Why Rising Employer Health Premiums Matter: Insights for Managed Healthcare Leaders

In 2025, the average yearly premium for employer-sponsored health insurance reached $9,325 for individuals and $26,993 for families. This represents a 5% rise for individuals and a 6% increase for families compared to the previous year. These figures come from the 27th annual KFF Employer Health Benefits Survey, which tracks health benefits covering around 154 million Americans under 65.

The survey looked at data from 1,862 randomly selected employers, both large and small. Interestingly, small firms, those with 10 to 199 employees, tend to have higher premiums. The research shows that premiums depend on a variety of factors, including the type of health plan and the company’s size. For instance, employees in high-deductible health plans often pay lower premiums than those with other plans but face higher out-of-pocket costs.

Workers generally contribute around 16% towards single coverage premiums and about 26% for family plans. Those in smaller firms contribute more for family coverage compared to workers in larger firms, with averages of $8,889 vs. $6,227.

Deductibles are another area of concern. The average deductible for single coverage stands at $1,886, but can reach $2,631 in smaller firms. Over a third of workers have plans with deductibles of $2,000 or more, a trend that has been increasing in the last decade.

Copayment costs also add up. For primary care visits, workers pay around $27, and specialist visits average $45. However, 99% of employees enrolled in these plans have prescription drug coverage, with most plans using tiered cost sharing for medications.

More firms are integrating wellness programs and alternative care options. Over half of small firms and more than 80% of large ones provide services for things like smoking cessation and weight management. Virtual care is becoming more common, with around 30% of firms offering it as part of their health plans.

Despite the rising costs, many employers believe their provider networks meet their employees’ needs. However, access to mental health services poses an issue, with only 70% reporting adequate availability. Concerns about cost-sharing remain prevalent, particularly among large employers.

The ongoing struggle between maintaining quality healthcare coverage and managing rising costs remains a pressing concern. Over the past five years, family premiums have climbed by 26%, an increase that mirrors wage growth and inflation.

Experts note that unless substantial changes occur, costs could continue to rise. Employers might need to rethink plan designs and cost-sharing arrangements, especially concerning specialty medications and preventive care. This trend is crucial as healthcare demands evolve and the workforce changes.

For further insights into healthcare trends, consider checking reports from sources like the Kaiser Family Foundation.

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