Finding the Right Health Care Plan

Choosing the right health care plan is even more important this year due to anticipated increases in insurance premiums and other changes. Kimberly Lankford of Kiplinger Financial offers guidance to help you choose.

Question: What is expected to happen to premiums for employer health insurance plans in 2026, and do you have any advice for choosing a healthcare plan during open enrollment this fall?

Answer: When you enroll in a 2026 health insurance plan this fall, don’t be surprised if you see a significant increase in your premium. Large employers expect health care costs for employee coverage to rise by a median 9% in 2026, according to the Business Group on Health. “This is the highest single-year forecast in more than a decade,” says Ellen Kelsay, BGH president and CEO.

Employers plan to pass along more of the increase to employees than they have in the past few years, and some are offering new kinds of plans with restricted provider networks as another way to manage their expenses.

Despite these developments, you still have solid strategies at your disposal to make smart decisions on choosing the right health care plan and managing the costs during open enrollment. Here’s what to expect when assessing your options this fall.

New employer-plan options

The BGH study’s 9% projected increase in health care costs is driven primarily by the rising price of pharmaceuticals, the growing popularity of obesity treatments (especially GLP-1 medications, such as Ozempic), an increase in cancer diagnoses, and higher usage of mental health services, which many employers have expanded in the past few years.

The employers who responded to the survey expect to moderate the increase to a median 7.6% by tweaking the design of their health plans, including some changes that affect employees’ options and costs. The plans may limit or reduce coverage for GLP-1 medications and require prior authorization for more procedures and services before they provide coverage.

Employers may also pass along a larger share of the cost increase to employees than they have over the past few years, through higher premiums, deductibles and co-payments. The median estimate for employee contributions to annual premiums is rising from $2,983 to $3,251 per employee in 2026 (the figure includes both single and family coverage), and the median yearly out-of-pocket cost for employees is increasing from $1,825 to $2,224, according to the BGH study.

But a growing number of employers are also looking for alternatives to increasing deductibles, recognizing that high deductibles can cause people to avoid seeking care, leading to more-expensive medical issues in the future. More than one-third of the plans surveyed by Mercer, a human resources and employee benefits consulting firm, expect to offer a medical plan with no deductible or a low deductible, and 12% expect to offer at least one plan with no premiums for employees.

Some employers hope to reduce costs by offering plans with incentives for employees to use certain providers that offer high-quality and cost-efficient services. So when you are attempting to choose the right health care plan, you may see plans with new types of provider networks on the menu.

For example, if your plan includes a “high-performance network,” you may have lower deductibles and co-payments when you use certain providers than you do when you visit the rest of the providers in your plan’s standard network. A high-performance network is “generally like a PPO, but it’s a more curated network,” says Tracy Watts, senior partner at Mercer.

With these plans, you may be able to use out-of-network providers, but with higher costs for you, as is typical with a PPO (preferred provider organization). Another version of these high-performance network plans, called EPO (exclusive provider organization) plans, restrict coverage to in-network providers only.

As another option, some employers are offering “variable co-pay plans” that have no deductible and provide a range of co-payments that vary by provider, which the employees see up front. “The idea is you’re getting somebody to do their homework before they call the doctor,” says Watts.

You may also be able to use centers of excellence, which are hospitals that may be outside your area but specialize in certain conditions. More than half the companies surveyed by BGH plan to include centers of excellence in their networks in 2026 for bariatric surgery, musculoskeletal conditions, fertility treatments, or cancer. Centers of excellence are more commonly included in large-employer plans than those from smaller employers.

Employers and their health plans have also been beefing up navigator programs. Health care navigators can help you learn about your care options if you’re diagnosed with a medical condition and find in-network providers in your area.

Navigators may let you know whether your plan offers a center of excellence for your condition or whether you may be eligible to participate in a clinical trial, says Watts. They can provide information about other programs the employer offers, too, such as employee assistance programs, which are providing a growing number of in-person and online counseling options and other benefits.

Strategies for choosing the right health care plan

Because of the increasing costs and changes to employer health insurance, it’s worth making an extra effort to review all your choices during open enrollment this year. The following steps can help you pick the right health care plan.

Make the most of each spouse’s benefits. If both you and your spouse have coverage at work, compare the options. “Don’t assume that if you work for a bigger company, your family should all go on your plan,” says Watts. It may make sense to stay on your own company’s plan but have your children on your spouse’s plan. Or you could get medical coverage through your plan but dental and vision coverage through your spouse’s employer.
Do the math. Add up premiums plus the costs for the care and prescription drugs you and your family need regularly under the plans offered by your employers. Also check coverage if you were to get a serious diagnosis, such as cancer or a condition that requires major surgery, so you’ll understand how your medical care may be covered under each plan, says Watts. If you choose a high-deductible health insurance policy paired with a health savings account and the employer contributes money to the HSA on your behalf, subtract that amount from the potential costs.
Contribute to an HSA, if you do choose a high-deductible policy. Many employers seed HSAs for employees with eligible health plans or match their contributions. To qualify for an HSA in 2026, your policy must have a deductible of at least $1,700 for single coverage or $3,400 for family coverage. You’ll be able to contribute up to $4,400 in 2026 if you have self-only coverage or $8,750 for family coverage, plus an extra $1,000 if you’re 55 or older.
Learn about new network options, which may be a way to reduce your costs. If you don’t have a strong relationship with any doctors, or if your current doctors happen to be in the network, making use of a plan that offers a preferred network could help you save money on premiums without paying a high deductible, says Watts. Find out whether the plan will cover out-of-network providers with higher cost-sharing or if it will cover only in-network providers.
Check how the plans will cover your medications, especially if you need expensive maintenance drugs. Some plans are altering their formularies, which specify whether a drug is covered and what your co-pay would be, says Watts. Even if the plan includes your drug, you may need to meet prior-authorization requirements before the insurer will cover it for you. Don’t assume your drugs will continue to be covered the way they had been in the past.
Take advantage of extra benefits. For example, employers are making their wellness programs more attractive for many employees. Employers may give you a few hundred dollars each quarter for a gym membership, for example, rather than require you to complete a complicated health assessment. Employers may also offer more mental health benefits and other programs both in-person and remotely, such as virtual physical therapy.

Kimberly Lankford is a contributing writer at Kiplinger Personal Finance magazine. For more on this and similar money topics, visit Kiplinger.com.

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