PwC’s annual medical trend report projects that group health insurance costs will rise 8.5% in 2026, matching last year’s trend and rates last seen 15 years ago.
They surveyed 24 U.S. health plans, covering more than 125 million employer-sponsored members and 12 million Affordable Care Act (ACA) marketplace members for this annual report. The medical cost trend is the expected increase of health care costs by health plans. PwC’s report identified key factors driving this upward trend:
- Hospital costs are up, from wages to supplies, leading to increased inpatient admissions and higher costs for commercial payers.
- New therapeutics, including GLP-1s, are driving higher costs in oncology, immunology, cardiovascular, obesity, and diabetes care, with further off-label uses expected.
- Behavioral health care spending is up, with inpatient claims rising nearly 80% and outpatient claims up almost 40%. Actuaries expect a 10%-20% increase in 2026.
Despite rising costs, the report also highlights some factors that could help slow medical trend growth in 2026:
- Biosimilars remain the top cost deflator for health plans, with adoption rising in 2024 and more approvals expected.
- Cost management strategies, like utilization review, pharmacy oversight, and AI-driven tools, are helping health plans control expenses.
Click here to read the PwC complete Behind the Numbers 2026 report.
Employer Takeaway
Federal policy changes like the One Big Beautiful Bill Act may increase cost pressures in 2026, affecting Medicaid eligibility, ACA subsidies, and drug tariffs.
Health care costs are expected to keep rising in 2026 and beyond. Employers will seek ways to manage expenses while maintaining affordable coverage. Download the bulletin for more details.
