A new study conducted by J. Price McNamara reveals that employer-sponsored health benefits in the United States are entering a period of unprecedented change. With premiums rising faster than wages, prescription drug costs surging, and mental health resources under strain, employers are preparing to redesign benefits in ways that will reshape the workplace healthcare landscape.
Premiums Rising Beyond Inflation
The study highlights that health insurance premiums are climbing at a pace not seen in decades.
- In 2024, the average family premium was $25,572.
- By 2025, that figure rose more than 7 percent, reaching $27,362.
- Worker contributions also increased, with employees paying $6,296 toward family coverage in 2024, a figure that continued to rise in 2025.
These increases outpaced both wage growth (4.5 percent) and inflation (3.2 percent), meaning that healthcare costs are consuming a larger share of household budgets. Deductibles are also climbing, with the average single-coverage deductible at $1,787 in 2024, up 47 percent over the past decade.
Prescription Drugs as the Pressure Point
Prescription drug costs remain the fastest-growing component of employer health spending.
- In 2024, drug costs rose 8 percent, with another 5.8–6 percent increase expected in 2025.
- GLP-1 medications such as Ozempic, Wegovy, and Mounjaro often exceed $1,000 per patient per month.
- Specialty oncology and autoimmune drugs, along with biosimilars to Humira, now account for over half of all prescription spending.
- Gene and cell therapies, priced between $1–3 million per treatment, represent catastrophic risks for self-insured employers.
By 2027, more than 70 percent of benefit executives expect gene therapy costs to become a major financial challenge, likely leading to reduced coverage and greater employee cost-sharing.
Employers Shift Toward Cost-Sharing
The study shows that employers are increasingly turning to cost-sharing to offset rising expenses.
- In 2025, 45 percent of large employers redesigned their health plans.
- By 2026, that figure is projected to reach 51 percent, marking a record level of plan redesign.
Cost-sharing measures include higher deductibles, increased copays, and tighter out-of-pocket maximums. Employers are also experimenting with copay-based plans, variable copay models tied to provider pricing, and level-funded self-insured plans that combine predictable premiums with stop-loss protection.
Telehealth Becomes a Standard
Telehealth, once considered an optional benefit, is now a permanent fixture in employer health plans.
- Between January and June 2024, telehealth reliance rose 2.3 percent, with 68 percent of claims tied to mental health.
- By mid-2025, all U.S. hospitals either offered or planned to offer telehealth.
- 41 percent of hospitals expect to deliver more than 20 percent of care virtually by the end of 2025, up from just 9 percent in 2023.
Employers are also adopting high-performance networks (HPNs), which save 11–20 percent on costs by narrowing provider choices while maintaining clinical quality.
Mental Health: A Growing Gap
The study underscores a widening gap between mental health needs and available resources.
- 22.8 percent of U.S. adults (57.8 million people) experience mental health challenges annually.
- 36 percent report difficulty accessing care due to provider shortages.
- Federal funding cuts of $1.3 billion in 2026 are expected to further strain behavioral health services.
Employers are responding with digital stress management programs, but engagement remains low. Only 30 percent of employers report strong participation, and just 40 percent of large companies train managers to recognize mental health issues.
Regulatory Pressure on Pharmacy Benefit Managers
Congressional scrutiny of pharmacy benefit managers (PBMs) is intensifying. New rules in 2025 and 2026 will require PBMs to pass manufacturer rebates directly to employer plans and disclose all fees. While intended to reduce costs, these reforms could also reshape how employers negotiate drug pricing and coverage.
The Employee Retention Factor
The study also highlights the link between benefits and employee retention. Nearly three in four employees say they would stay in a role if benefits were better tailored to their personal needs. Employers that fail to adapt risk higher turnover, while those that innovate with flexible, personalized benefits may gain a competitive edge.
The Road Ahead
The study conducted by J. Price McNamara concludes that employer health benefits are shifting toward a new model defined by cost-sharing, telehealth expansion, and regulatory reform. Employers that embrace flexibility and personalization will be better positioned to retain talent, while employees must prepare for higher out-of-pocket costs and narrower coverage options.
The message is clear: the era of stable, employer-funded healthcare is ending, and both workers and companies must adapt to a more fragmented, cost-conscious system.