2027 Medical Trend: What the Surveys Say, and What the Stop-Loss Market Is Doing About It

Every summer the trend surveys arrive a few weeks apart, each with its own basis, and every fall a carrier renewal cites one of them. The 2027 readings are the highest in roughly two decades, and for once they agree with each other. This is what they say, what they blame, and what they mean for the renewals landing this fall.

The 2027 Readings, Side by Side

Read the basis before the number. PwC and Segal survey the people who price the plans, so theirs is the trend a fully insured renewal will be justified against. Mercer, WTW and Business Group on Health survey employers, and their two figures bracket the renewal conversation: the gross number is what the current plan would cost untouched, the net number is what employers expect to pay after the design and contribution changes they have already decided to make. The three-point gap between them is the work.

What They Blame

The surveys name the same five drivers. GLP-1 drugs, for weight management and now for cardiovascular, sleep apnea and kidney indications. Specialty drugs generally, with Segal putting specialty trend at 11.9 percent. Hospital prices, which PwC measured at 7.59 percent year over year in February 2026, a post-pandemic high, and which 62 percent of Business Group on Health members cite as a major driver. Provider billing tools that use AI to document and code visits, which 70 percent of PwC's health plans rank as a top-three inflator. And No Surprises Act arbitration, where providers win 88 percent of disputes and Mercer estimates the awards add as much as a point of trend.

The one deflator anyone names is biosimilars. Adalimumab biosimilars now hold more than 80 percent of that molecule's volume, and the ustekinumab versions reached 42 percent in the first quarter of 2026. A plan whose formulary still prefers the reference brands is leaving money on the table that every survey above has already counted as gone.

The Stop-Loss Market Renewed in the Mid-Teens

For self-funded and level funded groups the trend surveys are half the story. The other half is the specific and aggregate stop-loss renewal, and the 2026 cycle was the hardest in years. Aegis Risk's survey of 1,378 policies found premium increases from 13.6 percent at a $100,000 specific deductible to 15.9 percent at $750,000, about five points higher than the 2025 renewals. Segal's dataset of 225 plans averaged 12.7 percent for groups that held their deductible, with the median specific now $350,000. Mercer's January 2026 placements averaged 23 percent, and Voya repriced its book by about 24 percent. Leveraged trend, the extra increase a fixed deductible produces as claims inflate past it, ran about five points across the industry.

Behind the pricing is frequency. Sun Life's 2026 report found million-dollar-plus claims up 46 percent in frequency from 2022 to 2026, with blood cancers averaging $5.45 million in 2025. QBE andTokio Marine HCC both report $1 million claim frequency roughly tripling over five years, and Tokio Marine notes that children under ten account for 39 percent of claims over $1 million, which argues against a low laser on any group with a young workforce. Tokio Marine's chief executive expects the tightening to run through 2027.

Setting Trend for 2027

A survey figure is where the renewal conversation starts, not where the projection ends. Three things separate a group's own trend from the headline number. The first is leverage: a higher deductible plan trends faster on the plan side, because the member's share is fixed in dollars and every inflated dollar above it lands on the plan. The second is the GLP-1 decision, which belongs on its own line rather than inside trend; Segal's 18.3 versus 10.5 percent split between plans that cover anti-obesity GLP-1s and plans that do not is the size of that line. The third is the period: trend in a projection runs from the midpoint of the experience period to the midpoint of the plan year, usually eighteen months for a renewal built in the fall, so a 9.5 percent annual figure compounds to roughly 1.146.

Then hold the carrier to the same standard. A fully insured or level funded renewal that cites 9 percent trend and lands at 18 percent has nine points to explain, and the surveys above are the evidence for that conversation. The renewal projection walkthrough shows where each assumption enters, and the stop-loss guide covers the contract terms that matter more than the quote this year.