EIEA – October 2026 HR Brief

Written by Admin on October 5, 2026. Posted in News.

Question of the month:

Did You Know?

You can make changes to your medical coverage during Open Enrollment! This is the time to review your benefits, make eligible changes to your coverage, and ensure you have the right plan in place for the upcoming year.

Open Enrollment Basics

Open enrollment is the designated period each year when you can review, change or sign up for health insurance and other benefits, whether that coverage comes through an employer, a private plan, the Marketplace or through a federal program such as Medicare. Each of these paths has its own enrollment window and rules, but they all share the same basic idea: this is your yearly chance to make sure your coverage still fits your life, rather than defaulting to whatever you had before.

For most working adults, this window shows up through their employer. Every fall, most workplaces open a short period during which employees can review, change, or renew their health insurance and other benefits for the coming year. It’s one of the more consequential dates on the work calendar, yet it’s often overlooked — employees default to their existing plan without reviewing other options. Understanding what open enrollment is and using it well can save you real money all year long.

This article explains what open enrollment is, when it typically happens, what you can actually do during it and a few simple tips for making confident decisions.

What Is Open Enrollment?

During this window, you can sign up for health coverage, switch to a different plan, add or drop dependents or cancel benefits altogether — your annual opportunity to reassess your circumstances and make sure your coverage still reflects your life today, not the life you had when you last enrolled.

For example, most employers hold their open enrollment window each fall, giving employees a set number of days or weeks to review their workplace benefits and make changes before the new plan year begins.

Outside of this window, your choices are generally locked in for the rest of the plan year. That means you can’t decide in March that you want a different health plan. The elections you make (or don’t make) during open enrollment typically carry you all the way through to the next cycle. If you miss open enrollment, you’ll usually have to wait until the following year to make changes, even if your needs shift in the meantime. The one major exception is a qualifying life event, such as marriage, divorce, the birth or adoption of a child or a loss of current coverage. Eligibility can vary by event type and the employer’s specific rules.

That’s what makes the open enrollment window so important. For most people, it’s the one guaranteed opportunity each year to realign their benefits with their actual needs, whether that means adjusting coverage levels, switching plans to better fit a growing family or taking advantage of new options your employer may be offering for the first time.

When Does It Happen?

For employer-sponsored coverage, each employer sets its own open enrollment dates, but most organizations offer it in the fall, with new coverage taking effect at the start of the following calendar year. The window itself tends to be short, often just a couple of weeks, so it’s worth learning your organization’s specific dates ahead of time. Your HR or benefits team will typically send the exact dates along with enrollment instructions.

What Can You Actually Do?

Depending on your employer’s plan offerings, open enrollment usually lets you make several types of changes at once. Here’s what’s typically on the table:

Keep your current plan. Many employers automatically renew existing elections if you take no action, a practice known as passive enrollment. It’s worth double-checking that rule rather than assuming.
Switch plans. Move to a different medical, dental or vision plan that your employer offers.
Add or remove dependents. Update coverage for a spouse, partner or child.
Enroll in extras. Sign up for supplemental benefits such as life insurance and disability coverage. You can also enroll in, or adjust contributions for, a health savings account (HSA) or flexible spending account (FSA).
Cancel coverage you no longer need.

Terms to Know

Benefits paperwork is full of jargon that can make even a simple plan feel confusing. Here are some cost terms you’ll run into most often:

A premium is the fixed amount taken from your paycheck each pay period, regardless of how much care you use. A lower premium means more take-home pay today, but it often shifts more of the cost to you later if you need care.
A deductible is what you pay out of pocket before insurance starts covering costs. A higher deductible usually comes paired with a lower premium, so you’re trading a smaller hit to every paycheck for a larger potential bill if you have a medical event.
A copay is a fixed dollar amount you pay for a specific service, such as a doctor’s visit or prescription, though, depending on your plan, it may apply before or after the deductible is met.
Coinsurance is your percentage share of the cost for a service once the deductible is met. For example, the plan might cover 80%, with you responsible for 20%.
An out-of-pocket maximum is the most you’ll pay in a year for covered, in-network care before the plan covers everything, effectively capping your financial exposure no matter how bad a year gets.

