The State of Open Enrollment 2026

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With healthcare costs projected to rise 8–10% in 2026 and more than a third of employees struggling to understand their open enrollment communications, the gap between benefits strategy and employee experience has never been more costly. This piece breaks down four pressure points shaping this year's enrollment — communicating cost changes clearly, supporting better decision-making, reaching every employee, and treating enrollment as a launchpad rather than a finish line — along with practical steps employers can take before the window closes.

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Four pressure points shaping this year's enrollment, and what leading employers are doing differently

Open enrollment asks employers to balance cost, coverage, and employee needs. Healthcare costs are climbing, pharmacy is consuming a larger share of spend, and employees are being asked to make increasingly consequential benefits decisions, often without fully understanding the strategy their employer spent months building. All of these factors make the balancing act harder than it has been in more than a decade.

If employees don’t fully understand their benefits, enrollment can quietly go sideways. Changes designed to manage cost can create new problems if employees don't understand what changed, why it changed, or what they should do differently.

The planning is done. Now it comes down to execution. Here are four pressure points worth watching as enrollment gets underway, and the questions worth asking while there's still time to act.

01 | Make the Cost Story Make Sense

Employees feel rising healthcare costs in their paychecks, deductibles, prescription costs and the choices available to them. And this year, there is more to explain.

Healthcare cost trend is projected to increase 8-10% for 2026, a continuation of some of the highest cost growth employers have faced in more than a decade. This reflects total plan cost trend, not just premium changes, and the gap between what employers absorb and what employees pay is narrowing at many organizations. (Mercer National Survey of Employer-Sponsored Health Plans, 2025; PwC Health Research Institute, 2026; Business Group on Health, 2025)

Pharmacy costs continue to accelerate and now represent more than 20% of total plan spend at many large employers, with annual pharmacy trend outpacing medical trend for the third consecutive year. GLP-1 medications are among the primary drivers of that growth, alongside specialty drugs and expanding treatment indications. (Business Group on Health, 2025; Benefitfocus, 2025)

Employers are responding with changes to plan design, cost sharing, networks, pharmacy strategies, and other levers intended to manage spend.

The question to ask now:

Can your employees explain what changed and why?

Employers have spent much of the year making difficult decisions about how to absorb, manage, or share rising costs. How those decisions are communicated matters.

When employees see a higher contribution, different deductible, or change in coverage without understanding the reason behind it, the benefits strategy can quickly become an employee experience problem.

Employees should understand what changed, what it means for them and what they can do about it. That might include how to compare total plan costs, where to access lower-cost care, how pharmacy coverage works, or why certain plan decisions were made.

The better employees understand the strategy, the better equipped they are to make decisions within it.

02 | Help Employees Make Better Decisions

Employees are being asked to make increasingly complex financial and healthcare decisions during a relatively short enrollment window. OneDigital's own , which has surveyed more than 4,000 U.S. employees, finds that more than half have concerns their medical plan isn't competitive—a signal that the gap between what employers invest and what employees perceive is wider than most realize. Additionally:

Only 57% of employees fully understand what their benefits cover, and 72% want their employer to provide benefits communications tailored to their individual needs. (MetLife 23rd Annual U.S. Employee Benefit Trends Study, September 2025)
38% say they struggle to understand their employer's open enrollment communications, up 6 percentage points from the prior year. (MetLife 23rd Annual U.S. Employee Benefit Trends Study, September 2025)
Employees who understand their benefits are nearly twice as likely to trust their employer's leadership compared to workers who don't. (MetLife 23rd Annual U.S. Employee Benefit Trends Study, September 2025)

That creates a costly disconnect. Employers can spend months designing a benefits strategy, only to have employees make their selections based on last year's choice, the lowest premium or what a coworker recommended.

The question to ask now:

Are your employees making informed choices or just defaulting to last year’s plan?

Employees need help translating plan features into a decision that makes sense for their health needs, financial situation and family. That becomes even more important when plan designs have changed.

Make it easy for employees to answer three questions:

What changed?
What does it mean for me?
What should I do next?

A single, easy-to-access hub for plain-language communications, plan comparison tools, cost estimators, decision support, and human guidance gives employees one source of truth and the confidence to make more informed choices.

At OneDigital, our Engagement & Education team builds engaging, jargon-free benefits education materials with engagement analytics and insights so employers can track what employees are engaging with and where understanding breaks down. We also partner with decision-support tools that guide employees through their options based on their individual health and financial profile, not just the plan with the lowest premium.

Give employees a clear place to ask questions, too. Silence doesn't always mean understanding.

03 | Reach the People You're Missing

An enrollment communication strategy is only effective if employees actually see and understand it.

“It takes a shift in perspective, one that encourages employers to see their people as individuals, rather than a collective group of employees.

