer retiree health benefits but do not offer benefits through a Medicare Advantage plan in 2026, 5% are somewhat likely to do so in the next two years [Figure 11.10].

Figure 11.6: Among Large Firms That Offer Retiree Health Benefits to Medicare-Age Retirees, Percentage of Firms That Contract With a Medicare Advantage Plan, 2026

Figure 11.7: Among Large Firms That Offer Retiree Health Benefits to Medicare-Age Retirees, Percentage of Firms That Contract With a Medicare Advantage Plan, 2017-2026

Figure 11.8: Among Large Firms Offering Retiree Benefits Through a Contract With a Medicare Advantage Plan, Percentage of Firms Which Offer Retirees a Choice, 2026

Figure 11.9: Among Large Firms Offering Retiree Benefits Through a Contract With a Medicare Advantage (MA) Plan, Percentage of Firms Which Believe the Shift to MA Lowered the Cost Per Retiree, 2026

Figure 11.10: Among Large Firms Offering Retiree Benefits But Not Currently Contracting With a Medicare Advantage (MA) Plan, Percentage of Firms Which Plan to Start Offering Health Benefits Through an MA Plan in the Next Two Years, 2026

Employers frequently review and modify their health plans to incorporate new options or adapt to changing circumstances. Topics covered this year include employer satisfaction with their health plans, the structure and breadth of provider networks, employer responses to higher costs, coverage of GLP-1 agonists for weight loss, prior authorization practices, and employer access to information on prices and utilization.

EMPLOYER SATISFACTION WITH HEALTH PLANS

Firms that offer health benefits were asked about their satisfaction with several aspects of the health plans offered to their employees.

• Cost of care. Only 17% of firms say that they are “very satisfied” with the overall cost of care for employees, 51% say that they are “satisfied”, 29% say that they are “dissatisfied” or “very dissatisfied”, and 4% say that they do not know [Figure 12.1]. Firms with fewer than 200 workers are less likely than larger firms to say that they are “very satisfied” with the overall cost of care for employees (16% vs. 23%).
• Quality of network providers. Forty-two percent of firms say that they are “very satisfied” and 53% say that they are “satisfied” with the quality of providers in plan networks. Only 2% say that they are “dissatisfied” or “very dissatisfied” with the quality of network providers, and 3% say that they do not know. [Figure 12.1].
• Timely access to services. Thirty-three percent of firms say that they are “very satisfied” and 58% say that they are “satisfied” with the timely access to services in the health plans that they offer. Only 5% say that they are “dissatisfied” or “very dissatisfied” with timely access to services in their health plans, and 4% say that they do not know [Figure 12.1].
• Access to behavioral health care. Twenty-six percent of firms say that they are “very satisfied” and 56% say that they are “satisfied” with access to behavioral health care in the health plans that they offer. Only 7% say that they are “dissatisfied” or “very dissatisfied” with access to behavioral health care in their health plans, and 11% say that they do not know [Figure 12.1]. The share of firms offering health benefits that report being “very satisfied” with access to behavioral health care in their health plan has increased since 2022, the last time firms were asked about plan satisfaction (26% vs. 16%).
• Employee access to information about the cost and quality of treatment options. Twenty-four percent of firms say that they are “very satisfied” with employees’ ability to obtain information about the cost and quality of treatment options before receiving care, while 60% say that they are “satisfied.” Seven percent say that they are “dissatisfied,” 2% say that they are “very dissatisfied,” and 8% say that they do not know [Figure 12.1]. Firms with 1,000 or more workers are more likely than smaller firms to say that they are “dissatisfied” or “very dissatisfied” with employees’ access to this information (15% vs. 8%).

Figure 12.1: Firms’ Level of Satisfaction With Aspects of Their Health Plans, 2026

Figure 12.2: Large Firms’ Level of Satisfaction With Aspects of Their Health Plans, 2026

HEALTH PLAN NETWORKS

Firms and health plans structure their provider networks to ensure access to care while also encouraging enrollees to use providers who are lower cost or provide better care. Firms were asked about several aspects of their provider networks, including network breadth, virtual care options, and access to on-site clinics.

BREADTH OF NETWORKS

Some firms offer their employees health plans with relatively small, or narrow, networks of providers. Narrow network plans limit the number of participating providers, which may help reduce costs and are generally more restrictive than standard HMO networks.

• Among firms that offer health benefits, 8% offer a narrow network plan in 2026, similar to the percentage last year (9%). Firms with 1,000 to 4,999 workers (13%) and 5,000 or more workers (20%) are more likely than smaller firms to offer a narrow network plan [Figure 12.3].

