NEW YORK – Employers across the U.S. are preparing to make difficult decisions about their 2026 health benefit offerings, with many likely to shift more healthcare costs onto employees, according to Mercer’s latest Survey on Health and Benefit Strategies.
The study, released Tuesday, reveals that more than half (51%) of large employers—defined as those with 500 or more employees—are considering changes such as higher deductibles and out-of-pocket maximums to curb rising health plan expenses. That’s up from 45% in last year’s survey, reflecting growing concern about projected cost increases.
“Employers project average health benefit costs to grow by nearly 6% this year, and 2026 may be even more challenging from a cost perspective,” said Ed Lehman, Mercer’s US Health & Benefits Leader. “While short-term cost containment actions might be needed, we also see employers turning to strategies that emphasize high-quality, high-value care.”
One such strategy includes the adoption of non-traditional health plans. About 35% of large employers plan to offer alternative plan designs in 2026, such as variable copay plans. These plans often feature lower or no deductibles and set copayments based on provider pricing, offering employees upfront cost transparency and incentives to choose lower-cost providers.
Currently, only 6% of large employers offer variable copay plans, but among those that do, 28% of their covered employees opted into them in 2025.
A major cost pressure comes from the rising use of GLP-1 drugs—originally developed for diabetes but increasingly prescribed for weight loss. While 44% of large employers currently cover GLP-1 drugs for obesity, many are now reevaluating that coverage amid concerns about sustainability. These drugs can cost around $1,000 per patient per month, before rebates.
“Employers are weighing the immediate costs of covering these drugs against the potential for generating savings down the road once their workforce’s health improves,” said Alysha Fluno, Mercer’s Pharmacy Innovation Leader. GLP-1 coverage emerged as the top priority in pharmacy benefit management, with 77% of employers calling it extremely or very important.
More broadly, 61% of large employers are exploring alternatives to traditional pharmacy benefit manager (PBM) contracts in an effort to gain greater clarity and control over prescription drug costs.
Despite cost concerns, employers are not pulling back from mental health and well-being initiatives. Over 75% of large employers plan to offer digital stress management or resilience tools in 2026, such as mindfulness or cognitive behavioral therapy-based apps. Additionally, 51% will provide live or in-person training or coaching sessions for stress management.
Recognizing the role of leadership in mental health support, nearly 40% of all large employers—and 60% of those with 20,000 or more employees—now offer mental health training for managers to help them identify and support struggling team members. This trend comes as Mercer’s research finds that 45% of U.S. workers report feeling stressed most days on the job.
The findings are based on responses from 711 U.S.-based organizations, including 504 with at least 500 employees. The survey was conducted between April 8 and April 25, 2025.
