Health / Economy — KFF's 2026 benchmark survey: total family premiums hit $28,303, workers' share jumped $621 in a year — two and a half times the pace of wage growth — and small-firm workers pay $2,847 more than everyone else.
Workers with job-based health insurance paid an average of $7,471 toward family coverage premiums in 2026 — up 9%, or $621, from 2025 — according to KFF's annual Employer Health Benefits Survey released Thursday, October 22. Including the employer's share, the total annual premium for family coverage now averages $28,303, up 5% or $1,310 in a year. Single coverage averages $9,804, also up 5%, with workers contributing $1,672 on average. Over the same period wages rose 3.7% and general inflation 2.7% — meaning the worker's share of health cover grew roughly two and a half times faster than the pay it comes out of.
The small-firm penalty
The survey of more than 1,900 employers — the 28th annual edition, covering the system that insures almost 157 million Americans under 65 — exposes a sharp two-tier structure. Workers at small firms (under 200 workers) contribute an average of $9,687 toward family coverage, which is $2,847 more than workers at large firms ($6,840). Small-firm workers pay an average contribution rate of 37% of the premium against 25% at large firms, and nearly one-third of small-firm workers are in plans requiring them to pay more than half the family premium, against just 6% at larger firms. Employers are passing costs through deliberately: among large firms, 44% increased the share of premium workers pay this year and 21% raised deductibles or other cost-sharing. Thirty-eight percent of covered workers are now in a plan with a general annual deductible of at least $2,000 for single coverage, up from 34% in 2025 — a share that has grown 31% in five years and 63% in a decade.
Why this matters
"We have been hearing a lot about Affordable Care Act and Medicaid cuts. Now add a 9% increase in what workers with employer coverage paid toward family premiums in 2026 to the reasons voters are so concerned about their health care costs," KFF President and CEO Drew Altman said. That sentence lands twelve days before a midterm election in which an AP-NORC poll found about 7 in 10 registered voters calling health care one of the most important issues. The political significance is that this is not the uninsured or the ACA marketplace — it is the insured middle: people with jobs and coverage watching $621 more a year leave their pay before deductibles they are also watching rise. Forecasts point the same way for 2027, with employer cost projections in the high single digits (Aon projects 9.5%), driven by pharmacy spending including GLP-1 drugs, mental-health claims and provider pricing. Since 2021, family premiums are up 28% and worker contributions 26%, tracking wages (27%) and inflation (24%) over five years — it is this year's sudden acceleration of the worker's share, not the long trend, that is new.
Both sides of the argument
Employers argue they absorbed most of the increase — they still pay about $20,833 of the average family premium — and that raising worker shares and deductibles is how plans survive without cutting networks; 89% of employers describe their largest plan's network as broad. Worker advocates answer that a deductible is a cost whether it appears in a premium table or at a pharmacy counter, and that the small-firm tier — where pay is typically lower — is being charged the most, which is the opposite of how insurance pooling is supposed to work. The administration has pitched most-favoured-nation drug pricing as its affordability answer; the survey's message is that, for employer coverage in 2026, the bill rose anyway.
What happens next
Open enrollment makes these numbers real in household budgets over the next two months, in the middle of the new Congress's first session. Watch 2027 plan filings for whether the projected near-double-digit increases materialise — and whether deductibles, already at record shares above $2,000, become the next political fight after premiums.
Sources
KFF, 2026 Employer Health Benefits Survey (28th annual; 1,937 employers surveyed January–July 2026), released October 22, 2026, and KFF summary release. Associated Press coverage, October 22, 2026. Aon employer cost projections via Barron's, October 2026.