Firms offering health benefits were asked about the breadth of the provider network of their plan with the largest enrollment. A broad network includes most local doctors and hospitals; a narrow network has a limited number of providers.

• Among these firms, 51% say that the network is “very broad,” 38% say that it is “somewhat broad,” 5% say that it is “somewhat narrow,” 3% say that it is “very narrow,” and 4% say that they do not know [Figure 12.5]. Firms with 200 or more workers are more likely than smaller firms to characterize the network of their health plan with the largest enrollment as “very broad” (64% vs. 50%) [Figure 12.5].

Firms offering health benefits were also asked about the breadth of the provider network of their plan with the largest enrollment for mental health and substance use conditions.

• Among these firms, 22% say that the network for mental health and substance use conditions is “very broad,” 42% say that it is “somewhat broad,” 12% say that it is “somewhat narrow,” 3% say that it is “very narrow,” and 20% say that they do not know [Figure 12.5]. Firms with 200 or more workers are more likely than smaller firms to characterize the network for these services as “very broad” (32% vs. 21%), while firms with fewer than 200 workers are more likely to say that they do not know (21% vs. 10%) [Figure 12.5].

Figure 12.3: Among Firms Offering Health Benefits, Percentage That Offer a Narrow Network Plan, by Firm Size, 2026

Figure 12.4: Among Firms Offering Health Benefits, Percentage of Firms That Offer a Narrow Network Plan, by Firm Size, 2014-2026

Figure 12.5: Among Firms Offering Health Benefits, How Broad the Firm Considers Its Largest Plan’s Network, by Firm Size, 2026

TREATMENT OPTIONS FOR SUBSTANCE USE CONDTIONS

Firms with 200 or more workers offering health benefits were asked whether they had made efforts in the last two years to expand the availability of services to treat substance use conditions. Firms also were asked whether they had taken actions to reduce out-of-network coverage for these services due to concerns about cost or quality.

• Among these firms, 34% say that they have added new virtual providers within the last two years, and 20% say that they have added new providers or facilities for in-person care [Figure 12.6].
• Three percent of these firms say that they have taken actions to reduce out-of-network coverage for substance use services due to concerns about cost or quality [Figure 12.6].

Figure 12.6: Percentage of Large Firms That Changed Networks for Substance Use Providers in the Past 2 Years, 2026

VARIABLE COPAY PLANS

Some firms offer plans, such as those from Surest and Coupe Health, that replace deductibles with copayments that vary based on the provider chosen by the enrollee. Enrollees who choose more efficient providers generally face lower copayments.

• Among firms with 200 or more workers that offer health benefits, 4% offer a plan to at least some employees that uses this variable copayment approach. Firms with 5,000 or more workers are more likely than firms with 200 to 4,999 workers to offer such a plan (10% vs. 4%) [Figure 12.7].

Figure 12.7: Percentage of Large Firms That Vary Copays Based On Provider Costs, by Firm Size, 2025-2026

ON-SITE AND NEAR-SITE CLINICS

Some firms provide health care services through clinics located at or near their workplaces. These clinics are staffed by health professionals and may treat work-related or non-work-related conditions.

• Among firms with 50 or more workers that offer health benefits, 24% have an on-site or near-site clinic at at least one of their major locations. Seven percent have an on-site clinic and 20% have a near-site clinic [Figure 12.8].
• Among firms with 200 or more workers that offer health benefits, 24% have an on-site or near-site clinic [Figure 12.9]. Among firms with 200 or more workers that have this type of clinic, 28% have a near-site clinic, 46% have an on-site clinic, and 25% have both an on-site and a near-site clinic. Overall, 13% of large firms have an on-site clinic and 17% have a near-site clinic [Figure 12.9].

Figure 12.8: Among Firms Offering Health Benefits, Percentage of Firms With an On-Site Health Clinic, by Firm Size, 2026

Figure 12.9: Among Large Firms Offering Health Benefits, Percentage With an On-Site Health Clinic, by Firm Size, 2019, 2023, and 2026

REACTIONS TO HIGHER PROJECTED COSTS

Health insurance costs were projected to increase relatively rapidly in 2026. Firms offering health benefits were asked whether they took certain actions in response to projected cost increases for their plan with the largest enrollment.

