For the 2026 health insurance plan year, a recent survey of health plan actuaries projected that the medical cost growth trend will remain at 8.5% for the group plan market and at 7.5% for the individual plan market. These are the same as 2025, the report stated. Medical cost trend was defined by the report as the projected percentage increase in the cost to treat plan members from one year to the next, assuming benefits remain the same. Insurance carriers utilize cost growth predictions to establish health plan pricing.
One out of three health plan actuaries who participated in the survey named behavioral health services as a top three inflator, and said they expect a 10% to 20% trend for behavioral health next year. Between January 2023 and December 2024, claims for inpatient behavioral health services increased by nearly 80%, and claims for outpatient behavioral health services increased by nearly 40%, the report stated.
The report attributed the predicted cost growth trend for 2026 to higher operating costs for medical facilities, higher utilization of inpatient and outpatient behavioral health services, and higher drug spending, influenced in part by the widespread adoption of GLP-1 medications and newly launched pharmaceutical products.
The report’s recommendations for managing costs include:
- Health plans could address immediate cost trend challenges by focusing more heavily on care cost management programs focused on establishing sustainable spending levels.
- To address cost growth due to behavioral health utilization, the report recommended that payers collaborate with provider organizations to develop strategies such as condition-based alternative payment models, which could include capitation models.
- Health plans and payers could partner with employee assistance programs and other third parties to offer customers comprehensive coverage while limiting the health plan’s share of the cost, the report suggested.
From 2007 through 2024, medical cost trends have fluctuated between the low of 5.5% (in both 2017 and 2022) to the high of 11.9% in 2007, according to the report. Since the 2024 plan year, the medical cost trend has remained at 8.5%, the report stated.
The survey was conducted by PwC with 24 health plan actuaries covering 125 million group plan members and 12 million individual plan members. These actuaries were asked to share medical cost trend projections, their top inflators and deflators, trends they are watching, and other potential future changes.
These findings were presented in Behind the Numbers 2026, by PwC. The report forecasts expected increases in per-member health care service and prescription drug costs that impact insurers’ workplace and individual coverage segments.
The full text of Behind the Numbers 2026 was published on July 16, 2025, by PwC. A free copy is available (accessed August 21, 2025).
For more information, contact: Kristin McHugh, Chief Marketing and Communications Officer, PricewaterhouseCoopers LLP, One North Wacker Drive, Chicago, Illinois 60606; 609-903-4394; Email: kristin.mchugh@pwc.com; Website: https://www.pwc.com/
October 2025 00US25EUA0040