The findings come as healthcare affordability becomes a prominent issue ahead of the US midterm elections. With almost 157 million Americans below retirement age relying on employer-sponsored health insurance, rising premiums are affecting a substantial share of the workforce, while employers face difficult decisions about maintaining benefits.
Family Health Insurance Costs Rise Sharply for American Workers
According to the healthcare research organisation KFF, its 2026 Employer Health Benefits Survey found that workers now contribute an average of $7,471 annually towards premiums for employer-sponsored family health coverage.
That represents an increase of approximately 9%, or $621, compared with 2025. The survey, released on 22 October, gathered information from roughly 1,900 employers with at least 10 workers.
The financial burden is particularly pronounced among employees of smaller businesses. Workers at firms employing between 10 and 99 people contributed an average of $9,687 towards family coverage in 2026, compared with $6,840 at companies employing 200 or more people. In 2025, the corresponding figures were approximately $8,900 and $6,200 respectively.
The difference also extends to the proportion of premiums employees must cover. Workers at smaller firms contribute an average of 37% of family insurance premiums, compared with 25% at larger organisations.
Among employees receiving coverage through small businesses, 32% are enrolled in plans requiring them to pay more than half the family premium. At larger companies, that figure stands at just 6%. “Workers are paying a bigger chunk this year,” said Matthew Rae, associate director of KFF’s Program on the Health Care Marketplace, raising further questions about affordability. Rae also noted that smaller firms face higher deductibles than larger employers and greater volatility in the insurance market.
Small Businesses Struggle To Maintain Employee Health Benefits
Rising insurance costs are placing additional pressure on small businesses, which employ approximately 62.3 million Americans, representing 45.9% of private-sector workers, according to the Small Business Administration.
For some employers, maintaining health coverage has meant reducing expenditure elsewhere. Jenna Caligaris, who manages a contracting business employing roughly 25 people in upstate New York, described the difficulties of balancing insurance costs with the need to retain workers in a competitive labour market.
Her company pays 80% of health insurance coverage for non-union employees, leaving workers responsible for the remaining 20%. To preserve that arrangement, the business has extended the working life of vehicles and equipment, reduced year-end bonuses and cancelled its annual company picnic.
Despite switching insurance providers during the past three years to control expenditure, the company is facing a 25% increase in premiums this year. The findings also carry political significance. According to an October AP-NORC poll, approximately seven in ten registered voters consider healthcare one of the most important issues in the midterm elections.
President Donald Trump has promoted proposals to reduce prescription drug prices and promised rebates for some Americans. Meanwhile, other measures introduced by his administration have increased costs for certain groups. For workers and employers, the latest survey documents rising insurance contributions at a time when healthcare affordability remains a major concern for voters.
