Lockton's 2026 Benefits Survey: Everyone Is Feeling the Pressure - Few Are Making Big Moves…Yet

​Rising healthcare cost has officially taken over the conversation according to Lockton's 2026 US Benefits Survey

Cost pressure isn’t new. But the urgency behind finding solutions and not disrupting employees is causing some tension inside US companies.

This tension is stemming from groups that generally focus on different outcomes.

• HR is optimizing for: 
  • Talent attraction/retention 
  • Employee experience 
  • Compliance
• Finance is optimizing for: 
  • Cost predictability 
  • Margin protection 
  • Capital allocation discipline 

It’s important to remember that both are right. We’re just solving for different outcomes with the same dollars.

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Managing rising costs is the primary decision-making driver 
Employers have always cared about cost. But 2026 marks a clear shift in how much.

• 54% of employers now say reducing cost is the top factor in benefits decision-making - up sharply from 38% just one year ago
• Meanwhile, talent attraction and retention has dropped to 19% as the top priority in decision making - down from 30% in last year's survey.

The trend that started last year is now a reordering of priorities.
And here’s where it gets more interesting:

• 81% of employers still say employee impact is a primary consideration

And so we end up with a balancing act - cut costs and  don’t upset employees.
That’s a constraint to strategy and implementation. As such, employers are increasingly asking for more help from their brokers and consultants.

Everyone’s Looking for Answers
You might expect that kind of pressure to drive bold action.
It hasn’t…yet.
Instead, the survey shows a market that’s experimenting:

• Employers are testing different cost-saving strategies, leaving no stone unturned
• Progressive approaches to specialty drug and chronic condition management as well as captive stop-loss arrangements are under serious consideration.
• No single approach has emerged as the clear path forward 
• Companies are taking the time to learn more about disruptive strategies such as ICHRAs, RBP and spousal exclusions.

In other words, organizations know they need to do something—but they’re still trying to figure out what works without creating too much disruption.
Another example shows up in network strategy:

• 94% of employers still offer broad national networks
• When narrow/high-performing networks are used, they’re often offered as an option

Bottom Line: Employers want savings and are not yet ready to force change.

Incrementalism Prevails
When zooming out, a consistent theme emerges - most employers are choosing incremental and progressive changes over structural, disruptive ones. For example,
Eligibility & Plan Design

• 23% apply spousal surcharges (up from 20% in 2025)
• 13% exclude spouses with access to other coverage (up from 9% in 2025)
• Almost 3% exclude spouses entirely (up 300% from 2025)

Pharmacy Strategy

• 67% still bundle pharmacy with medical plans
• 26% carve out specialty drugs from PBM
• 3% are requiring specialty onsite cost of care management

Affordability Efforts

• 59% offer lower-cost plan option
• Only 10% use income-based contributions 

These are real actions. They’re measured, limit disruption, avoid big tradeoffs and they tend to produce measured, incremental results.

Targeted Investments Continue
Despite rising cost pressure, employers are still investing in their people. While reducing costs is the top priority for survey respondents, it is not the only consideration. Notably, 17% of plan sponsors rank improving quality of care as their top priority.
Selectively, where the data, utilization and benchmarking justify investment, it’s happening.

• 73% say employee wellbeing programs remain a priority
• 63% offer enhanced EAPs for behavioral health support
• 24% of employers covered GLP-1s for weight-loss and another 24% are actively considering it if eligibility is coupled with a lifestyle management program.
• Advocacy and navigation services continue to grow year over year 

This is a shift toward targeted investment—focusing on areas tied to high-cost claims or meaningful uplift to employee experience.
What This Really Means for Employers
The headline isn’t just that costs are rising. It’s that the current pace of change doesn’t match the current level of pressure. That combination naturally leads to slower, more cautious decisions. And the risk is incremental action in a non-incremental environment.
The 2026 Lockton Survey makes clear that maintaining the status quo is no longer sustainable and the questions heading into 2027 become:

• Which plans and strategies have strong utilization and are showing value?
• Where are you willing to accept disruption?
• Which tradeoffs are worth it? For instance, would you accept an incremental 3% cost increase for a 1% reduction in turnover?
• How long can incremental change keep up with accelerating costs?

These are not easy conversations but they’re the ones this data is pointing toward.
Final Thoughts
While the 2026 survey doesn’t point to a single winning strategy, it does show that the US benefits market is in transition caught between:

• Financial reality
• Employee expectations
• And organizational hesitation