Employer Health Benefits 2027: 7 Ways Plans Are Being Redesigned

In September 2026, Marsh released early results from its national employer survey with a number of benefits teams had been dreading. Health benefit costs per employee are expected to climb 8.2% in 2027, the steepest jump since 2003, even after employers make cuts.

That pressure is reshaping employer health benefits 2027 plans from the ground up, and two conditions sit at the center of the redesign: mental health and chronic disease. This guide breaks down the seven changes employers are making, the federal rules that make them possible, and what they mean for workers at open enrollment.

Why Employers Are Redesigning Health Benefits Now

For years, most companies handled rising costs with small tweaks. A slightly higher deductible here, a new wellness app there. That approach is running out of road.

Business Group on Health (BGH), which surveys large US employers every summer, found that actual health costs beat employer forecasts for three straight years. Each miss was bigger than the one before. When budgets keep breaking, employers stop tweaking and start redesigning.

The 2027 Cost Numbers in One Table

Employer health costs are projected to rise between roughly 8% and 9% in 2027, according to the two largest employer surveys. Without cost-cutting changes, Marsh says the increase would reach about 11%. Family coverage already averages close to $27,000 a year.

Employer health cost projections for 2027, before and after plan design changes.

Why Mental Health and Chronic Disease Sit at the Center

Chronic disease is now the norm among American adults, not the exception. According to the CDC, three in four US adults have at least one chronic condition, and more than half have two or more. The agency ties these conditions to the nation's $5.3 trillion in annual health care costs.

Mental health demand is climbing alongside it. In BGH's survey fielded in mid-2025, 73% of large employers reported higher use of mental health and substance use services, and another 17% expected an increase. Yet access is still thin. SAMHSA's 2024 national survey found that only 52.1% of adults with a mental illness received any treatment in the past year.

Together, these two groups of conditions explain why employers are redesigning around them. They are common, they are long-lasting, and they are expensive when care comes late.

7 Ways US Employers Are Redesigning Health Benefits

Not every employer is making every change, and most of the data below comes from surveys of larger employers. Here are the seven moves showing up most often.

1. Moving Chronic Care Below the Deductible

High-deductible health plans paired with health savings accounts (HSAs) have one big flaw for people with chronic conditions. Someone with diabetes might pay full price for insulin for months before the deductible kicks in, which makes steady, ongoing care harder to afford.

A federal rule lets employers fix that. Under IRS Notice 2019-45, an HSA-eligible plan may cover 14 specific chronic-condition items before the deductible, without costing members their HSA eligibility. Examples include:

• • Diabetes: insulin and other glucose-lowering drugs, glucometers, hemoglobin A1c testing, and retinopathy screening
• • Heart disease: statins, beta-blockers, ACE inhibitors, and LDL cholesterol testing
• • Asthma: inhaled corticosteroids and peak flow meters
• • Hypertension: blood pressure monitors
• • Depression: selective serotonin reuptake inhibitors (SSRIs)

Chronic-condition items an HSA-eligible plan may cover before the deductible.

2. Making Telehealth and Direct Primary Care HSA-Friendly

The One Big Beautiful Bill Act, signed in 2025, gave employers two more design tools. The IRS explained both in Notice 2026-5.

• • Telehealth before the deductible, permanently. HSA-eligible plans can now cover telehealth and other remote care with no deductible, for plan years starting after December 31, 2024. A temporary pandemic-era rule became permanent.
• • Direct primary care with an HSA. Starting in 2026, people in HSA plans can join a qualifying direct primary care practice and pay its monthly fee from their HSA. The fee must be $150 a month or less for one person, or $300 for a family.

Both matter for chronic disease and mental health, because frequent check-ins are what keep these conditions stable. For guidance on when virtual care works and when it doesn't, see our breakdown of when telemedicine beats in-person care.

3. Rebuilding Mental Health Access Beyond the EAP

For decades, the Employee Assistance Program (EAP) was the main mental health benefit. Usually, it offered a handful of free counseling sessions. Employers now see that as a starting point, not a strategy.

Access is the core problem. In the 2025 KFF Employer Health Benefits Survey, only 70% of firms believed their largest plan gave timely access to mental health services. The same firms rated primary care at 92% and specialty care at 89%.

Employers are responding in a few ways:

• • Manager training: BGH found 72% of large employers train managers to spot mental health issues and point workers toward help.
• • Network expansion: adding more in-network therapists and psychiatrists so people don't hit waitlists or surprise bills.
• • Virtual therapy: using the telehealth flexibility above to cut wait times.
• • Cost and quality checks: BGH now urges employers to look beyond access and also review the price and appropriateness of the care being used.

4. Tightening GLP-1 Coverage

GLP-1 drugs such as Wegovy and Zepbound treat obesity, a chronic condition, but their price has forced hard choices. In BGH's August 2026 survey, the share of large employers covering GLP-1s for obesity fell from 72% to 60%. Not one respondent said it planned to add coverage.

Employers that keep coverage are adding conditions, such as biometric checks or a required weight management program. Marsh estimates that rising GLP-1 use alone adds about one percentage point to 2027 cost growth. Our full guide to employer GLP-1 cost strategies covers pricing, Medicare rules, and coverage trends in depth.

