{"id":5015,"date":"2025-09-17T06:48:23","date_gmt":"2025-09-17T11:48:23","guid":{"rendered":"https:\/\/westplexnews.com\/index.php\/2025\/09\/17\/missouri-workers-can-bet-on-paying-more-for-health-insurance-next-year-2\/"},"modified":"2025-09-17T06:48:23","modified_gmt":"2025-09-17T11:48:23","slug":"missouri-workers-can-bet-on-paying-more-for-health-insurance-next-year-2","status":"publish","type":"post","link":"https:\/\/westplexnews.com\/index.php\/2025\/09\/17\/missouri-workers-can-bet-on-paying-more-for-health-insurance-next-year-2\/","title":{"rendered":"Missouri workers can bet on paying more for health insurance next year"},"content":{"rendered":"

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Tania Hewett-Mader, who owns Alma Mader Brewing on Southwest Boulevard with her husband, is familiar with the stress of rising health insurance premiums many businesses are facing (Suzanne King\/The Beacon).<\/p>\n

Tania Hewett-Mader, who owns Alma Mader Brewing with her husband, believes providing health benefits to her employees is the right thing to do.<\/p>\n

\u201cThat\u2019s part of our values \u2014 taking good care of our people,\u201d she said. \u201cNot only for their sake, but to be competitive in the market.\u201d<\/p>\n

But two years ago, after the company had offered traditional insurance coverage for a couple of years, premiums were going to become unaffordable. The Kansas City small business, which only has five employees \u2014 including Hewett-Mader and her husband \u2014 had to find a different option.<\/p>\n

\u201cWe had to make a decision at that point,\u201d Hewett-Mader said.<\/p>\n

It\u2019s a familiar story for business owners. Large and small businesses alike have been scrambling to absorb rising insurance costs for years, and the 2026 increases are promising to be even worse.<\/p>\n

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Missouri proposed rate filings for 2026<\/h3>\n<\/div>\n

Rates proposed for the state\u2019s small-group market in the single risk pool<\/p>\n

\n\n\n\n\n\n\n\n\n
Insurance plan<\/strong><\/td>\nAverage % change<\/strong><\/td>\nMaximum % change<\/strong><\/td>\nMinimum % change<\/strong><\/td>\n<\/tr>\n
Blue Cross and Blue Shield of Kansas City<\/td>\n19.12%<\/td>\n22.17%<\/td>\n13.95%<\/td>\n<\/tr>\n
Anthem Blue Cross and Blue Shield<\/td>\n9.81%<\/td>\n11.28%<\/td>\n8.47%<\/td>\n<\/tr>\n
Medica<\/td>\nn\/a<\/td>\nn\/a<\/td>\nn\/a<\/td>\n<\/tr>\n
Allstate Benefits<\/td>\n11.48%<\/td>\n14.95%<\/td>\n5.31%<\/td>\n<\/tr>\n
United Healthcare<\/td>\n12.86%<\/td>\n18.59%<\/td>\n6.36%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/figure>\n

Source: Missouri Department of Insurance<\/em><\/p>\n<\/div>\n<\/div>\n

According to Mercer, the global consulting firm, benefit costs per employee for large firms are expected to increase<\/a> an average 6.5% in 2026, the largest jump in 15 years. And that\u2019s only if businesses take \u201ccost-reduction measures.\u201d If they don\u2019t, Mercer said, plan costs would go up almost 9% on average.<\/p>\n

For small groups \u2014 businesses with fewer than 50 employees \u2014 the increases could be far steeper.<\/p>\n

Blue Cross and Blue Shield of Kansas City has requested<\/a> an average increase next year of 19% for its small-group plans that are regulated by the state of Missouri. Other insurers in the state\u2019s small-group market have requested rate increases of 10% to 13%.<\/p>\n

Rick Welsch, an insurance broker in Fairway, said he has already broken the news to clients that rates will be going up \u201cdramatically.\u201d And other insurance brokers in the area said they\u2019re seeing a similar trend.<\/p>\n

\u201cI was a little blown away,\u201d Welsch said.<\/p>\n

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Business owners \u2018hope it\u2019s not awful\u2019<\/h4>\n

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Now business owners may be left deciding how to absorb significant cost increases.<\/p>\n

For Alma Mader Brewing<\/a>, the answer to continuing health benefits was to switch from a traditional insurance plan to a self-funded plan. That means the business pays into a pool of money that covers claims.<\/p>\n

The change came with more paperwork and bigger copays for employees. The business also takes on more risk. If claims are higher one year, premiums will increase the next to compensate, which makes Hewett-Mader nervous.<\/p>\n

She found out that next year the business will see a 13% jump because claims this year ran higher. But even that rate is doable, unlike the traditional coverage, so employees will keep their health insurance.<\/p>\n

\u201c\u2018It would be really hard to offer it and take it away,\u201d she said.<\/p>\n

Karen Crnkovich, owner of DMC Service Inc.<\/a>, a commercial heating and cooling company in Olathe, said she spends hours every year trying to find a plan her company can afford that still provides good coverage for the 23 employees who are insured.<\/p>\n

\u201cWe hold our breath and cross our fingers and hope it\u2019s not awful,\u201d she said.<\/p>\n

Last year she saved $20,000 by moving to an individual coverage health reimbursement arrangement, known as an ICHRA plan. That gave employees a tax-free allowance to buy an individual plan on the Affordable Care Act marketplace. But the model proved to be \u201ctoo burdensome.\u201d That and expected increases<\/a> in the cost of marketplace plans next year made Crnkovich rethink that switch. She\u2019s moving back to a self-funded plan.<\/p>\n