Making the Most of Your Enrollment Period

A few simple habits can turn open enrollment from a rushed formality into a decision you actually feel good about. Before you submit your choices, consider the following:

Look back before you look forward. Think about what you actually spent on healthcare last year, and whether it matched your needs.
Check the network. Confirm that your doctors and preferred facilities are still in-network for any plan you’re considering.
Check your medications. If you take regular prescriptions, review the plan’s drug list to make sure they’re covered.
Think ahead. Consider what’s coming up in the year ahead, such as a new baby or a planned surgery. Any of these can change how much care you’ll need, or whether a plan with a lower deductible makes more sense than one with a lower premium.
Don’t skip the extras. Dental, vision, life insurance and FSA/HSA accounts are often bundled into the same enrollment and are easy to overlook.

Conclusion

Open enrollment is your annual opportunity to ensure your benefits fit your current needs and goals. Set a reminder for your organization’s enrollment dates, take the time to compare your options and don’t hesitate to ask HR questions if anything is unclear. A little attention now can prevent a lot of surprises later.

Why Healthcare Costs Will Rise Significantly in 2027

Healthcare costs, and consequently employee benefit costs, have been growing at an alarming rate in recent years, and they’re not slowing down. Mercer projects that the total health benefit cost per employee will rise 8.2% on average in 2027, after accounting for cost-cutting measures, the highest increase in 15 years. To put it in perspective, the past decade normally increased 3% annually. In addition, PwC expects medical costs to grow at 9% to reach their highest level in 17 years. The Business Group on Health (BGH) similarly projects a median 9.2% increase in healthcare costs for 2027, which employers expect to offset to about 8% through plan design changes. Regardless of the exact figure for 2027, employees can expect their healthcare costs to continue to skyrocket throughout the next year.

Faced with sustained high healthcare costs, more employers are passing costs along to their employees. That can show up as higher premiums, deductibles and copayments. According to a Mercer survey, two-thirds of large companies expect to raise monthly premiums for employee health coverage through paycheck deductions in 2027. While some organizations may try to limit the premium increase, they could raise other out-of-pocket costs, such as deductibles and copayments, making it important to review all aspects of your healthcare costs. Lastly, individual Marketplace plans are likely to go up even higher, as much as 15%-20%, the second consecutive year of double-digit hikes.

Understanding today’s drivers of healthcare costs can help you make informed decisions about your coverage and financial planning. This article explores key factors driving increases in employees’ healthcare costs in 2027.

Cancer Care

According to the BGH, cancer care has been the top driver of employer cost increases for five years in a row. The spending has worsened due to the growing prevalence of cancer diagnoses and the escalating cost of treatment. Cancer is complex; therefore, its diagnosis and treatment don’t follow the same path for every individual.

Cancer diagnoses are increasing, not just among older adults but also among younger working-age individuals. This means more employees and dependents are entering treatment, often requiring long-term and intensive care. Additionally, new and innovative therapies—including cell and gene therapies, immunotherapies, targeted drugs and personalized medicine—may offer better outcomes but come with high price tags. These treatments often cost hundreds of thousands of dollars per patient, especially in late-stage cases.

With cancer cases and costs on the rise, employers may try to focus on healthy lifestyle promotion, cancer prevention and screenings, or centers of excellence partnerships.

GLP-1s and Prescription Drugs

Glucagon-like peptide-1 (GLP-1) drug use for weight loss is already widespread, and adoption continues to climb. According to Gallup’s 2026 National Health and Well-Being Index, 11% of U.S. adults currently take a GLP-1 medication for weight loss, up from just 3% in 2024, and 15% report having used one at some point. Awareness of these drugs has also surged, rising to 91% of U.S. adults in 2026 from 80% in 2024.

GLP-1 medications typically cost hundreds of dollars per month with insurance or manufacturer discount programs, but can exceed $1,000 per month without coverage. Many plans only cover GLP-1s for diabetes or won’t cover these prescriptions at all. These costly medications are intended to be taken in perpetuity to achieve their benefits. This means that GLP-1 users may experience health benefits but will be required to use these high-cost treatments on an ongoing basis.

In response to the popularity of GLP-1s, more employers may require employees who use these medications for weight loss to get prior approval, participate in weight management programs or meet other requirements.

AI-driven Billing and Documentation

A newer factor is reshaping how much employers pay for care. According to PwC, AI-powered documentation and coding tools are helping providers capture more billable detail without necessarily increasing the intensity of care delivered. Nearly 70% of health plans surveyed named this among their top three drivers of rising healthcare costs in 2027. As these tools become more widespread across provider networks, employers may see claims reflect higher billed severity even when patient treatment itself hasn’t changed.

