- Key Insight: Discover how skyrocketing specialty drug costs force benefit strategies toward hyper-personalized enrollment.
- What's at Stake: Employer premiums, talent retention, and insurer solvency face rising fiscal and legal pressure.
- Forward Look: Prepare for OBBBA and ACA subsidy changes to materially increase commercial premiums in 2026.
- Source: Bullets generated by AI with editorial review
With stormy developments brewing across the U.S. commercial health insurance landscape, benefit brokers and advisers are bracing for strong headwinds that could reshape their
They include steeper projected increases in group health plan costs from record-high medical inflation traced to costly treatments that include specialty drugs and GLP-1s — the latter market projected to grow to $471 billion by 2032 from $46.7 billion last year.
The Business Group on Health is projecting its
Other factors worth noting include the dual impact on commercial insurance rates of One Big Beautiful Bill Act cuts and elimination of Affordable Care Act exchange subsidies that will spike monthly premiums — spotlighting the need for employer-provided coverage to pick up any slack.
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Pressure also is mounting on employers to employ more aggressive cost-containment strategies but not at the expense of plan participants — a careful balancing act given growing concerns over ERISA litigation tied to fiduciary breaches under the CAA. It serves as a stark reminder that despite the direction of market forces, plan participants come first.
All of these industry challenges have taken a toll on the psyche of HR and benefit professionals. As many as 87% of companies polled by the Kaiser Family Foundation in 2021 surmised that the cost of providing health insurance for their workers would become "unsustainable" in the next five to 10 years.
With such coverage considered a linchpin for attracting and retaining talent in post-World War II America, a re-evaluation of long-held expectations about the employment contract could be well under way in an era that's expected to unleash a wave of hyper-personalized benefits communication with the help of AI and other technologies. Such a move will be essential for helping five generations in the workforce with disparate needs and desires make better choices when selecting their benefits for next year.
Unprecedented cost increases
"It's no secret that employers are facing unprecedented healthcare cost increases looking ahead to 2026," says Erika Illiano, a managing partner at Brown & Brown. Among the pressures they're thinking through more strategically with brokers and advisers is how to more equitably share those increases with employees in ways that differ from prior years when
Such tactics include expanding coverage tiers for covered dependents, re-evaluating working-spouse surcharges, narrowing provider networks and promoting centers of excellence for a number of costly areas, including anything from cancer and musculoskeletal injuries to substance abuse.
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She says messaging about shared accountability and responsibility for health and wellness is back in vogue, noting how some employers are implementing surcharges for those who don't receive an annual preventive care or wellness exam and requiring employees to have a primary care physician on file to help improve health outcomes.
Whatever solutions are put in place, it has become increasingly clear that a more granular view is necessary to produce better results. "When open-enrollment season begins, it is very challenging to think that every individual has exactly the same needs and issues," observes Perry Braun, president and CEO of Benefit Advisers Network, an association of independent benefit brokers from across the U.S. and Canada.
The trick is to treat each individual as a blank canvas with his or her own unique circumstances along the way to triaging pain points, but the challenge will be finding enough time to actually pursue this approach in the first place. He has seen more brokerage agencies helping understaffed HR teams field employee inquiries. That's one reason why so many companies have introduced technology as a vehicle to help buttress HR's capacity to handle heavier communications.
Even so, he says there's no substitute for human interaction as a means of building constructive and empathetic recommendations to employees and their dependents that surface during these open-enrollment periods.
Braun likens open-enrollment preparation in the face of so many marketplace challenges to a riptide: "You want to swim with it. You don't want to swim against it, and then hopefully it calms down and you can surface."
