Employers have spent several years taking steps to avoid shifting healthcare costs to workers, but as expenses continue to rise, some firms are looking to change course, a new survey shows.
Analysts at Mercer polled 711 employers (PDF), including large and small firms, and found that 51% said they are either likely or very likely to shift costs to employees for their 2026 plans. That's up from 45% who said the same for 2025, according to the survey.
Of that group, 19% said they were very likely to shift costs and 33% said they were likely to do so in 2026, the survey found. For 2025, 14% of employers said very likely and 31% said likely.
Employers' healthcare costs grew 4.5% in 2024, and are expected to increase by an average of 5.8% this year, according to Mercer. That figure accounts for cost-saving measures, but costs could rise by an estimated 8% if employers take no action.
Employers had taken steps to pull back on cost-shifting in a tight labor market as a recruitment and retention tactic. However, the ongoing cost increases are forcing them to take another look at those strategies, the researchers said.
"Facing a third year of elevated cost growth, employers are revisiting cost management strategies," the report said. "The tight labor market and concerns about health care affordability have made employers reluctant to use cost-shifting to employees as a tactic to slow healthcare cost growth."
"But given the ongoing acceleration in cost trend, more employers are seriously considering plan design changes that would shift more cost to employees, such as raising deductibles or out-of-pocket maximums, than considered it last year," it said.
While more employers are considering cost-shifting measures, they're also looking to balance that with initiatives to address the affordability of care. More than one-third, 37%, said they offer a medical plan that has a low or no deductible, also known as a copay plan.
Eight percent said they are offering telehealth services to employees who do not qualify for medical coverage as a measure to reach low earners, and 7% are offering greater contributions to health savings accounts for lower-wage workers.
They're also increasingly looking to alternative benefit models to manage both their healthcare spend and employees' affordability. While 18% of those surveyed said they have a high-performance network in place or planned for 2026, 24% said they are considering it for 2026 or 2027.
In addition, just 7% of those surveyed said they have a variable copay plan in place or planned for 2026, while 20% said they're weighing the option for 2026 or 2027.
In addition to medical costs, prescription drug costs are also a major area of concern for employers. Expenses rose by 8% in 2024, a trend driven by specialty pharmacy products and the continued uptake of GLP-1 drugs.
While managing GLP-1s is a key focus of those surveyed, with 77% of those surveyed labeling it as either or extremely or very important, employers are also considering taking new approaches with their pharmacy benefits in general. More than half, 58%, said that evaluating new contracting models for PBM arrangements is either extremely or very important.
This could include a new arrangement with their current pharmacy benefit manager, switching to a different carrier or embracing other models, such as unbundling.
"There is an increased focus on plan sponsor fiduciary responsibility and growing concern about a historical lack of transparency in PBM contracts," the analysts said. "Without greater transparency, it may be more difficult for sponsors to demonstrate they are meeting fiduciary obligations, and the lack of price information also presents barriers for plan sponsors seeking to play an active role in managing pharmacy benefit costs."
About a third, 34%, said they are looking at new and emerging PBMs, and 34% also said they are requiring their PBM to disclose all enterprise revenue, including rebates, specialty, mail-order pharmacy and more. Forty percent said they are looking into alternative contracting models offered by major PBMs, while 10% said they are considering a modular approach rather than a traditional contract with one PBM.
Beyond GLP-1s, 57% employers said that managing the cost for cell and gene therapies is either extremely or very important, with many leaning on stop-loss coverage should they need to pay for these drugs. Sixty-eight percent of those surveyed said they deploy a traditional stop-loss plan for these claims.
Purchasing a stop-loss plan specifically for gene therapies is rare, though, the survey found.
"Today, the vast majority of stop loss carriers cover gene therapy claims via the plan mirroring provision, making traditional stop loss the most common avenue self-funded employers use to manage these costs," the researchers said.