TL;DR

  • Average family coverage premiums hit $26,993 in 2025, up 6 percent in one year and up 26 percent since 2020.
  • The share of small firms still offering health insurance keeps sliding, which removes the last cost-control lever most small employers thought they had.
  • Employer-market members face rising deductibles and shrinking plan choice, yet no quality rating system steers them the way CMS Star Ratings steers Medicare Advantage members.
  • Quality teams cannot afford to treat employer-market members as a different data problem; they need the same live chart review pipeline that quality measurement now demands everywhere else.

The market that pays

The strongest case against the employer insurance market right now comes from looking at the actual premiums. KFF’s 2025 Employer Health Benefits Survey, its 27th annual edition, puts average annual employer-sponsored premiums at $9,325 for single coverage and $26,993 for family coverage, with single premiums up 5 percent and family premiums up 6 percent over the previous year (KFF, 2025). That family number has grown 26 percent since 2020 and 53 percent since 2015 (KFF, 2025). Employees pay a meaningful slice of it, but the rest comes off employer balance sheets, and for small firms the whole equation now tips into the negative column. The same cost trend is compressing carrier margins across every line of business (see our Rising MLRs analysis).

On the other end of the same report sits the offer-rate story. Where the premium crosses roughly $27,000 in family coverage, the smallest employers have begun simply not to offer, which is what the survey’s offer-rate section has for several years quietly documented and which Bob Herman’s STAT series “Out of Pocket, Out of Reach” turns into the central crisis of American small business (STAT, 2026). A small business that does not offer coverage hands the employee an individual Marketplace plan, if one is available and affordable where they live.

The quality measurement does not reach the buyer

Here is the part that turns this from a cost story into a quality-measurement story. In Medicare Advantage, a member can compare plans by Star Rating, which means payers have a market-facing incentive to invest in quality measurement. In the employer market, no comparable rating system reaches the employee who is being asked to pay more of their paycheck each year. ICHRAs made this gap worse, not better, by handing employees a stipend and pointing them at individual plans whose quality signals are even thinner than employer-sponsored ones (see our ICHRA in 2026 analysis).

The plans that win those discretionary dollars are not rewarded by the market for clinical quality. They are rewarded for network breadth, deductible structure, and brand familiarity. A quality program inside one of those plans is not producing a rating anyone in the buying chain sees; it is producing internal QI work, which means the leadership team deciding each budget cycle has fewer external reasons to keep the quality infrastructure funded. Even the CMS Quality Rating System stops short of the plans ICHRA employees are steered toward, as our ICHRA’s Missing Piece post shows.

That is a real strategic problem, and it is one the employer market cannot solve with cost-sharing tweaks. The structure of the market has to change before quality becomes legible to the buyers, which is a multi-year regulatory project rather than a single rule comment. In the meantime, the quality teams inside employer-market plans are doing the same measurement work with a weaker external justification.

The workaround is more quality infrastructure, not less

The paradox worth holding onto is that the right response to a weaker justification is not less measurement. It is measurement that pays for itself a different way. A plan that can close care gaps for its commercial population is not just producing HEDIS rates for an internal dashboard; it is holding down the emergency costs that drive the premium trend, and it is preserving the option to compete on quality the moment the buying chain starts to value it. NCQA’s move toward digital quality measures, covered in our dQM roadmap post, applies to commercial and Medicaid product lines with the same force it applies to Medicare Advantage, because the digital specification work is the same specification work.

That is the argument for building the chart-review pipeline now, while the employer market’s pressure is highest. The data a plan needs for commercial quality measures today, a live bi-directional feed of the clinical record, is the same data MA Star Ratings requires, the same data risk adjustment requires, and the same data that will underwrite whatever rating system eventually reaches the employer market. A plan that builds it once can afford to wait for the market to catch up with the rest.

Quality measurement has to reach the buyer to change behavior, and in the employer market it does not yet. Quality Health’s chart review gives quality teams the live measure-level visibility they need, in any market, Star Ratings or not.

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Sources

  • KFF, “2025 Employer Health Benefits Survey” (October 2025): $9,325 single and $26,993 family average premiums, 5 percent and 6 percent annual increases, 26 percent growth since 2020 and 53 percent since 2015, and the small-firm offer-rate context. www.kff.org
  • STAT News, “Why health insurance costs so much: ‘Out of Pocket, Out of Reach’” (July 7, 2026): the framing of employer-based coverage strain and the small-business retreat from offering coverage (Bob Herman, 2026). www.statnews.com