Chronic Health Conditions

Chronic conditions affect millions of Americans and require ongoing treatment, monitoring and medication, which adds up quickly for both individuals and employer-sponsored health plans. In fact, around 90% of U.S. healthcare spend is on people with chronic and mental health conditions. Chronic conditions include heart disease, stroke, cancer, diabetes, arthritis and obesity.

In general, chronic disease is increasing in prevalence in the United States and is projected to continue to do so in 2026 and the coming years.

Catastrophic Claims

Catastrophic claims, which are extremely high-cost medical events, are significant contributors to recent healthcare costs. These claims typically involve severe illnesses, complex treatments or long-term care needs and occur across all ages of employees.

Catastrophic claims are often associated with cancer treatments, neonatal intensive care (or NICU) stays, organ transplants, mental health crises, severe trauma or accidents, genetic disorders and advanced therapies (e.g., cell and gene therapy). General inflation and the consolidation of health systems are driving up prices for services, making catastrophic claims even more expensive.

Healthcare Labor Costs

The supply of healthcare workers continues to fall short of the growing demand for utilization. This shortage is due to rising healthcare demands, an aging population, retiring workforces and insufficient talent entering the healthcare industry. When key players in the healthcare industry are required to spend more on labor, those expenses are often passed on to both employers and users of the healthcare benefit: employees and their dependents.

What Can You Do?

While you can’t necessarily control these driving factors, educating yourself as a healthcare consumer is one way to help manage healthcare costs. Start by fully understanding what your health plan does and doesn’t cover to help reduce your healthcare spending. This step can help you plan and budget accordingly. Additionally, prioritize preventive care services to help avoid costly treatments later.

If you have more questions about your benefits, reach out to your HR representative.

Health Care Cost Spotlight: GLP-1 Medications

Health care costs are projected to increase substantially this year. According to industry surveys and reports, employers anticipate health care costs to increase by 7%-8% in 2025. As a result, employer-sponsored health care plans will continue to cost more per employee, impacting employers and employees alike.

With glucagon-like peptide-1 (GLP-1) drugs gaining popularity and being used by more plan participants, they are a key driver of rising health care costs. This Health Care Cost Spotlight article focuses on GLP-1s and how they’re impacting health care costs this year and beyond.

The Growing Demand for GLP-1s

The first GLP-1 medication was approved by the U.S. Food and Drug Administration (FDA) in 2005 for Type 2 diabetes, but clinical trials revealed that patients experienced significant weight loss, giving way to the first GLP-1 approved for weight loss in 2014. Innovation continued, and GLP-1 use has risen to prominence as a weight loss tool in recent years.

Obesity is a disease that can result from personal behaviors, medication use, dietary patterns, family history and genetics. Yet, other contributing factors, such as larger food portions, inactivity and increased food insecurity, also tend to put Americans at risk for obesity or worsening obesity. Obesity can lead to many other illnesses, such as Type 2 diabetes, heart disease and certain cancers. More than 2 out of 5 adults in the country have obesity. While long-term weight loss is possible with lifestyle, diet and1 mindset changes, many are turning to weight loss drugs instead.

A KFF poll revealed that 1 in 8 Americans have already used a GLP-1 drug, while 6% are currently taking one. However, this number is projected to rise in the coming years; J.P. Morgan estimates that 9% of the U.S. population could be on GLP-1s for weight loss by 2030. The popularity of these drugs is likely to increase in 2025 and beyond as more patients become aware of GLP-1s and take action to improve their health.

GLP-1 drugs are already proving popular with plan participants eager to lose weight and improve their overall health. Mounjaro (which has the active ingredient tirzepatide), Ozempic and Rybelsus (which both use the active ingredient semaglutide) are approved for treating diabetes but are commonly prescribed off-label for weight loss. Zepbound (tirzepatide) and Wegovy (semaglutide) are drugs that use the same active ingredients but are approved to treat obesity for qualifying patients. Most recently, Ozempic was approved to reduce the risks of kidney disease worsening, kidney failure and death due to cardiovascular disease in adults with Type 2 diabetes and chronic kidney disease. In addition to these conditions, the active ingredients in GLP-1 medications have shown promise for treating other conditions, including Alzheimer’s disease, heart disease and even sleep apnea. While these use cases are still undergoing clinical trials for approval, the potential applications of GLP-1s could lead to these costly drugs being used to treat even more patients.

Additional GLP-1 drugs are expected to hit the market by 2026, which could further drive up employers’ health plan costs. GLP-1s suppress appetite, which usually leads to an energy deficit and, ultimately, muscle loss. As such, muscle loss is a concern for many people taking anti-obesity medication and manufacturers are working to create drugs that can help preserve muscle while dropping weight. As pharmaceutical companies recognize the success of semaglutide and tirzepatide, more than 100 drugs are in clinical development for obesity.