Among these firms:

• Seventeen percent increased deductibles or other cost sharing for most services [Figure 12.10]. Firms with 1,000 or more workers are more likely than smaller firms to have taken this action (33% vs. 16%).
• Four percent increased cost sharing for selected services [Figure 12.10]. Firms with 1,000 or more workers are more likely than smaller firms to have taken this action (20% vs. 4%).
• Two percent reduced or tightened eligibility for certain benefits [Figure 12.10]. Firms with 1,000 or more workers are more likely than smaller firms to have taken this action (10% vs. 2%).
• Three percent added additional management requirements, such as prior authorization, for some services [Figure 12.10]. The likelihood of taking this action increased with firm size, ranging from 3% of firms with 10 to 199 workers to 21% of firms with 5,000 or more workers.
• Eighteen percent increased the share of the premium paid by employees [Figure 12.10]. The likelihood of taking this action increased with firm size, ranging from 16% of firms with 10 to 199 workers to 66% of firms with 5,000 or more workers.
• Eleven percent changed insurers or administrators.
• Five percent switched to a plan with a tiered or narrower provider network.

Figure 12.10: Among Firms Offering Health Benefits, Firm Responses to Higher Projected Health Plan Costs, 2026

Figure 12.11: Among Large Firms Offering Health Benefits, Firm Responses to Higher Projected Health Plan Costs, 2026

GLP-1 DRUG COVERAGE FOR WEIGHT LOSS

GLP-1 (glucagon-like peptide-1) agonists are used to help control blood sugar levels in people with type 2 diabetes, and have also been shown to be effective treatments for obesity. Common brand names include Wegovy, Saxenda, and Zepbound. Health plans generally have covered GLP-1 drugs when prescribed to treat diabetes, but there is widespread interest in their use for people who have a clinical need to lose weight. Although the costs of these drugs have been declining, the large number of people who may benefit from them, combined with the potential for long-term use, has raised questions about their impact on plan spending. The increasing availability of direct-to-consumer programs for these medications, often at relatively low costs, have also provided options for employers to potentially fund access through alternate methods, such as account contributions.

Firms with 200 or more workers that offer health benefits were asked about coverage of GLP-1 agonists when used primarily for weight loss in their plan with the largest enrollment.

• Among these firms, 16% of firms with 200 to 999 workers, 29% of firms with 1,000 to 4,999 workers, and 33% of firms with 5,000 or more workers cover GLP-1 agonists when used primarily for weight loss [Figure 12.12].
  • Firms with 200 to 999 workers are more likely than larger firms to say that they do not know whether their plan covers GLP-1 agonists for weight loss (19% vs. 8%).
  • The overall percentage of firms with 200 or more workers that cover GLP-1 agonists for weight loss (18%) is similar to the percentage last year (19%) and two years ago (18%) [Figure 12.13].
  • The percentage of firms with 5,000 or more workers that cover GLP-1 agonists for weight loss is similar to the percentage last year (33% vs. 43%) [Figure 12.13].
• Among firms that cover GLP-1 agonists for weight loss, 40% require enrollees to meet with a clinical professional (such as a dietitian, case manager, or therapist) or participate in a lifestyle program in order for the drug to be covered, similar to the percentage last year (34%) [Figure 12.14].
  • Firms with 200 to 999 workers are less likely (35%) and firms with 5,000 or more workers are more likely (59%) to have such a requirement [Figure 12.14].
• Among firms that cover GLP-1 agonists for weight loss, 29% say that covering these medications has had a significant impact on their plan’s prescription drug spending, 27% say that the impact has been moderate, 23% say that the impact has been minor, 10% say that there has been no impact, and 11% say that they do not know [Figure 12.15].
  • The share of these firms saying that covering GLP-1 agonists for weight loss has had a significant impact on prescription drug spending increases with firm size, ranging from 21% of firms with 200 to 999 workers to 61% of firms with 5,000 or more workers [Figure 12.16].
  • Firms with 200 to 999 workers are more likely than larger firms to say that covering these medications for weight loss has had only a minor impact on prescription drug spending (30% vs. 5%) [Figure 12.15].
• Among firms with 200 or more workers that do not cover GLP-1 agonists for weight loss in their plan with the largest enrollment, 12% say that they stopped covering these medications for weight loss within the last 12 months [Figure 12.17].
• Among firms with 200 or more workers that do not cover GLP-1 agonists for weight loss in their plan with the largest enrollment, only 1% say that they are very likely to begin covering GLP-1 agonists for weight loss within the next 12 months, while 13% say that they are somewhat likely to do so, 79% say that they are not likely to do so, and 7% say that they do not know [Figure 12.16].

