It’s time to review your benefits strategy – Learn about the current US healthcare cost trends and the factors influencing your benefits renewal.

Understanding Trends

Trend is a forecast of per capita claim cost increases that take into account various factors, including price inflation, utilization, government-mandated benefits, and new treatments, therapies and technology. Trend is the estimated increase in future healthcare costs.

Although there may be a high correlation between a trend and the actual cost increase assessed at renewal, trend and the net annual change in plan costs are not necessarily the same.

• Renewals close the gap between health care fees and actual plan costs
• A client can experience a 5% trend and could receive a 10% renewal because health care fees may account for prospective costs that will be incurred in the future (small group claim experience is not credible and has a higher degree of volatility)
• Renewals will vary nationally based on regional pricing variations, state required plan design changes and changes in provider rates

Other factors that impact renewals include, but are not limited to:

• High-cost claims
• High ER usage over other more cost-efficient care when applicable
• Rx specialty drug utilization
• Obtaining services in-network vs. out-of-network

2026 General Health Care Trend Inflators*

Inflator: Artificial Intelligence (AI)

Artificial Intelligence (AI) is driving short-term cost increases to detect disease earlier leading to more frequent testing, follow-up, and specialists visits. Some newly identified abnormalities may not require intervention, contributing to potential overdiagnoses and unnecessary procedures. 

Inflator: Changing Drug Mix

Changing drug mix is impacting pharmacy trend as lower cost drugs are being replaced with newer, more expensive drugs that have multiple indications, being used for a variety of purposes (ie. GLP-1s) and is driving higher utilization.

Inflator: Hospitals

Hospitals, like many sectors, are continuing to experience inflation due to increases in the cost of goods, services and labor.

Inflator: Specialty Drugs

Specialty drugs have increased in usage and continue to be the leading cost driver in pharmacy trends.

Inflator: Telehealth and Mental Health Services

According to SHAPE data, mental health costs are rising more rapidly than overall medical expenses each year. This growth is fueled by increased treatment utilization, driven by reduced stigma, expanded behavioral health networks and improved treatment infrastructure. Furthermore, when mental health conditions coincide with other medical issues, costs can rise even further, especially for high-cost claimants.

TriNet Resources:

• Telemedicine options for mental and behavioral health are available within most of the TriNet-sponsored medical plans. Telemedicine for mental health can provide access to mental health services and professionals without traveling, waiting or compromising privacy. This may increase the likelihood of people getting the care they need, when they need it. The use of telemedicine may save money over the long term by potentially avoiding in-or-outpatient services.
• AllOne Health is a great resource to help support worksite employees on a wide range of issues including mental health, relationships, stress, finding support resources and more. There is no cost, no registration and it is completely confidential. All full and part-time worksite employees have access to the EAP.
• TriNet-sponsored medical carriers have a wide array of resources to support mental and behavioral health from specific programs to apps to talk therapy.

Inflator: Gene Therapies

Gene therapies that are emerging for specific conditions cost more, including Hemophilia, Sickle Cell and Retinal Dystrophy.

Inflator: Treatment of Chronic Conditions

The cost of managing chronic conditions such as cancer, heart disease, obesity and diabetes is increasing.

2026 General Health Care Trend Deflators*

Deflator: Biosimilars

Most specialty drugs are biologics derived from viruses or living organisms; biosimilars are "highly similar” to existing biologic medications (akin to generic versions of traditional non-specialty brand drugs) and represent potential savings over the unit cost for existing brand-name specialty Rx. The emergence of biosimilars as alternatives to costly specialty drugs is driving more competition within this category leading to cost reductions.

Deflator: Advancement in Pharmacotherapies 

Advancements in pharmacotherapies (the use of medicine) to treat, prevent and cure diseases/illness.

Deflator: Plan Design Incentives

Plan design incentives to shift to lower cost settings for treatment options.

Deflator: Precision Medicine

Precision medicine to improve outcomes through targeted treatments reducing costs of unnecessary treatments.

Deflator: Use Health Navigators or Health Advocate Services

Health navigators and health advocate services have exceeded the requirements of transparency regulations by assisting participants in maximizing their healthcare benefits. These patient advocacy services typically involve identifying high-quality providers, offering personalized health recommendations, guiding participants to preferred provider options and sometimes assisting with appointment scheduling.

TriNet Resources:

• Health Advocate is available to worksite employees enrolled in a TriNet-sponsored medical plan. The Health Advocate team of nurses and billings/claims specialists can help worksite employees get the answers they need from resolving claims and billing issues, understanding treatment options and more.
• Benefits Decision Support—Powered by Healthee, is an integrated application within the TriNet platform that helps eligible worksite employees better understand the value of their TriNet-sponsored medical, dental and vision benefit options (if applicable), so they can identify the plan(s) that best fit their needs and make informed benefit elections.

Deflator: Promote Use of Wellness Program

Wellness programs promote healthy behaviors among employees, such as regular exercise, healthy eating and preventive screenings. By detecting health issues early or preventing them altogether, people are less likely to require costly medical treatments.

TriNet Resources:

• Preventive care, such as cholesterol and cancer screenings, along with annual well visits are important for early disease detection and intervention. TriNet-sponsored medical plans cover preventive services at 100% in-network.
• Wellness support is available through the TriNet-sponsored medical plans at no additional cost to worksite employees. Access to gym membership discounts, nutrition guidance and many other valuable resources support overall well-being.

Insurance Company Trends

Another factor to consider when looking at the overall healthcare environment landscape is the insurance carriers. They set their own trends and rates, and look at several factors, including national healthcare trends, the geographic regions they serve, and state-mandates. For example, depending on the region, costs may vary greatly. Those costs, such as the costs of goods and services, can impact healthcare expenses. A benefit of working with TriNet is that we work closely with the insurance carriers to offer the best possible renewal to our clients as just a piece of our overall strategy.

We set our benefits renewal rates each year, by client, based on a combination of several factors, including insurance company trends, anticipated recurrence of high-cost claims, changes in risk profiles of a client, as well as utilization patterns. These utilization patterns include items such as screenings and well visits, settings of care, medication adherence, and chronic conditions.

How Your Worksite Employees Drive Cost

There are four main areas that impact cost:

Click on each area to view a short, animated video that explains the importance of managing each cost driver.

Pro Tip: Share these videos with your worksite employees! 

• Care Setting: Many people use the ER when they could choose a less expensive option such as in-network urgent care or telemedicine.

• Preventive Care: Preventive care may identify chronic diseases early, potentially making them less costly and easier to treat.

• Chronic Condition: As the leading driver of U.S. healthcare costs, poorly managed chronic conditions—such as not following treatment plans—can increase co-existing conditions and overall healthcare costs.

• Healthcare Illiteracy: Employees who don’t understand healthcare basics are less able to make smart benefit decisions, potentially leading to poor plan elections and utilization.

What Can You Do To Help Contain Cost

Proactive Benefits Education is key! When worksite employees understand their benefits and how their choices impact their health and future costs, they can make smarter healthcare decisions. TriNet is here to help. Explore the interactive resources below to empower worksite employees to choose and use their plans wisely.

• Benefits in a Box
• Benefits Basics Video Library
• Client Benefits Education Site

_{*2026 Segal Health Plan Trend Survey}