Take Command’s 2026 State of Employee Health Benefits Survey provides new data about the health insurance market landscape
It’s not news that the American healthcare system no longer works. The question is what to do about it. Employers are trying to recruit and retain talent by offering a quality benefits package, but group health insurance is pushing budgets past their breaking point.
As the pioneering ICHRA administrator, Take Command has a vested interest in long-term healthcare benefits. To drive our ongoing work, we conducted a health insurance survey with 1,000 employees from across the U.S. working in industries including education, healthcare, hospitality, manufacturing, nonprofit, and retail. Company sizes ranged from small businesses to enterprise organizations. The data tells a powerful story.
In this blog, we cover:
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Health benefits are one of the strongest recruitment and retention tools
- The great health benefits shift
Employees want more choice in their health insurance
97% of large employers provide group health insurance.1 That makes sense since group insurance has been the default for more than eight decades.2 But the old way no longer works; it’s tanking company budgets, and it’s not what employees want.
Instead of having just one or two group plans to choose from, employees want to make their own health insurance decisions and the flexibility to choose plans that better fit their doctors, families, and budgets.
In fact, 49% of employees said that if their employer gave them money to choose their own health insurance, they would prefer that over being placed on a company plan. And while more than half of employees believe they should control their health insurance choices, most employers (62%) offer just one or two plans.
Knowing I don’t have the best coverage makes me stressed and nervous about what would happen if something went wrong with my health.
The mental toll of losing a provider
Our survey also examined how health coverage affects employee wellbeing. We know that continuity of care is linked to stronger health outcomes and wanted to understand employees’ experiences in that regard.
Many respondents expressed concerns about losing access to preferred providers if their employer changed group plans. Some people noted that they will no longer be able to see their established doctor because the company moved to a different insurance carrier.
While we knew that this was the case anecdotally, it’s important to have hard data about continuity of care so we can move forward with more employee-friendly benefits options.
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Download key survey findings
Health benefits are one of the strongest recruitment and retention tools
Claiming that the limitations of group health insurance are expensive and proving it are two different things. So let’s do a by-the-numbers breakdown of health benefits cost implications.
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Payroll is the number one budget item for every industry in the U.S.3
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The total cost to hire a new employee can be three to four times the position's salary.4
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>90% of employees said health benefits were somewhat or extremely important when deciding whether to stay at a job.
The upside is the more and more employers are turning to HRAs as a budget-friendly way to offer personalized, tailored health insurance to their employees.
The great health benefits shift
Out with the old, in with the ICHRA
As group health insurance has become increasingly problematic, HRA Council data5 for 2024–25 show that HRAs are becoming a popular solution for employers and employees.
Important findings include:
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Large employer ICHRA adoption is up 34% year over year
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83% of small businesses used an HRA to offer health benefits for the first time ever
- Employees enrolling dependents in their HRA saw a 37% year-over-year increase
These numbers showcase that modern benefit models like ICHRA allow employers to adopt cost-controlled health insurance while giving employees the freedom to choose their own plans.
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Download key survey findings
Future-proofing benefits with HRAs
One of the biggest values HRAs provide is peace of mind. Employers can count on a consistent budget, and employees can count on consistent coverage. Flexibility comes in at a close second, giving endless options to design plans and budgets.
A few fan favorites when it comes to HRAs:
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Budget predictability and forecasting: Employers decide the health benefits allowance amount, and it only changes if they want it to.
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Plan portability: Employees change jobs every three years on average.6 In the old group model, they lose their insurance when they leave a job. But with an HRA, the employee owns the plan and can take it with them (they take over payments.) This removes the administrative burden of COBRA and ensures the employee stays covered.
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ICHRA employee classes: This is the ultimate in health benefit flexibility. ICHRA lets employers designate employee classes such as FT/PT, salaried/hourly, and location; each class can have a specific allowance amount.
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Geographical coverage: No matter where employees live, they can use an HRA. Maybe some are at an Ohio headquarters and others at satellite offices in California and Pennsylvania. HRAs are available in every state and work the same regardless of whether employees work in one location or are dispersed all over the country.
- Work modality: This echoes the geographical flexibility. It doesn’t matter if employees are in-office, hybrid, or fully remote: HRAs cover them all.
HRAs give brokers a new strategy
As the health insurance landscape evolves, employers are leaning on their brokers for expert advice. Understanding all of the options puts brokers in a strong position to serve as an expert guide—taking care of clients and their book of business.
P&L, personalization, and peace of mind.
Employers typically gravitate toward the balance that HRAs provide, honing in on the dual benefits for the company and the employee.
HRA benefits
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Budget control
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Personalized plan choices for employees
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Simple, flexible plan designs
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No employer responsibility for health risks
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No participation concerns
- Only with Take Command: In-house support team
Keep reading
Health insurance risk management
Employers are questioning the status quo and replacing it with data-driven decisions about health benefits. Find out why smart risk management in health insurance is important.
Why health insurance risk management is crucial
Should you break up with your group health benefits?
If you’re unhappy with your group plan or just curious about other options, here are some considerations for moving on and why an HRA might be better for your business.
Switching from group health insurance
Top 5 reasons group health plans are overburdening mid-market companies
Mid-market companies occupy a uniquely uncomfortable spot in the employer health benefits landscape and are absorbing premium increases that their budgets were never designed to handle.
Top 5 challenges for mid-market group plans
Contact Take Command to learn about HRAs
Take Command HRA experts are here to answer your questions. Contact us to talk through what would work for your business or request a demo.
References
- https://meps.ahrq.gov/data_files/publications/rf54/rf54.shtml
- https://www.takecommandhealth.com/blog/switching-your-group-health-insurance-plan#origin-of-employee-benefits
- https://www.bls.gov/news.release/ecec.htm
- https://www.shrm.org/topics-tools/news/talent-acquisition/real-costs-recruitment
- https://www.hracouncil.org/report
- https://www.bls.gov/news.release/pdf/nlsoy.pdf
Let's talk through your HRA questions
I wrote this blog to help people make smart health insurance decisions. I am a small business owner, a husband, and a dad to three boys, so I've seen firsthand how important understanding insurance decisions can be. As a co-founder of Take Command Health and a licensed health professional, I've been recognized as a leading expert on healthcare transparency and defined contribution arrangements (QSEHRA). I've been featured in the New York Times, Wall Street Journal, Dallas Morning News, Forbes and others. Learn more about me and connect with me on our about us page. Thanks!