Figure 12.12: Percentage of Large Firms Whose Largest Plan Includes Coverage for GLP-1 Agonists When Used Primarily for Weight Loss, by Firm Size, 2026

Figure 12.13: Percentage of Large Firms Whose Largest Plan Includes Coverage for GLP-1 Agonists When Used Primarily for Weight Loss, by Firm Size, 2024-2026

Figure 12.14: Among Large Firms Covering GLP-1s for Weight Loss, Share Requiring Lifestyle or Clinical Support, by Firm Size, 2026

Figure 12.15: Large Firms’ Views On the Impact of GLP-1 Coverage for Weight Loss On Prescription Drug Spending, by Firm Size, 2026

Figure 12.16: Among Large Firms Not Covering GLP-1 Agonists for Weight Loss, Views On the Likelihood of Adding Coverage in the Next 12 Months, by Firm Size, 2026

Figure 12.17: Among Large Firms Not Covering GLP-1 Agonists for Weight Loss, Percentage That Dropped Coverage Over the Last 12 Months, by Firm Size, 2026

PRIOR AUTHORIZATION OF SERVICES

Certain health plan management practices, particularly prior authorization, have received considerable attention in recent years. Firms with 200 or more workers that offer health benefits were asked about recent changes in the usage of prior authorization in their plan with the largest enrollment.

• Seven percent of these firms say that the number of services subject to prior authorization is higher than it was last year, 2% say that it is lower, 70% say that it is about the same, and 21% say that they do not know [Figure 12.18].
  • Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that the number of services subject to prior authorization is higher than it was last year (12% vs. 6%) [Figure 12.18].
  • Among firms that say that the number of services subject to prior authorization is higher than it was last year, 18% say that the primary reason is that the plan has a new insurer or administrator that makes greater use of prior authorization, while 16% say that new services were made subject to prior authorization to target specific areas where use or costs were higher than expected or seemed unreasonable, 48% say that prior authorization was added to additional services to help control overall cost growth in the plan, and 18% say that they do not know [Figure 12.19].

Figure 12.18: Among Large Firms That Offer Health Benefits, Number of Services Subject to Prior Authorization Compared to the Previous Year, 2026

Figure 12.19: Among Large Firms That Increased the Number of Services Subject to Prior Authorization, Primary Reason for This Change, 2026

IN VITRO FERTILIZATION

Improving affordable access to in vitro fertilization (IVF) and other assisted reproductive services has received considerable public attention in recent years. During the 2024 presidential campaign, President Trump proposed making IVF services free for patients, and in 2025, he signed an executive order directing the development of recommendations to expand access to IVF and reduce its cost. Firms with 200 or more workers that offer health benefits were asked whether their plan with the largest enrollment covers IVF services, either through the plan or through a third-party vendor.

• Among these firms, 24% of firms with 200 to 999 workers, 38% of firms with 1,000 to 4,999 workers, and 47% of firms with 5,000 or more workers provide coverage for IVF services. Firms with 200 to 999 workers are more likely than larger firms to say that they do not know whether their plan covers IVF services (27% vs. 9%) [Figure 12.20].
• The percentage of large firms offering health benefits that cover IVF services in 2026 (27%) is the same as the percentage in 2024 (27%).

Figure 12.20: Percentage of Large Firms That Provide Coverage for in Vitro Fertilization (IVF), by Firm Size, 2026

EMPLOYER ACCESS TO INFORMATION ABOUT THE COST AND USE OF MEDICAL SERVICES BY PLAN ENROLLEES

Providing employers with greater transparency into the cost and use of health care services within the plans they sponsor has become an important priority for policymakers and plan sponsors. Firms were asked a series of questions about the cost and utilization information available to them, including whether they have access to claims data for their plan enrollees.

ABILITY OF EMPLOYERS TO OBTAIN INFORMATION ABOUT THE COST AND USE OF SERVICES

Firms with 200 or more workers that offer health benefits were asked about their ability to obtain information about the cost and use of medical services (apart from prescription drugs) in their plan with the largest enrollment. This information may include summary information from an insurer or plan administrator, or more detailed data reports. Specifically, firms were asked how strongly they agreed or disagreed that they have enough information to understand each of the following areas:

