For years, large employers treated group health insurance as the only realistic option. Two major 2026 data releases suggest that is changing quickly. The number of applicable large employers (ALEs) offering an ICHRA more than doubled year over year, reaching 2,663 — and growth was steepest at the top of the market, with a 178% increase among employers with 1,000 or more employees.
Nine years of county-level market data helps explain why. Group premiums rose every single year from 2017 through 2026, up 70% in the median county, while individual market costs rose 51% and actually fell in five of those nine years. In 2017, group coverage was the more affordable option in 80% of U.S. counties. By 2025, that was down to 50%.
This report breaks down what those numbers mean for HR and finance leaders heading into their next renewal — including retention data showing why employers who make the switch rarely switch back, a look at one 200-employee nonprofit saving roughly $500,000 a year, and what accelerating large-employer adoption means for the stability of the individual market.
Inside the report:
- ALE adoption from 2021 to 2026, broken out by employee count
- Nine years of group vs. individual pricing compared at the county level
- Why 77.4% of ALEs offering an ICHRA in 2026 were already offering it in 2025
- A case study on a 200-employee employer that cut roughly $500K a year in benefits spend
- What rising large-employer adoption means for the ACA risk pool
