
Perhaps the scariest thing employers encountered this Halloween season wasn’t an ornate costume or over-the-top yard display. It was the grim realization that health care costs will likely rise substantially next year, and there’s not much you can do about it.
If your organization sponsors a calendar-year health insurance plan, you’re probably already in open enrollment for 2026 or will be soon. But just because you can’t control rising health care expenses in the coming months doesn’t mean you can’t address them in future versions of your plan and with employees.
How high?
In September 2025, global consultancy Willis Towers Watson released the results of its 2025 Best Practices in Healthcare Survey. The company analyzed responses from 417 employers, representing about 5 million employees. Among the key findings were that U.S. employers project their health care costs to increase by 9.1% in 2026 before plan changes (up from 8.1% in 2025 and 7% in 2024). Even with plan changes, respondents still foresee an 8% increase (up from 7% in 2025 and 6% in 2024).
The survey identified three major factors driving the price escalation:
- Pharmacy costs, primarily specialty pharmaceuticals and GLP-1 medications,
- High-cost claimants, and
- Chronic conditions — especially musculoskeletal disorders and cancers.
For years, employers have largely shifted costs to employees to mitigate the higher price tag of health care coverage. However, according to the survey, 59% of respondents plan to implement “broader cost-savings actions” over the next three years (up from 46% over the previous three years).
What can you do?
The survey described some of the actions that help maintain affordability for employees. For example, 41% of respondents are using nontraditional plan designs that focus on:
- Alternative or select providers,
- Price or cost transparency,
- Enhanced navigation,
- Expanded use of participant-facing technology, and
- Advanced or high-performance primary care.
These features can push employees to use more cost-effective providers while better informing and educating them about managing their health care costs. The survey identifies other potentially helpful strategies, too, including:
Evaluating vendor performance. Almost half of respondents (46%) said they’re taking a hard look at their vendors to evaluate return on investment. This generally involves identifying key performance indicators and benchmarking them against established standards.
Bidding out your plan. When in doubt, shop around. More than a third of respondents (36%) said they’ve issued a request for proposal to carriers for a new health insurance plan. Although you’ll need to put serious effort and resources into such a process, you might find a better deal.
Conducting medical claims audits. Higher health care expenses make every error or inefficiency more costly. One third of respondents (33%) are auditing their medical claims to catch overpayments and unnecessary costs.
Reviewing prior authorizations or evaluating qualifying payments for out-of-network services. Similar to claims audits, these reviews or evaluations can verify medical necessity, curb improper payments and fraud, control costs, and improve plan performance. According to the survey, 22% of respondents have done them in the past and 34% plan to do them in the near future.
Who can help?
We’d be remiss not to mention another critical step in addressing rising health plan costs: being transparent with your employees. Health care benefits are essential to their well-being, and they deserve to understand what’s driving rates higher. During open enrollment and throughout the year, communicate what you’re doing to manage costs while preserving quality of care.
Contact us for guidance on analyzing the cost efficiency of your health insurance plan. We can help you identify strategies to optimize spending that support both your organization and its workforce.
© 2025 TopLine Content Marketing Team





