Workers at small firms paid $9,687 on average toward family health coverage in 2026. That is $2,823 more than workers at companies with 5,000 or more employees, according to KFF’s annual Employer Health Benefits Survey.
The 28th edition of the survey covers 1,937 US employers. Its findings arrive as open enrollment approaches, with renewal conversations already shaped by expectations of further cost increases in 2027.
Average family premiums across all employer sizes reached $28,303 in 2026, up 5% from 2025. Workers contributed $7,471 of that total on average, a 9% jump from the prior year. Wages rose 3.7% over the same period and inflation 2.7%.
The gap between small and large employers runs deeper than contribution amounts. Workers at firms with fewer than 200 employees face an average single-coverage deductible of $2,624, versus $1,772 at large firms. More than half of small-firm workers are enrolled in a plan with a single-coverage deductible of $2,000 or more.
That deductible figure has risen 18% across all firm sizes over the last five years and 34% over the last decade. Small-firm workers also carry a heavier family premium burden: 32% are in plans where they contribute more than half of the family premium. At large firms, the comparable figure is 6%.
Hub International had projected national medical and prescription drug trends at 8% to 10% for 2026. The KFF confirmed figures place worker contribution growth above that range, while total premium growth landed toward its lower end.
Among large firms, the most common response to projected cost increases was raising the worker share of premiums, cited by 44%. Increasing deductibles or other cost-sharing for most services was second, at 21%. Changing insurers or administrators was cited by 16%.
The survey found that 38% of covered workers in smaller firms are enrolled in level-funded plans. These pair a self-funded component with stop-loss insurance and sit outside state mandates covering essential health benefits for the small group market. They can offer cost and design flexibility, but plan sponsors carry more exposure if claims run high. For small-group clients already stretching to cover rising contributions, that claims exposure is worth walking through explicitly before renewal.
Coverage of glucagon-like peptide-1 (GLP-1) agonists for weight loss held flat in 2026. Among large firms, 18% cover the drugs specifically for weight loss, unchanged from 2025 and 2024. Among those that do, 29% report a significant impact on prescription drug spending. Most large firms not currently covering GLP-1s for weight loss say they are not likely to add the benefit in the next 12 months.
Twelve percent of firms in the survey say they stopped covering GLP-1s for weight loss within the past year. A separate Business Group on Health survey found that GLP-1 weight management coverage among large employers fell from 72% to 60% between 2025 and 2026.
Early forecasts point toward premium increases approaching double digits in 2027, KFF noted. Among firms with 5,000 or more employees, 66% said they had already raised worker contributions in response to anticipated cost growth. KFF flagged the shift as a potential affordability concern, noting that the worker share of premiums had held relatively stable for decades before this year.