Furthermore, 15 drugs—including Ozempic, Rybelsus and Wegovy—were recently selected for the second cycle of the Medicare Drug Price Negotiation Program. Once drug companies confirm their participation, negotiations will continue through 2025. While Part D negotiations will help lower costs for seniors, this move may also have greater implications for drug access, insurance coverage, supply and total health care spending.

The Cost of GLP-1s

On average, GLP-1 treatment costs around $1,000 per individual each month. When considering covering weight loss drugs, many employers are concerned that they must be used for extended periods to be effective, requiring a long-term commitment.

A Business Group on Health (BGH) survey validated that heightened interest and spending on GLP-1 drugs is a major driver of rising health care costs in 2025. Large employers covering 17.1 million Americans participated in BHG’s annual health care strategy survey. These employers predicted their health care costs would rise about 7.8% in 2025 before plan design changes, mostly due to pharmacy costs. More than half (57%) of the respondents said that GLP-1 spending was “driving health care costs to a great or very great extent.” Other concerns focus on costly cell and gene therapies and over all pharmacy costs. Participating employers in the BGH survey said they won’t reduce benefits and plan to absorb most of the costs themselves instead of passing them on to their employees.

Cost-mitigation Strategies for Employers

Although employers have historically not covered GLP-1s for weight loss, increased demand from workers and obesity concerns among U.S. adults are forcing employers to reconsider comprehensive obesity care benefits. While most employers cover GLP-1s for approved uses to treat Type 2 diabetes, decision-makers have hesitated to cover them for weight loss. In fact, KFF found that fewer than 1 in 5 organizations with 200 or more employees covered the drugs in 2024. Furthermore, only 3% of large firms that currently don’t cover GLP-1s are “very likely” to do so in 2025. About one-quarter of large companies say they are “somewhat likely” to cover the drugs. Similarly, consulting firm Mercer reported that about 44% of U.S. employers with 500 or more employees covered drugs for weight loss in 2024, up from 41% in 2023. Additionally, 64% of employers with more than 20,000 employees covered weight loss drugs in 2024, compared with 56% in 2023. While employers are cautious about covering weight loss drugs, more are doing so as the treatments gain popularity among today’s workforce.

While employers are largely covering these drugs due to employee demand, they often experience the advantages of a healthier workforce. Employees with obesity are likely to incur more medical costs, file workers’ compensation claims and take more sick days than other employees. Add those things up, and they can be pricey for employers. In fact, obesity cost employers more than $400 billion in 2023. Employees who are over weight or obese can cost between $1,200 and $6,700 per year in excess costs. However, these excess costs may not sway all employers due to the higher price tags and the need for the employee to take GLP-1s indefinitely.

While rising health care costs may be unavoidable, some employers are pursuing the following strategies to lower costs related to GLP-1s:

Choose whether to cover GLP-1 medications for obesity, or strictly provide cover age for Type 2 diabetes.
Raise the body mass index (BMI) threshold for plan participation. For example, some employers may require either a 30 BMI or a 27 BMI in addition to other relevant health conditions to qualify.
Introduce guardrails or controls for employees, such as prior authorization, step therapy or other actions, before gaining coverage for GLP-1 use.
Combine weight loss drug coverage with wellness programs. Research suggests GLP-1s are more effective when combined with physical activity and dietary changes, so some employers offer wellness programs focusing on overall lifestyle changes. These types of programs may also help users who want to stop taking the medication but sustain weight loss.
Take advantage of prescription drug-saving programs, such as rebates, coupons and other pharmacy options.
Adjust cost-sharing arrangements, such as increasing employees’ deductibles, coinsurance, copayments or premium contributions.

Employers can consider which strategies can have a tangible impact on their healthcare spend, specifically concerning GLP-1 medications. Pursuing the right initiatives can have a sizeable impact on an organization’s bottom line and the financial health of
its employees.

Summary

The popularity of weight loss drugs has soared in the United States and is likely to be a key driver of rising health care costs in 2025. This trend has even made its way into the workplace as employees ask their employers to cover weight loss drugs. Given the priciness of GLP-1 drugs and their long-term commitment, employers may still be on the fence about whether they should cover the drugs despite demand. Staying up to date on developing market trends in this fast-moving space can help employers stay educated and inform their decisions.