Last year was a pivotal year for health plans and benefit leaders. At Meritain Health®, we saw trends like alternative plan models and member engagement strategies take center stage. This year brings new challenges and fresh solutions. Below is our 2026 market outlook, highlighting the major themes shaping employer conversations. From rising costs to evolving benefits, here are the key trends we’re seeing for 2026.
Rising costs and affordability top the list
Affordability is still a core concern for employers and members. And that’s likely not too surprising. Over the last few years, we’ve seen the cost of everyday items—from groceries to household goods—skyrocket nationwide. Health care expenses are following this pattern, too, at an even faster pace.
According to Mercer’s annual survey, health costs could increase six to seven percent1. If so, this would be the largest jump since 2010. Other forecasters, including Business Group on Health (BGH) and PwC, predict even higher increases of seven to nine percent 2,3.
Driving factors include provider rate increases, the growing cost of advanced therapies and a consistent high demand for services. In addition, provider shortages are adding pressure around supply and demand, further adding to the rise.
Preventive care and primary care stay in focus
Chronic conditions continue to impact workforces around the country. In fact, 94 percent of employers already see or expect to see effects from chronic diseases among employees. Early intervention remains one of the most effective ways to lower long‑term costs.
Employers are responding to this by promoting annual wellness visits, routine screenings and offering support for choosing a primary care physician (PCP). Studies show, on average, adults who see a PCP have 33 percent lower costs. They also experience better long‑term outcomes compared to those who seek only specialist care.
Self-funding and alternative models continue to shine
Heading into 2026, 67 percent of workers are covered by a self-funded plan. Self-funded models are especially popular with large employers. But we expect this percentage to go up even more as employers of all sizes look to prioritize cost control and transparency.
Interest in alternative plan models is growing as well. Around 24 to 36 percent of employers may look to further explore alternative health plans models through 2028.
Captive solutions saw record adoption last year and that momentum is likely to continue. According to data we’ve collected, over 40 percent of employers are either already using or thinking about captives as an alternative option for their benefits4.
Value-based structures are gaining momentum
High‑quality, high‑value care continues to draw attention. Employers are placing more emphasis on directing members to providers known for measurable quality and outcomes. Transparency plays a key role. As many as 82 percent of employers believe visibility into care quality is essential for improving outcomes. Value‑based arrangements support this goal. These models help reduce hospitalizations and readmissions and better manage total cost of care.
The road ahead
As a leading third‑party administrator (TPA), we purposely stay closely connected to emerging industry trends. If you’d like more insight into our full 2026 market outlook, reach out to us. We look forward to working together in the year ahead to support our clients, consultants and members.
This material is for information only and is not an offer or invitation to contract. Health benefits and health insurance plans contain exclusions and limitations. Plan features and availability may vary and are subject to change. This information is not intended as medical advice.
Sources:
12024 Mercer National Survey of Employer‑Sponsored Health Plans
2BGH 2026 Employer Health Care Strategy Survey
3PwC Medical Cost Trend: Behind the Numbers 2026
4WTW 2025 Benefits Trends Survey