— Courtney Perez, VP of Education and Engagement, OneDigital

Employees work in different places, consume information differently, and have different levels of familiarity with their benefits. A communication strategy that works for a corporate employee sitting at a laptop may completely miss a frontline employee, remote worker or spouse involved in the benefits decision.

Strong enrollment strategies use a mix of digital and human communication based on the needs of the workforce. Research from MetLife shows that webinars and benefits fairs correlate to the highest rates of benefits satisfaction among employees, but channel preferences shift significantly by generation. Gen Z responds to short video and social formats. Gen X responds to email. Boomers respond to in-person conversation and online portals. A single-channel strategy leaves a meaningful portion of your workforce behind.

Mobile-friendly content, video, text, email, digital platforms, webinars, and one-on-one support can all play a role.

The question to ask now:

Who isn't your OE strategy reaching?

Are you relying too heavily on email?
Can employees easily access enrollment information from a phone?
Are you reaching spouses and family members who may influence the decision?
Do employees who need more help have access to it?
Are you repeating the most important messages enough for them to actually land?
Are you providing more than one language option?
Are you offering non-digital enrollment paths for employees with limited tech access?
Have you considered employees with low health literacy? Is the content truly easy to understand, not just translated?

OneDigital consultants use population health analytics and Impact Studio benchmarking to identify where communication gaps are most likely to exist based on workforce demographics and utilization patterns. That data shapes not just what we communicate, but how and to whom.

Effective communication reaches employees where they are and gives them information they can understand and act on.

04 | Treat Enrollment as the Beginning, Not the Finish Line

The decisions employees make during open enrollment will influence utilization, engagement, employee experience and plan performance throughout the year. Enrollment is where the strategy employers helped design finally meets the people it was built for.

Once enrollment closes, employers have an opportunity to reinforce those decisions and learn from them.

When benefits communication goes quiet after OE, employees may be left with benefits they selected but don't fully understand how to use. Employers can also miss valuable signals about whether their strategy is producing the behaviors and outcomes they intended.

The question to ask now:

What will you know in January that you don't know today?

Decide before OE closes what happens next.
Make sure employees know when coverage begins, when to expect ID cards, where to get help and how to access the programs they selected.

Then look at what enrollment tells you.

Where did employees migrate? Which plans or programs were misunderstood? What questions kept coming up? Where did employees disengage? What surprised you?
Those insights can inform what you communicate in January, where you focus throughout the year and what you begin thinking about for your next renewal.

One Issue to Watch: Pharmacy Is Becoming a Workforce Conversation

Few issues show the connection between cost strategy and employee expectations as clearly as GLP-1 medications.

GLP-1s have nearly doubled their share of total pharmacy spend in two years, jumping from 9% of total pharmacy spend in 2022 to 17% in 2024, and that trajectory is continuing into 2026. Employers are weighing cost, access, eligibility, clinical management, and long-term plan sustainability. At companies with 5,000 or more workers, 59% of those covering GLP-1s for weight loss say utilization exceeded their expectations. (International Foundation of Employee Benefit Plans, 2026; Benefitfocus, 2025; KFF Employer Health Benefits Survey, 2025)

Employees have a much more immediate question: Is this covered for me?

How an organization approaches GLP-1 coverage has implications beyond pharmacy spend. Employees need to understand what is covered, who is eligible, what requirements apply, and where they can go with questions.

The same principle applies to other significant benefits decisions. When coverage changes affect employees directly, how those decisions are communicated can shape how they are received and used.

OneDigital's pharmacy consulting practice, through our RxConnection solution, works with employers on exactly these questions - building GLP-1 strategies that balance clinical access, cost management and long-term plan sustainability, and translating those decisions into employee-facing communication that reduces confusion and supports appropriate utilization.

“Having an experienced partner and fierce advocate to optimize spend for every healthcare dollar will be the go-to prescription for navigating the next era of pharmacy benefits.

— Jeff Post, Principal, OneDigital Pharmacy Consulting

For a deeper look at the coverage decision, see our whitepaper: GLP-1 Class Drugs: To Cover or Not?

Open enrollment lasts weeks, yet the decisions last all year.

The choices employees make during open enrollment carry into the year ahead.

A strong enrollment experience helps employees understand what they have, choose what works for them and know how to use their benefits once January arrives. It also gives employers a valuable look at whether benefits strategy, employee experience and cost strategy are working together as intended.

At OneDigital, our consultants combine benefits strategy, pharmacy analytics and employee engagement expertise to help employers connect the decisions made during planning season to the experience employees actually have on January 1. Open enrollment is where strategy becomes reality - and we help make sure it lands.

Whether you're pressure-testing this year's enrollment strategy or already thinking about what needs to change for 2027, we can help you see what's working, where the gaps are and where to focus next.