What’s Driving the Healthcare Cost Crisis?

Why medical trend hit 9% when members aren’t getting sicker — and what benefits advisors can tell clients.

Partner Insights from Garner Health

U.S. employers expect healthcare costs to rise 9% in 2026, the highest medical trend in over a decade. The usual explanation is that people are getting sicker and care is getting more expensive. The claims data doesn’t support that.

Disease prevalence in the under-65 population has been close to flat for years, which means the increase is coming from somewhere else.

This report analyzes 75% of all U.S. medical claims, covering more than 320 million patients, to isolate where the increase actually originates. It identifies four systemic drivers and quantifies how much each one contributes to annual employer trend.

Written for benefits advisors who need to explain the increase to clients with something more specific than trend.

INSIDE THIS REPORT

The four cost drivers behind the 2026 increase, and what each contributes
Why a price transparency rule intended to lower hospital prices is raising them
How AI-assisted coding is inflating claims without changing care
Where prescribing patterns add cost without improving outcomes

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Employee Benefit News (EBN) is the primary media resource for decision makers in the worlds of employee benefits, human resources and workplace culture. As the dynamics of these spaces continue to shift and become increasingly complex, EBN delivers expert insights to allow business leaders to navigate their industries with agility. From helping benefits managers meet the challenges of reducing care costs and improving retirement plans to providing HR leaders with guidance on building a talented and diverse workforce, EBN drives the conversation and delivers the research and analysis to help readers support their companies’ objectives.

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