5. Steering Members to Higher-Quality Care

The same procedure can carry very different prices and quality from one provider to the next. That's why 58% of large employers in the Marsh survey rate guiding members toward higher-quality care as important or very important.

Common tools include:

• • Care navigation services that help members choose doctors and understand bills
• • Variable copay plans, where the copay depends on the provider's cost and quality. Marsh found 12% of large employers plan to offer one in 2027, rising to 18% among employers with 20,000 or more workers.
• • Non-traditional medical plans, which more than a third of large employers plan to offer in 2027

6. Targeting Cancer and High-Cost Claims

Cancer has become the single biggest cost concern. In BGH's latest survey, 70% of large employers named it their top cost driver, up from 58% a year earlier. Musculoskeletal and cardiovascular conditions also ranked among the steady drivers.

Marsh reports that managing high-cost claims is now employers' top priority. In practice, this means earlier screening, expert second opinions, and centers of excellence for complex care. Steady care for chronic conditions is part of the same effort, since unmanaged conditions can turn into costly hospital stays.

7. Shifting More Cost to Employees

This is the change workers will feel most directly. According to Marsh, about two-thirds of employers with 500 or more workers expect to raise the employee share of premiums in 2027. Overall, 59% of employers plan cost-cutting changes such as higher deductibles.

Workers already carry a large share. KFF found that employees paid an average of $6,850 toward family coverage in 2025. That's why the first two redesign moves matter so much. Cutting costs for chronic care can offset some of the pain of a higher deductible.

Mental Health Parity in 2026: What's Enforced and What's Paused

The Mental Health Parity and Addiction Equity Act requires group health plans to treat mental health and substance use benefits no more restrictively than medical and surgical benefits. The rules around it have shifted several times since 2024, which leaves many employers confused.

Here is where things stand:

1. 1. The law still applies. The statute, its 2021 amendments, and the 2013 regulations remain fully in effect. Plans must still complete comparative analyses of their nonquantitative treatment limits, such as prior authorization rules.
2. 2. The 2024 rule is paused. In May 2025, the Departments of Labor, Health and Human Services, and the Treasury said they would not enforce the newer parts of the September 2024 rule while a legal challenge plays out, and for 18 months after.
3. 3. A replacement is coming. In a March 2026 court filing, the Departments said they would no longer defend the 2024 rule and planned to propose replacement regulations, with a target date of December 31, 2026.
4. 4. Enforcement continues. In September 2026, the Labor Department's Employee Benefits Security Administration issued Field Assistance Bulletin 2026-03, setting out its guiding principles for enforcing the parity rules on treatment limits.

What This Means for Employees at Open Enrollment

If you get health coverage through work, you'll likely see some of these changes in your 2027 options. A few practical steps help:

1. 1. Compare total costs, not just premiums. A lower premium with a higher deductible can cost more if you manage a chronic condition.
2. 2. Check the preventive drug list. If you use insulin, a statin, an inhaler, or an SSRI, see whether your HSA plan covers it before the deductible.
3. 3. Look up mental health access. Search the provider directory for in-network therapists before you choose a plan, and note any virtual therapy options.
4. 4. Read the GLP-1 rules. If you use a weight-loss medication, check for new requirements such as a lifestyle program.
5. 5. Use navigation tools. If your employer offers care navigation, use it before scheduling major procedures.

Comparing total costs, not just premiums, matters more as plans change in 2027.

A 2027 Renewal Checklist for HR and Benefits Leaders

For employers heading into renewal, this short checklist turns the trends above into action:

1. 1. Pull claims data by condition. Find out how much of your spending goes to chronic conditions, mental health, and cancer.
2. 2. Review your HSA plan design. Decide whether to adopt the IRS chronic-care preventive list, pre-deductible telehealth, or direct primary care.
3. 3. Test mental health access. Ask your carrier or administrator for wait times and network size, not just whether coverage exists.
4. 4. Document parity compliance. Keep your nonquantitative treatment limit comparative analysis current under the 2013 rules.
5. 5. Set a clear GLP-1 policy. Decide on eligibility rules and communicate them early.
6. 6. Model the employee impact. Before shifting cost, check how it affects lower-paid workers and people managing chronic conditions.
7. 7. Communicate early and plainly. Explain what changed and why before open enrollment begins.

Rising costs also connect to wider shifts across the system, from AI to value-based care. Our overview of the biggest US healthcare trends covers the bigger picture.

Frequently Asked Questions

Conclusion

Employers can no longer absorb rising costs with small fixes. The redesign of employer health benefits 2027 plans focuses on the conditions that drive the most spending and the most suffering: chronic disease and mental health. The smartest changes make ongoing care cheaper and easier to reach, through pre-deductible chronic care, permanent telehealth flexibility, and better mental health access.

The less welcome change is cost-shifting, and workers will feel it at open enrollment. Knowing what your plan covers, and why, is the best protection.

What change are you seeing in your 2027 benefits? Share it in the comments, and pass this guide to someone on your HR team who's planning next year's renewal.