WASHINGTON, D.C. — Workers with employer-sponsored health insurance are paying more for coverage in 2026, with employees and companies at small businesses facing some of the sharpest increases, according to a new survey from the health care research nonprofit KFF.
The 2026 Employer Health Benefits Survey, released Thursday, found that covered workers are contributing hundreds of dollars more toward premiums than they did last year. The burden is especially heavy at companies with 10 to 99 employees, where workers generally pay a larger share of their health insurance costs than employees at bigger firms.
The rising price of health care has become a major concern for voters ahead of the midterm elections, adding to wider worries about affordability. About 7 in 10 registered voters said health care was “one of the most important issues” in the election, according to an AP-NORC poll conducted in October.
Nearly 157 million Americans under retirement age receive health coverage through an employer. KFF found that workers with employer-sponsored family plans are paying an average of $7,471 a year toward premiums in 2026 — about 9% more than last year, or an increase of $621.
“Workers are paying a bigger chunk this year,” said Matthew Rae, associate director of KFF’s Program on the Health Care Marketplace. “That also brings up the issue of affordability.”
President Donald Trump has made health care affordability part of his midterm election message, arguing that his most-favored nation prescription drug pricing plan would lower costs and promising rebates for some Americans. However, other policies adopted by Trump’s Republican administration have increased expenses for some people. The KFF survey suggests that many workers are paying more for health insurance without seeing clear improvements in their benefits.
Small businesses could feel the pressure most acutely. They employ about 62.3 million people, representing 45.9% of private-sector workers, according to the Small Business Administration.
Workers at smaller companies who receive coverage contributed an average of $9,687 toward family premiums in 2026, compared with $6,840 at firms with at least 200 employees, the survey found. In 2025, those figures were about $8,900 and $6,200, respectively. Employees at smaller businesses covered an average of 37% of the family premium, versus 25% at larger firms.
The disparity is also reflected in plan designs: 32% of covered workers at small businesses are enrolled in plans requiring them to pay more than half of the family premium. At larger companies, that share is just 6%.
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As premiums rise, small businesses are being forced to balance competitive employee benefits against a growing list of other expenses.
Jenna Caligaris, who manages an upstate New York contracting company with about 25 employees, said the challenge of providing health insurance weighs heavily on her.
Because her company operates in a highly competitive labor market, Caligaris said it looks for ways to prevent employees from taking on a larger share of insurance costs. The firm pays 80% of coverage for its nonunion workers, with employees responsible for the remainder.
The company has extended the use of its vehicles and tools, reduced year-end bonuses and eliminated its annual picnic as it tries to preserve health coverage and remain competitive. “We’re trying to maintain coverage and stay competitive — so we’ll have to eat these price increases,” Caligaris said.
The company has changed insurers in each of the past three years to control expenses, but Caligaris said it is still facing a 25% premium increase this year.
Rae said smaller companies also tend to face higher deductibles than larger firms, along with greater volatility in the health insurance market.
KFF’s annual employer health benefits survey covers large and small businesses and includes about 1,900 employers with 10 or more workers.
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