Controlling Costs While Preserving Coverage to Employer-Sponsored Health Plans

• July 27, 2026

By Adam V. Russo

The expiration of the Affordable Care Act’s enhanced premium subsidies has affected healthcare affordability nationwide, leaving many enrollees facing higher out-of-pocket premiums for ACA Marketplace coverage.

According to data from the Centers for Medicare & Medicaid Services (CMS) released in late January, more than 1 million fewer people have signed up for ACA coverage compared to the same time last year.

The number of individuals dropping ACA coverage is expected to grow steadily in the months ahead, as a sizable share of ACA enrollees were automatically reenrolled in policies and may not realize how much their premiums will increase until they get their first bill.

Subsequently, employer-sponsored plans continue to experience an influx of new participants seeking care for themselves and their families. As a result, some employers may shift costs to current plan participants by raising premiums, copays, out-of-pocket maximums and deductibles to offset the costs. Smaller employers that compete with ACA markets for enrollees are particularly likely to do so.

As a result, many employees may delay care and fuel higher long-term expenses for the plan itself. Instead, smart cost-containment strategies, such as claim auditing, subrogation and innovative plan design, have never been more vital for employer-sponsored plans covering employee populations of all sizes.

This is where independent insurance agents and brokers come in. As industry stakeholders who help employers realize substantial healthcare cost savings, agents and brokers have a prime opportunity to rein in costs by spearheading strategic cost-management programs tailored to their clients’ specific workforce needs and business goals.

Additionally, it’s incumbent upon brokers to educate employers not only about the various cost-containment programs available to them, but also about how to maximize their benefits.

Employers need actionable insight into complex claims and dizzying vendor activity so they can genuinely comprehend what is happening. They need help recognizing patterns, outliers and out-of-network cost drivers to make strategic renewal decisions that align with their long-term interests. Overall, transparency ensures that employees understand not only what they’re paying for, but also why, as well as potential opportunities for improvement.

For many employers, the health insurance landscape—from the fulfillment of regulatory requirements to the multi-pronged claim review process—is already riddled with confusion. The fact that their enrolled population is now growing in leaps and bounds only makes it more daunting. With this ongoing trend, the guidance from brokers is truly indispensable.

With millions of Americans flocking to employer-sponsored plans, there has never been a greater need for brokers to get creative and find new and exciting ways to help plans keep costs in check while prioritizing accessibility to robust benefits and ensuring airtight regulatory compliance.

Adam V. Russo, Esq., is chief executive officer of The Phia Group.