Employer health premiums rise 9% for workers, small firms pay most, KFF survey finds

Workers pay more for family coverage

Covered workers paid more toward their premiums in 2026 than a year earlier, according to the 2026 Employer Health Benefits Survey from the healthcare research nonprofit KFF, released on Thursday, 22 October. Employers report that workers contribute an average of $7,471 a year toward family coverage, up roughly 9%, or $621, from 2025. The survey draws on more than 1,900 employers, and about 157 million Americans under retirement age rely on employer-sponsored coverage. Total annual premiums for a family, including the employer's share, average $28,303, a rise of 5% from 2025. Axios reports that the worker share of a family premium is 27%, about the same as in 1999, even though premiums have tracked general inflation and wages over the past five years.

Matthew Rae of KFF's marketplace program put the trend in plain terms.

Workers are paying a bigger chunk this year, which also brings up the issue of affordability.

Affordability has become a midterm issue. In an AP-NORC poll conducted in October, roughly seven in ten registered voters rated healthcare as one of the most important issues in the election.

Small firms absorb the steepest increases

Workers at firms with fewer than 200 employees contributed an average of $9,687 toward family coverage in 2026, compared with $6,840 at firms with 200 or more workers. A year earlier, smaller-firm workers paid roughly $8,900 and those at larger companies about $6,200. Small employers have less leverage with insurers, and a Washington Post opinion column by Elisabeth Rosenthal notes that more than 90% of companies with over 50 employees offer health insurance, a share that falls to roughly 50% for companies with 10 to 24 workers. Smaller companies also tend to offer plans with higher deductibles.

Elizabeth Mitchell, president and chief executive of the Purchaser Business Group on Health, which represents large employers, described the pressure they face.

We're going under our third year of double-digit increases and that's for jumbo employers.

Employers try clinics, direct contracts and cheaper drugs

Axios reports that employers are trying to soften cost increases without pushing most of the burden onto workers. KFF found 24% of surveyed firms now have a clinic onsite or nearby, staffed by clinicians. Large employers have increasingly contracted directly with hospitals or health systems for care outside their plan's network, and the share of large firms with such arrangements doubled between 2019 and 2025. Some employers vary copays according to the cost and quality of providers to steer workers toward more affordable or better-performing care. About a third of employers offer workers access to lower-cost mail-order generic drugs, and some bypass insurers and pharmacy benefit managers through third parties such as Mark Cuban Cost Plus or GoodRx. Others are looking at giving workers money to access direct-to-consumer programs for lower-cost GLP-1 drugs.

Access strain and the policy debate

KFF data put the average single-coverage deductible at $1,955 in 2026, compared with $1,886 in 2025.

Two surveys released on Thursday show families postponing doctor's visits, treatments or prescription fills while budgets are squeezed by higher food and gas prices. The number of uninsured Americans is rising as more people struggle with unpaid medical bills. A KFF poll found roughly six in ten adults very or somewhat worried about affording care. President Donald Trump has made healthcare affordability part of his midterm pitch, saying his most-favored-nation prescription drug pricing would reduce costs and promising rebates for some Americans. Other steps taken by his Republican administration have raised costs for some, and many people are seeing premiums climb without clearer gains in benefits.