Top 5 Employee Benefits Trends Shaping 2026

Employers face mounting pressure to balance affordability with competitiveness, all while navigating complex regulatory updates and emerging healthcare innovations. Understanding these developments is critical for employers seeking to attract and retain talent while managing benefits costs effectively. Rising healthcare costs, evolving pharmaceutical trends, legislative changes, and shifting worker expectations are reshaping employee benefits trends in 2026

1. Rising healthcare costs

Healthcare costs have been growing at an alarming rate in recent years, and they’re not slowing down. A few of these key cost drivers, such as glucagon-like peptide-1 (GLP-1) and specialty drugs, will be further explained in the following sections. Chronic health conditions, cancer care, health labor costs, and medical inflation are also driving employer cost increases.

Surveys project that health care costs in the United States are likely to increase by 6.5% to, in many cases, as much as over 10% in 2026. Regardless of the exact figure, employers can expect their health care costs to continue to skyrocket throughout 2026, and they will absorb much of the costs.

2. Continued popularity of GLP-1 drugs

Americans’ heightened interest in and spending on GLP-1 drugs is a major driver of rising health care costs. While GLP-1 drugs are traditionally used to treat diabetes, they are now in demand for weight loss. The number of prescriptions for the drugs has tripled since 2020. A RAND report revealed that 12% of Americans have used GLP-1 medications for weight loss, and 14% are interested in using the drugs.

Currently, there are around 7 to 8 GLP-1 drugs, with more expected to hit the market in 2026. Additional drugs could further drive up health plan costs, especially with the most recent development of the first oral GLP-1 pill, making the drug more accessible and convenient. With pharmaceutical companies recognizing the success of semaglutide and tirzepatide, more than 100 drugs are currently in clinical development for the treatment of obesity.

Many employers are concerned when it comes to covering these drugs, as they require a long-term commitment to be effective. GLP-1 drugs, on average, cost around $1,000 per individual each month. This employee benefits trend impacts the workplace as employees ask their employer to cover weight-loss drugs.

3. The impact of the OBBBA

The One Big Beautiful Bill Act (OBBBA) includes a broad set of changes for employee benefit plans, most of which take effect in 2026.

• Expanded access to health savings accounts (HSAs)—Effective Jan. 1, 2026, HSA eligibility will allow individuals with direct primary care (DPC) arrangements to make HSA contributions if their monthly fees are $150 or less ($300 or less for family coverage). Also, DPC fees will be treated as medical care expenses that can be paid using HSA funds.
• Increased limits and tax credits for dependent care flexible spending accounts (FSAs)—Effective Jan. 1, 2026, the maximum annual limit for dependent care FSAs increases to $7,500 for single individuals and married couples filing jointly and $3,750 for married individuals filing separately (up from $5,000 and $2,500, respectively).
• A new tax-advantaged account (“Trump Account”) for children—Effective in 2026, Trump Accounts are a tax-advantaged savings account for children under age 18. Annual contributions are limited to $5,000 per child, and employers may contribute up to $2,500 per year to the account of an employee or an employee’s dependent.

4. New specialty drugs

The specialty drug market continues to expand rapidly, driven by a surge in approvals by the FDA and a robust pipeline of innovative therapies. These high-cost, high-impact treatments are reshaping the pharmaceutical industry. Experts estimate that nearly 80% of all FDA approvals in 2025 fall into the specialty category, reflecting a shift toward more targeted, complex therapies for chronic and rare conditions. This momentum is expected to continue throughout 2026.

This rapid growth is being fueled by more plan participants using these key specialty drugs:

• Biologics and biosimilars—Biologics currently dominate the specialty market, offering targeted treatment for autoimmune diseases, cancers, etc. However, as they lose exclusivity, biosimilars are gaining traction as cost-effective alternatives. With 29 new biosimilars approved in the past two years, the trend is expected to continue; predictions indicate that at least 10 new biosimilars will be approved annually over the next five years. This dual trend of popularity and lapsing exclusivity is expected to reshape employer strategies and formulary decisions. A biosimilar can only be marketed after the corresponding biologic loses its 12-year exclusivity rights following approval.
• Cell and gene therapies (CGT)—These cutting-edge treatments achieved record approvals in 2025, with groundbreaking treatments such as CAR-T therapy that is revolutionizing cancer treatments. While these innovations offer transformative outcomes for conditions such as blood cancers and rare genetic disorders, they face challenges in costs, logistics, and manufacturing. The industry is now shifting toward purpose-built automation and analytical technologies that streamline CGT production. This shift aims to reduce costs, improve scalability, and accelerate patient market access.

5. Expansion of fertility benefits

Many employees are turning to fertility treatments while trying to navigate their paths to parenthood. According to the U.S. Centers for Disease Control and Prevention, roughly 9% of men and 11% of women of reproductive age have experienced fertility problems. These treatments often include medications, which are sometimes combined with surgical procedures.

With some states already requiring insurance companies to cover infertility diagnosis and treatments, new federal initiatives aim to make in vitro fertilization (IVF) more affordable.
The new guidance provides that employers may offer the following:

• Fertility benefits can be offered as an independent, noncoordinated excepted benefit if the applicable conditions are met. Individuals enrolled in such coverage may also contribute to an HSA.
• An excepted benefit health reimbursement arrangement (HRA) may reimburse an employee’s out-of-pocket costs with respect to fertility benefits, as long as the HRA meets the applicable regulatory requirements, such as offering a traditional ACA-compliant health plan.
• Benefits for coaching and navigator services can be offered to help employees and their dependents understand fertility options under an employee assistance program (EAP) that qualifies as a limited excepted benefit. To qualify as a limited excepted benefit, the EAP cannot be coordinated with benefits under another group health plan, no employee premiums or contributions can be required as a condition of participation, and there must be no cost sharing under the EAP.

Employee demand for fertility benefits continues to grow, and reproductive health care benefits in general remain a key issue for employers as they strive to meet employee needs and remain competitive.

Final thoughts

2026 is going to be a pivotal year for employee benefits with trends such as escalating healthcare expenses, drug therapies, and new legislative initiatives. Employers need to proactively prepare for these changes to not only better position themselves in a competitive market but also to show their commitment to supporting their workforce through innovative benefits.

Feeling overwhelmed by benefit options? You don’t have to be. The Miller Group’s advisors are ready to build a benefits strategy that supports you and your team. Reach out to a trusted partner today and make a lasting impact.