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- Renewal shock is now the norm. Nearly 4 in 10 SMBs took a double-digit increase this year, and PEO employers fared worse.
- Most leaders suspect they're overpaying but don't act on it. Nearly half believe they've been overcharged; only a fraction feel equipped to push back.
- "My broker's got it handled" is mostly an assumption. Leaders count on their broker to find savings, but almost none have ever verified it.
- Where you're headquartered quietly reshapes your budget. The per-employee gap between regions runs into thousands of dollars a year.
- GLP-1s are the wildcard nobody's pricing. They're driving a growing share of renewals, yet most covering employers can't say how much they're actually spending on them.
What's inside
This report breaks down what 503 SMB leaders told us about the real cost of employer healthcare in 2026, from renewal shock to the GLP-1 line item most companies can't even see.
Inside you'll find:
- What SMBs actually paid at their latest renewal, and who got hit hardest
- The business and personal tradeoffs leaders made to absorb the increase
- Why so many are pricing their coverage with almost no visibility into what's driving cost
- The GLP-1 wildcard reshaping renewals that most covering employers can't quantify
- How rising costs are changing the fight for talent
- The 15-minute review almost nobody runs, and what keeps them from it
Section teasers
The Renewal Reckoning 39% took a double-digit increase. On PEOs that jumps to 49%. The average hike, outliers removed, was 7%.
The Cost Behind the Cost 64% made at least one business tradeoff to cover their increase. 59% say benefits costs have taken a personal toll.
Flying Blind Only 31% got a clear breakdown of what was driving their cost increase. 48% believe they've been overcharged, but most can't prove it.
The GLP-1 Wildcard 58% of covering employers can't say what GLP-1s add to their renewal. 63% would restrict or drop coverage if it pushed the next renewal up 6-14%.
The Talent Squeeze 53% say rising healthcare costs have made it harder to compete for talent. Better health insurance tops the employee expectation list at 80%.
The Savings Nobody Checks 41% assume their broker handles it. Only 6% have ever run a review.
Social proof / stat strip
- 503 SMB leaders surveyed
- 39% took a double-digit renewal increase
- 48% suspect they've been overcharged
- Only 6% have ever run a savings check
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