Several years ago, we wrote a piece on LinkedIn that the sky is not falling and that, in light of trend increases of what used to be 8% on health and 6% on dental, our small group book was only increasing by low single digits. Fast forward, the trend is now 10% and 8%, respectively, but we still hear the same cries. Employers see these numbers and also think about the warnings they heard about diabetes and weight loss drugs (GLP-1/2 and 3) and no doubt are frazzled. We only realized our renewals were bucking the trend because I was challenged to measure by my friend and colleague, Dave Patriarche. At the time, this spurred on a few other advisors within the industry association Dave founded (CGIB – for which I am a member) to also start tracking. So, here is the update from our block, three or so years later.
The question – what did our average SMB client actually pay? 2025 was a rough year; our renewals came in at a weighted average of 8.3%, and the typical client landed at 6.0%. With AI, we improved our game by assigning weightings based on the size of a plan, so that larger-than-average plans would not influence the average.
This isn’t a one-year fluke, and it isn’t an average hiding a lot of pain. In three of the last four years, i.e., 2023, 2025, and 2026 YTD — the median client renewal has been around 6% or lower. The exception was 2024, a peak-pressure year across the whole industry when post-pandemic catch-up and the first real GLP-1 surge pushed our block to roughly 12%. I suspect, right where the broader market sat, or perhaps worse. If I am mistaken, we need to own that one. What matters is the direction since 2025, in which it bent back down to 8.3%, and 2026 where it is currently tracking in the low single digits, per the table below:
The distribution is where it gets real for an employer trying to budget. Averages can paper over a few winners and a lot of losers. In 2025, one in five of our clients renewed with premiums flat or reduced (an actual decrease at renewal), and nearly two-thirds came in under 10%. This isn’t one large group dragging an average down; it’s a broad base of ordinary small and mid-sized employers, in the same drug-cost environment as everyone else, quietly beating the number, their peers accepted as fixed.
With a staff of 3, we are not exceptional by any stretch. Frankly, we would presume that any advisors who know the industry, leverage their account representatives and back-shop resources of a group MGA (or not), would have similar numbers. For our part, we don’t publish our figures regularly because telling newer clients with a 15% increase that they are that much higher than our book is not an easy conversation.
Where it makes a difference is with our longer tenured clients, who understand the value we add by negotiating aggressively every year at renewal, market testing tri-annually, introducing self-funding of health and dental at an early stage, and playing the long game (relationship) with the Insurer.
Our mostly single-digit average adjustments are perhaps just luck. It is certainly not just a cheaper Insurer (that Unicorn does not exist). I would like to think that for those of us who have been doing this work for multiple decades now, it’s the part of the job that never shows up on quote sheets. It is negotiating from evidence rather than hope. The trend is the same for all clients of an Insurer, what the client ultimately pays is negotiable.
