The Real Cost of Rising Premiums—and Why PT Is Part of the Solution
Health insurance is getting more expensive—again. Large employers expect health costs to rise around 9% in 2026, the steepest jump in more than a decade. Driving factors include higher provider prices, labor shortages, and the growing use of high-cost drugs like GLP-1s. Employees will shoulder more of that burden through higher premiums and deductibles.
At the same time, individual consumers face uncertainty in the ACA marketplace. If the enhanced premium tax credits expire, net premium payments could more than double on average next year, according to KFF. Combined with proposed rate hikes from carriers, affordability is becoming a shared problem across both employer-sponsored and individual markets.
Employers Are Feeling the Pressure
The Business Group on Health’s 2026 Strategy Survey paints a clear picture: cost containment has overtaken access and quality as the top concern for large employers. Nearly all respondents cited healthcare affordability as a major pain point, with many exploring plan redesigns, virtual care models, and direct provider relationships to control spend. Pharmacy costs alone now consume nearly a quarter of employer healthcare budgets.
Musculoskeletal (MSK) conditions remain one of the largest and most addressable categories of spend—nearly double the next category, only trailing cancer in terms of driving costs. Employers know it. They see the volume of orthopedic surgeries, prescriptions, complex imaging, and lost workdays—and many are actively looking for new strategies. The difference now is urgency. With premiums climbing, benefit leaders no longer have the luxury of waiting for incremental savings. They need partners who can drive measurable results this year, not in five.
That’s where PT practices come in.
What We’re Hearing
Across recent conversations with benefit leaders, brokers, and PT owners, the themes are consistent. Employers are entering 2026 with heightened anxiety about medical inflation and renewals. Many are trimming underperforming programs or pausing vendor expansions altogether. They’re skeptical of high-cost “point solutions” that promise engagement but deliver limited utilization. Instead, they want local partnerships—providers they can meet with, measure, and trust.
On the other side, PT leaders are watching reimbursement stagnate and overhead climb. Many know that direct-to-employer (D2E) contracting could be the lifeline that aligns better pay with better outcomes, but they aren’t sure how to get started. The appetite is there on both sides; what’s missing is connection.
The Playbook for PTs and Employers
For employers, the play is straightforward but powerful: make physical therapy the front door for MSK care. Lower copays and streamline access. Replace reactive, episodic care with early, guided intervention. Direct contracts make that possible, allowing employers to bypass the inefficiencies of traditional networks and pay fairly for value delivered.
For PTs, the path starts with clarity and consistency. A strong front office, reliable scheduling, and outcome tracking are prerequisites for partnering with employers. Once those are in place, practices can position themselves as the local MSK solution—combining hands-on care with hybrid options that boost adherence and prove measurable ROI.
Direct contracting isn’t theory anymore. Roughly two-thirds of the U.S. workforce work for a self-funded employer, and as many as 75% of them are actively looking for aligned provider partners who can help them manage chronic, high-cost categories like MSK.
The Bottom Line
Premiums are rising fast, and affordability has become the defining challenge for both employers and employees. For PTs, this moment represents more than just an opportunity—it’s a responsibility. Local care has never mattered more, and employers are ready to listen.
Physical therapy can make healthcare more sustainable, one partnership at a time. The question isn’t whether employers need help controlling MSK costs—it’s who will step up to provide it.
👉 Let’s talk about how Second Door connects PT practices with employers ready to act.
