How Agents Can Show Up for Clients as the Healthcare Market Evolves

• By: oliviaoverman
• June 22, 2026

The U.S. health and medical insurance market is valued at $1.6 trillion in 2026. It is projected to reach $2.1 trillion by 2031, reflecting a 5.37% compound annual growth rate (CAGR) and a steady expansion in the overall market size, according to Mordor Intelligence, a global market research firm.

Yet, as it grows, the healthcare market faces significant changes and challenges due to cost pressures, policy changes and regulatory scrutiny.

“The biggest disruptions in the past year have come from policy and the regulatory environment, specifically relating to the Affordable Care Act (ACA) cuts, Medicare plans changing and the forecast cuts to Medicaid,” says Clay Dean, CEO of First Mid Insurance Group. “The latter has particularly alarmed providers, half of whom in the U.S. are not profitably operated.”

“The result will be higher costs passed along to healthcare consumers,” he says.

Nevertheless, total health insurance enrollment continues to rise, growing by 31 million people from 269 million at midyear 2024 to 300 million at midyear 2025, according to the “U.S. Health Insurance Industry Analysis Report” by the National Association of Insurance Commissioners (NAIC).

Additionally, enrollment trends by category over the past 10 years indicate a 10 million increase in Medicaid enrollment, as well as a strong year-over-year growth in group comprehensive and the doubling of individual comprehensive and Medicare enrollees, according to the NAIC report.

While enrollment is expanding across coverage types, rising inflation and premium increases continue to strain the market. Costs are climbing across employer-sponsored, individual and ACA plans, making healthcare a top concern for many households and pushing consumers to consider alternative coverage options.

Between 2022 and 2025, average premiums for private health insurance plans—including those purchased through the ACA Marketplace and directly from insurers—increased by 15%, reaching an average annual cost of $7,452 this year, according to a report by insurance research site ValuePenguin.

As a result, insureds “are contemplating unsavory options due to unaffordable premiums,” says Ron E. Peck, chief legal officer, The Phia Group. “These include switching to more restrictive coverage plans with higher deductibles to manage premium costs.”

“The issue is that shifting cost onto the insured patients hasn’t had the impact on overall healthcare spending that insurance carriers had hoped,” Peck explains. “We know that higher co-pays and deductibles instead led to people avoiding care, which in turn resulted in untreated conditions worsening and eventually evolving into more costly situations, or alternatively, patients do not care about the cost of care they receive because they see their deductible as an amount to reach as quickly as possible.”

As the market evolves, agents play an essential role in helping clients navigate the increasingly complex healthcare market. “Agents can ensure clients are funding their coverage in the most effective way possible,” Peck says. “Self-funding versus traditional, fully insured models—both should be considered.”

From there, agents can help clients identify unnecessary costs. That includes “ensuring that clients aren’t paying for something they don’t need, such as the optional benefits included in the coverage that no one in their particular population will need, to ensuring that they aren’t paying a network to include a provider within that network that no plan member will ever visit, Peck says.”

Additionally, agents can ensure they are “educating plan members about how healthcare and health benefits work and arming them with data about both the price and the quality that is applicable to providers in their area,” Peck explains.

Meanwhile, as employer-sponsored insurance remains dominant for healthcare, agents can ensure “there are opportunities to negotiate better terms for groups who are self-insured, seeking improvement in case management and contractual terms between payers and providers,” Dean says. “Agents and brokers can help by understanding the payer-provider dynamics and trends.”

“Groups in particular have continued to see more cost-shifting acceleration, especially related to drugs, such as GLP-1s, which are both wildly expensive, as well as frequently prescribed for things such as weight loss, which may not be covered under many plans,” Dean explains.

Olivia Overman is IA content editor.