A salaried job with health benefits has long been the gold standard of US employment. That assumption is now under serious pressure. Sharply rising premiums are prompting young, healthy workers to opt out of company health plans.
Some are going without cover entirely. Others are turning to cheaper alternatives such as medical cost-sharing cooperatives. The trend is a growing concern for HR professionals, benefits consultants, and insurers alike.
Employer-Sponsored Health Insurance: What The Numbers Show
Premiums for company family plans rose 6% in 2025. Benefits consultant Mercer forecasts that total health plan costs per employee will grow at the fastest rate in over a decade in 2026, up 6.5%.
Medical care premiums now account for 7.7% of total compensation for US workers, according to the Bureau of Labor Statistics.
The share of workers covered by employer plans has slipped to 61%, down from 64% in 2020, according to KFF, the health policy research firm. That figure has remained broadly stable for two decades - but cracks are beginning to show.
About half of large employers say rising costs are pushing them to increase deductibles or exclude expensive treatments, including GLP-1 weight-loss drugs.
Workers Count The Cost
Jessica Balcerzak, a 33-year-old nurse in Buffalo, New York, waived her hospital employer's plan in 2025. Her share of family premiums amounted to $585 every two weeks - roughly $15,000 a year. She instead joined a medical cost-sharing cooperative for $297 a month and enrolled her children in a state low-cost programme.
The savings: $970 per month.
Daniel Wilson, 40, made a similar calculation for his family of five in Detroit. After his wife joined a new employer that covered 70% of the family premiums, they still found the plan too expensive. They opted for a health-sharing cooperative at $550 a month instead.
The Risks Of Opting Out
Forgoing traditional health cover is not without risk. Cost-sharing cooperatives do not carry the same consumer protections as regulated insurance. They can restrict cover for pre-existing conditions and mental health services, according to a 2023 Government Accountability Office study.
Insurance consultant Myranda Cleary, based in Kansas City, warns the trend could destabilise existing group plans.
She said every single person who opts out creates a lopsided situation where they cannot sustain the costs, and at some point, it breaks.
Employers depend on younger, healthier workers to file few claims and help keep premiums manageable for all. A meaningful exodus shifts that balance - and could push costs higher for those who remain.
What HR Leaders Are Doing About It
Some employers are already responding. Tommy Gaffney, vice president at benefits consultancy Evolved Benefits, says up to 40% of workers at some client firms waived major medical benefits last year due to cost, particularly at companies with large blue-collar or frontline workforces.
New York communications firm KCSA faced doubled premiums after an unusually high-claims year. HR chief Katie Roland held individual consultations to help workers find affordable options. Most ultimately stayed on the plan.
Roland said we are finding that medical insurance is more important to people than salaries.
Denise Rousseau, who chairs Carnegie Mellon University's Health Care Policy and Management programme, is blunt about poorly structured plans. She said having healthcare benefits you can't afford is like unlimited vacation - it's a false promise.
What This Means For Benefits Leaders
For HR executives and benefits professionals, the message is clear. Employer-sponsored health insurance can no longer be treated as a passive retention tool.
With open enrolment periods approaching, now is the time to audit plan affordability, review carrier negotiations, and engage workers directly on their cover options. Losing healthy employees from group plans risks a damaging spiral of rising costs for everyone who remains.
The companies that act now will be better placed to offer benefits that workers actually value - and use.