2026 is shaping up to be a reset year for U.S. employer-sponsored health benefits. According to a new study conducted by J. Price McNamara, more than half of large employers (51%) will redesign their health plans to offset costs. This comes as premiums surge past inflation and prescription drugs remain the fastest-growing expense. The result: higher employee costs, tighter provider networks, and a shift toward digital-first care models.

Premiums vs. Wages: A Decade of Disparity

Employer health premiums have consistently outpaced wages over the past 10 years:

  • 2014 Family Premium: $16,834

  • 2024 Family Premium: $25,572 (+52%)

  • 2025 Family Premium: $27,362 (+7% in one year)

  • Wage Growth, 2014–2024: ~36%

  • Deductibles: +47% over the last decade.

In other words, families are paying thousands more annually while wages fail to keep pace — a trend that will only deepen in 2026.

Employer Strategy: Cost-Sharing Returns

The study shows cost-sharing is back after years of restraint during tight labor markets.

  • 51% of employers will increase deductibles and copays in 2026.

  • Variable copay plans (charging more for expensive providers) are gaining ground.

  • Level-funded self-insured models are expanding among mid-size companies.

  • Supplemental benefits like accident and critical illness insurance are being added to fill coverage gaps.

This approach shifts risk back onto employees, fundamentally changing the affordability of care.

Telehealth: From Trend to Standard

Telehealth is no longer a novelty — it's core infrastructure.

  • Telehealth Uptake: +2.3% in 2024 alone.

  • Mental Health Use: 68% of telehealth claims address mental health needs.

  • Hospital Systems: By mid-2025, 100% of hospitals offer telehealth; 41% plan to deliver 20%+ of care virtually.

  • Employer Adoption: 20% of large employers used high-performance telehealth networks in 2024; adoption will rise in 2026.

For employers, this is both a cost-control tool and a recruitment differentiator, especially for remote and hybrid workers.

High-Performance Networks (HPNs): Narrow But Cost-Saving

HPNs, which limit provider choice, are gaining traction:

  • Savings range from 11–20% of total costs.

  • Employers like Blue Cross Blue Shield and Medica are leading the model.

  • While limiting choice, outcomes remain consistent — making it an attractive trade-off in 2026.

The Mental Health Crisis Deepens

Mental health remains one of the most significant challenges in employee benefits.

  • 22.8% of U.S. adults experience a mental health disorder annually.

  • 36% cannot access care, citing shortages.

  • Federal funding cuts of $1.3 billion in 2026 will strain Medicaid programs and providers further.

  • Only 40% of large employers currently train managers to recognize mental health red flags.

Low engagement with employer-provided programs (just 30%) shows that availability is not enough — navigation and personalization will be critical.

Prescription Drugs: The Breaking Point

Employer drug spending is reaching unsustainable levels.

  • GLP-1 drugs cost $1,000+ per patient per month.

  • Specialty drugs (oncology/autoimmune) make up 50% of Rx spending.

  • Gene therapy treatments priced at $1–3 million each expose employers to catastrophic financial risk.

  • 70% of executives expect gene therapy to destabilize budgets by 2027.

This risk explains why employers are aggressively shifting costs and seeking narrow provider and formulary strategies.

Policy Spotlight: PBM Regulation Could Change the Game

Pharmacy Benefit Managers (PBMs) will face sweeping reform in 2025–2026.

  • Rebates must be passed directly to employer plans.

  • All fees and compensation must be disclosed.

  • State-level laws will further restrict PBM practices.

If successful, these reforms could ease employer burden, but critics warn that savings may take years to filter down to workers.

Employee Retention and the Benefits Equation

Benefits are more than a cost center — they're a retention strategy.

  • 74% of workers say they would stay longer if benefits were better personalized.

  • Employers failing to innovate risk higher turnover and weaker recruitment appeal.

  • Telehealth, mental health access, and flexible supplemental benefits are no longer perks — they're competitive necessities.

Conclusion: 2026 as the Turning Point

The study from J. Price McNamara makes clear that 2026 will mark a turning point in the U.S. health benefits landscape. Premiums are rising faster than wages, prescription drugs are pushing costs to unsustainable levels, and employers are preparing to redesign plans at record pace.

For employees, this means higher deductibles, narrower networks, and increased financial exposure. For employers, it's an era of experimentation — leaning on telehealth, PBM reform, and high-performance networks to control costs without sacrificing quality.

If 2025 was the year of rising costs, 2026 will be the year of reset. The challenge will be whether employers can balance affordability, access, and retention in a healthcare system where costs show no sign of slowing down.