• Service use by type of medical provider. Sixteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the service use of plan enrollees by type of medical provider, 54% “agree,” 12% “disagree,” 3% “strongly disagree,” and 16% say that they do not know [Figure 12.21]. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand service use by type of medical provider (25% vs. 14%).
• The medical conditions of plan enrollees, including those that contribute the most to plan cost. Twenty percent of these firms “strongly agree” that they are able to get sufficient information to understand the medical conditions of plan enrollees, including those that contribute the most to plan cost, 52% “agree,” 11% “disagree,” 4% “strongly disagree,” and 14% say that they do not know [Figure 12.21]. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand the medical conditions of plan enrollees (28% vs. 18%).
• The prevalence of chronic conditions among plan enrollees. Eighteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the prevalence of chronic conditions among plan enrollees, 52% “agree,” 12% “disagree,” 2% “strongly disagree,” and 15% say that they do not know [Figure 12.21]. Firms with 1,000 or more workers are more likely than firms with 200 to 999 workers to say that they “strongly agree” that they are able to get sufficient information to understand the prevalence of chronic conditions among plan enrollees (27% vs. 16%).
• The prices the plan pays to in-network providers, and how those prices compare to other providers. Fourteen percent of these firms “strongly agree” that they are able to get sufficient information to understand the prices the plan pays to in-network providers and how those prices compare to other providers, 46% “agree,” 19% “disagree,” 4% “strongly disagree,” and 17% say that they do not know [Figure 12.21].
• Areas where enrollees may have unmet needs or gaps in care. Ten percent of these firms “strongly agree” that they are able to get sufficient information to understand areas where enrollees may have unmet needs or gaps in care, 45% “agree,” 20% “disagree,” 5% “strongly disagree,” and 19% say that they do not know [Figure 12.21].

Figure 12.21: Percentage of Large Firms That Agree That They Are Able to Get Information On the Cost and Use of Various Medical Services, 2026

Figure 12.22: Percentage of Large Firms (5,000 or More Workers) That Agree That They Are Able to Get Information On the Cost and Use of Various Medical Services, 2026

ACCESS TO CLAIMS DATA OF ENROLLEES

Firms with 200 or more workers that offer health benefits were asked about their access to claims data for plan enrollees. Claims data is defined as detailed information about the services used by plan enrollees, which may have personal identifiers removed, and the amounts paid to providers for each service.

• Among these firms, 27% say that it is “very easy” to access claims data from their plan administrator or vendors, 25% say that it is “somewhat easy,” 7% say that it is “somewhat difficult,” 10% say that it is “very difficult,” 25% say that they have not tried to access claims data, and 5% say that they do not know [Figure 12.24].
• Firms that have been able to access claims data for their enrollees were asked how helpful the data has been in making decisions about health benefits. Sixty-six percent of these firms say that their claims data has been “a great deal” of help, 29% say that it has been “somewhat” helpful, 4% say that it has provided “very little” help, and 1% say that it has been “not at all” helpful [Figure 12.25].

Figure 12.23: Percentage of Large Firms That Can Easily Access Claims Data From Plan Administrators or Vendors, by Firm Size, 2026

Figure 12.24: Among Large Firms That Tried to Obtain Claims, Percentage That Were Able to Obtain Data From Their Insurer or Plan Administrator, by Firm Size, 2026

Figure 12.25: Among Large Firms That Have Obtained Claims Data, Usefulness of Data in Making Health Benefit Decisions, by Firm Size, 2026

EMPLOYER ACCESS TO INFORMATION ABOUT THE COST AND USE OF PRESCRIPTION DRUGS

Firms with 200 or more workers that offer health benefits were asked about their ability to obtain information about the cost and use of prescription drugs in their plan with the largest enrollment. Specifically, firms were asked how strongly they agreed or disagreed with statements about their ability to obtain sufficient information about the following:

• Prescription medications used by plan enrollees. Twenty-four percent of these firms “strongly agree” that they are able to get sufficient information about the prescription medications used by plan enrollees, 40% “agree,” 14% “disagree,” 7% “strongly disagree,” and 15% say they do not know [Figure 12.26].
• Rebates and other manufacturer payments related to prescription drug use by plan enrollees. Fifteen percent of these firms “strongly agree” that they are able to get sufficient information about rebates and other payments, such as administrative fees and incentives, that drug manufacturers pay to the insurer, administrator, or PBM related to prescription drug use by plan enrollees, 34% “agree,” 17% “disagree,” 11% “strongly disagree,” and 23% say they do not know [Figure 12.26].

Figure 12.26: Percentage of Large Firms Able to Obtain Sufficient Information About Management of Prescription Drug Benefits, by Firm Size, 2026

Figure 12.27: Percentage of Larger Firms That Use a Transparent or “Pass-Through” PBM, by Firm Size, 2026

Figure 12.28: Among Larger Firms That Do Not Use a Transparent PBM, Likelihood They Will in the Next 2 Years, 2026