Workers with employer-sponsored family health plans are paying an average of $7,471 toward premiums in 2026, up 9% or $621 from last year, even as total premium growth moderated to 5%, according to KFF’s benchmark employer survey released Thursday.
Mail-order and international drug workarounds
A third of employers with at least 50 workers now offer lower-cost mail-order generic programs through vendors such as GoodRx, SingleCare, or Mark Cuban Cost Plus, according to KFF. Nine percent participate in international prescription purchasing services for maintenance medications. Those programs can shave retail pharmacy spend but rarely touch hospital bills, which still drive premium renewals.
Large employers also reported mixed visibility into drug rebates: about half said they receive sufficient information from insurers and pharmacy benefit managers on manufacturer payments, a transparency fight that matters when workers see deductible resets in January while CFOs negotiate 2027 renewals.
Who feels the squeeze hardest
The nonprofit health research group polled more than 1,900 public and private employers with at least 10 workers for its 28th annual study. Small firms with fewer than 200 employees showed the steepest worker share: covered staff contributed an average of $9,687 toward family premiums, $2,847 more than workers at large firms with 200 or more employees.
Single coverage tells a milder story but still outpaced inflation. Average total single premiums rose 5% to $9,804, while workers paid about $1,672 toward those plans. Wages increased 3.7% and general inflation ran 2.7% over the same period, meaning many households saw health paycheck deductions eat a larger slice of take-home pay than raises restored.
How employers shifted costs
Among large firms, 44% said they increased the share of premium workers pay to address higher projected health costs, while 21% raised deductibles or other cost-sharing for most services. Deductibles themselves were relatively flat: the average annual deductible for workers with single coverage stood at $1,955 versus $1,886 in 2025.
KFF President Drew Altman tied the numbers to voter anxiety, noting ACA and Medicaid politics alongside a 9% jump in what workers pay for family coverage. Roughly 157 million Americans under age 65 rely on employer plans, so the survey is a direct read on middle-income benefits rather than exchange subsidies.
GLP-1 and fertility benefits
About 18% of large firms cover GLP-1 drugs for weight loss, often with lifestyle program requirements. Most employers offering those drugs reported significant or moderate impacts on prescription spending, which helps explain why premium shares rose even when headline deductible averages barely moved.
IVF coverage held steady at about 27% of large firms. Mail-order generic discount programs through vendors such as GoodRx or Mark Cuban Cost Plus reached a third of employers with at least 50 workers, a small lever for maintenance medications but not for hospital stays.
What to do during open enrollment
If your employer’s enrollment window opens this fall, compare premium tiers against expected care — not just the cheapest paycheck deduction. A lower premium plan with a $3,000 deductible can cost more than a gold-tier option if you anticipate specialist visits or brand drugs.
Check whether your spouse’s employer offers coverage; KFF’s small-firm premium share gap makes dual-eligible households worth modeling. Health savings account-eligible plans still reward pre-tax contributions, but only if you can fund the account before unexpected bills arrive.
Mail-order and international drug workarounds
A third of employers with at least 50 workers now offer lower-cost mail-order generic programs through vendors such as GoodRx, SingleCare, or Mark Cuban Cost Plus, according to KFF. Nine percent participate in international prescription purchasing services for maintenance medications. Those programs can shave retail pharmacy spend but rarely touch hospital bills, which still drive premium renewals.
Large employers also reported mixed visibility into drug rebates: about half said they receive sufficient information from insurers and pharmacy benefit managers on manufacturer payments, a transparency fight that matters when workers see deductible resets in January while CFOs negotiate 2027 renewals.
Why this is not the ACA market
Employer coverage sits outside Healthcare.gov pricing, yet it is where most working families experience premium shocks. Thursday’s release gives negotiators and union members a concrete figure — $621 more per year for the average family contribution — to bring into 2027 contract talks, independent of whatever Congress does on subsidy extensions after the election.