National Survey of Employer-Sponsored Health Plans

^{*Projected.
2021 cost trend was disrupted by pandemic-related fluctuations in utilization.
Source: Mercer’s National Survey of Employer-Sponsored Health Plans (beginning in 2020 results are based on employers with 50 or more employees); Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April) 1993-2024.}

The survey found that the average per-employee cost of employer-sponsored health insurance reached $16,501 in 2024, an increase of about 5% over 2023. Employers expect cost to rise about 6% in 2025 after making planned changes – they reported cost would rise by nearly 8% if they made no changes.  

While nearly all health plans cover GLP-1 drugs for diabetes, that is not the case for obesity treatment. However, despite some headlines about some organizations dropping coverage for these obesity medications due to the cost, the prevalence of coverage rose overall in 2024.  Of all large employers (those with 500 or more employees), 44% offer coverage, up from 41% last year. Of those with 20,000 or more employees, nearly two-thirds now offer coverage, up sharply from 56% in 2023.

This trend may reflect the hope that GLP-1 medications will turn the tide on the obesity epidemic and positively impact downstream medical costs.  Cost is clearly a concern, and nearly all employers that cover obesity medications now have authorization requirements in place to ensure they are used by members who will benefit the most. 

Coverage for fertility treatment is becoming increasingly common, with in vitro fertilization (IVF) now covered by 47% of all large employers, up from 45% last year. Of the largest employers, 70% cover IVF, up from 62%. Elective egg freezing and elective sperm freezing are covered by 21% and 20% of all large employers, respectively.  Most large employers offering fertility benefits (64%) say that they are intended to be inclusive, meaning eligibility is not limited to those meeting the clinical definition of infertile. Fertility benefits have become table stakes for employers wanting to offer comprehensive, inclusive benefits. 

As health benefit cost growth began trending higher in 2023, cost management moved to the top of employers’ list of priorities, with a focus on managing high-cost claimants and the cost of specialty drugs. But they are also prioritizing benefit enhancements, which they see as necessary to attract and retain employees in a competitive labor market. While they need to manage the overall cost of healthcare coverage to achieve a sustainable level of spending for the organization, they remain concerned about healthcare affordability and ensuring that employees can afford the out-of-pocket costs when they seek care.  Balancing these priorities will be a central challenge for employers over the next few years.

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