In this episode of Blueprints for Better Benefits, Rodney Mattos Jr. and Rodney Mattos Sr. break down the real state of healthcare spend 2026 and what more than 1,500 CEOs, CFOs, finance leaders, and HR leaders are saying about rising costs.
The numbers are hard to ignore. Seventy-nine percent of small and mid-sized employers saw double-digit increases in total healthcare spend over the last 12 months. One in five saw increases of 30% or more. For employers already working with tight margins, those increases are not just a benefits issue. They are a direct threat to profit, cash flow, employee retention, and long-term planning.
This conversation looks at why the traditional fully insured renewal cycle is no longer enough, especially for mid-market employers that need more visibility, predictability, and control. Rodney and Rodney explain why employers are shifting their focus from simply shopping the next renewal to rethinking the structure of their health plan entirely.
Employee Benefits Costs Are Becoming a Margin Issue
Rising employee benefits costs are forcing CFOs, CEOs, and HR leaders to ask harder questions. A 15% increase on a $900,000 healthcare spend can erase $135,000 in profit. A 30% increase can erase $270,000. Those dollars could have gone toward equipment, hiring, reserves, growth, or keeping benefits stable for employees.
The episode explains why employers need to stop measuring success only by whether they negotiated a smaller renewal increase. Instead, leaders need to understand what is actually driving the spend and whether their current benefits strategy gives them the tools to manage it.
Self-Funded Health Plans and Structured Alternatives
Rodney and Rodney discuss why more employers are exploring self-funded health plans, captive strategies, and other structured funding arrangements. According to the research discussed in the episode, 77% of employers are actively exploring new health plan funding arrangements, and half are likely or extremely likely to switch brokers.
The message is clear: employers are tired of the same renewal conversation. They want better data, clearer maximum exposure, and a structure that helps them plan instead of react.
Stop-Loss Protection and Captive Layers
A major theme in this episode is the importance of stop-loss protection and properly structured captive layers. The goal is not to take on uncontrolled risk. The goal is to build a smarter funding structure with visibility, protection, and targeted action.
Rodney explains how specific deductibles, aggregate caps, stop-loss coverage, and captive participation can work together to limit how much any single claims year can hurt the organization.
Pharmacy Cost Drivers, GLP-1s, and High-Cost Claims
The episode also covers pharmacy cost drivers, including GLP-1 medications, specialty drugs, gene therapy, and other high-cost prescriptions. Pharmacy now represents more than one-quarter of total healthcare costs and is projected to rise another 11% to 12% by the end of 2026.
Beyond pharmacy, the conversation covers major medical cost drivers such as cancer, musculoskeletal conditions, diabetes, cardiovascular disease, mental health, and site-of-care differences.
For employers, the takeaway is simple: you cannot manage what you cannot see. Once leaders have access to claims data, they can identify the top cost drivers and begin taking targeted action.
In This Episode, We Cover
- Why 79% of small and mid-sized employers saw double-digit healthcare spend increases
- What a 15% to 30% renewal increase can do to company profit and cash flow
- Why the fully insured renewal cycle keeps employers stuck
- Why 77% of employers are exploring new health plan funding arrangements
- How self-funded health plans, captives, and stop-loss protection can create more predictability
- Why pharmacy, PBMs, GLP-1s, specialty medications, and gene therapy are putting more pressure on employer plans
- The three levers of margin protection: visibility, protection, and targeted action
- Why CFOs, CEOs, and HR leaders need to model healthcare costs before the renewal letter arrives
- Common objections employers have about moving away from fully insured plans
- Practical next steps for employers that want more control over their benefits strategy
Explore More
- Explore our insurance agency, Triforta: https://www.triforta.com/
- Learn more about our software for insurance agencies, Apeironix: https://apeironix.com
- Visit the full podcast website, The Rodney Mattos Show: https://rodneymattos.com/
Connect with Rodney
Email: rmattos@triforta.com
LinkedIn: https://www.linkedin.com/in/rodneymattos