\u201cEvery year we\u2019ve got to look at it,\u201d she said.<\/p>\n

Employers face a lot of pressure trying to maintain benefits when costs continue to rise, business owners said.<\/p>\n

\u201cIt\u2019s kind of like, \u2018How can you provide all the benefits and still be above water?\u2019\u201d said Ariel Johnston, who owns The Tasty Balance<\/a>, a dietitian practice with offices in Prairie Village and St. Louis.<\/p>\n

Johnston said the rates for her nine-person company will stay flat next year, but many employers won\u2019t be so lucky.<\/p>\n

Businesses confronting surging premiums may look for cost-saving options like adopting a self-funded model, like Alma Mader did. They may offer plans with narrower networks of doctors and hospitals in an effort to steer people to less-expensive providers, or force employees to pay more for going to a doctor not on a plan\u2019s preferred list. Employers might also choose plans that limit what drugs are covered.<\/p>\n

In addition, there is growing recognition that health plans that emphasize preventive care and behavioral health care will pay off in a healthier workforce and, eventually, lower premium costs. Johnston said many people don\u2019t realize that dietitian services, like the ones her business offers, are fully covered by most insurance plans.<\/p>\n

But to cover bigger premiums next year, many employers will also likely ask employees to pay more for their insurance.<\/p>\n

Almost 60% of large employers Mercer surveyed<\/a> said they would make cost-cutting changes, which generally means choosing plans with higher deductibles and bigger copays next year, adding to employees\u2019 out-of-pocket costs.<\/p>\n

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Who will pay?<\/h4>\n

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KFF research found<\/a> that nearly half of adults are already struggling to afford health care, more than one in three report skipping or postponing care and almost one in four said they have medical or dental bills that are past due that they can\u2019t pay.<\/p>\n

One in five people surveyed by KFF said they are paying off debt to a provider, 17% owe a bank or collection agency, 17% have put medical bills on a credit card and 10% said they owe family members.<\/p>\n

Additional health insurance increases would compound the problem, consumer advocates said, and add strain when people are already dealing with increased prices for other basic needs.<\/p>\n

\u201cWe see rising utility rates and rent going up and now health care,\u201d said Mary Shannon of the Consumers Council of Missouri<\/a>. \u201cIt reflects a broader trend of consumer costs increasing.\u201d<\/p>\n

Frank Lenk, an economist with the Mid-America Regional Council<\/a>, said that there will be economic consequences of rising medical costs. When people have to spend more on health care, already a sizable chunk of most household budgets, they\u2019ll have less money to spend on other things, like local stores and restaurants.<\/p>\n

\u201cIt will be happening when belts already seem to be tightening and the economy seems to be slowing down,\u201d Lenk said.<\/p>\n

The changes could also have longer-term consequences, he said. When people have to pay more for the doctor or to fill a prescription, they may be less likely to seek care, which could lead to a less healthy workforce.<\/p>\n

\u201cBusinesses may save money on the one hand,\u201d Lenk said, \u201cbut they may see loss of productivity on the other. It comes down to \u2014 there\u2019s no free lunch.\u201d<\/p>\n

Employer-sponsored health insurance is the primary source of health coverage in this country.<\/p>\n

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According to the U.S. Census Bureau, 92% of people had health insurance for at least part of the year during 2024. Employment-based insurance covered 53.8% of that population<\/a>, down from almost 67%<\/a> in 1998. Medicare covered 19.1%, Medicaid covered 17.6%, and 10.7% of people were covered by plans they purchased directly, including through the Affordable Care Act marketplace.<\/p>\n

Insurance premiums on employer plans have been trending up for years. The national average annual premium per employee enrolled in an employer-based plan was $5,963 in 2015, and jumped<\/a> to $8.486 in 2024. In the same period Missouri\u2019s average rates went from $5,726 to $8,552, and Kansas\u2019 went from $5,558 to $7,874.<\/p>\n

During that time, employers picked up between 75% and 79% of that premium cost. But employee costs still increased, both because the overall premium went up and because out-of-pocket costs climbed.<\/p>\n

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Why is insurance going up?<\/h4>\n

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Insurance companies give many reasons for increasing premiums. But the two main factors are the price of health care is going up and more people are using their health benefits, which means insurance companies have to pay more.<\/p>\n

Medical costs are set to grow 8.5% in 2026, according to a study<\/a> by the consulting firm PwC, also known as PricewaterhouseCoopers. That\u2019s the same rate as the last two years, but substantially greater than 2022 when the growth rate was 5.5%.<\/p>\n

That slower growth reflected lower medical use during the pandemic, which is also one of the factors driving increased costs now, analysts said.<\/p>\n

During the COVID pandemic, people put off doctor visits and routine care. That meant fewer claims being sent to insurance companies. It also caused a backlog of medical visits and procedures and led to growth in serious conditions that are more expensive to treat.<\/p>\n

More expensive drugs are also adding to insurers\u2019 costs. PwC said drug spending grew by $50 billion to $487 billion in 2024. GLP-1s, drugs that regulate blood sugar and help people lose weight, were a significant driver of the increase, leading some insurance companies to look at reining in who can get coverage for the drugs and for what conditions.<\/p>\n

Insurers are also having to pay hospitals and doctors more, another reason for increased premiums. Analysts said several factors have caused that:<\/p>\n