What Actually Changes When Employers Renew Their Benefits

Every year, hundreds of thousands of U.S. employers renew the benefit plans they offer their workers, and any single snapshot tells you little. Hillwinds data brings the full picture into focus — combining regulatory filings such as the Form 5500 with carrier, broker, and firmographic sources — to follow the same employers year after year, across more than five million records spanning 2019 through 2024.

This study centers on the part of the benefits package that matters most: the fully-insured medical (health) plan — its carrier, its broker, and its premium. The question is simple: when an employer renews, what actually changes?

The headline: almost nothing stays the same

Follow an employer's fully-insured medical plan from one year to the next and the odds of a quiet, unchanged renewal are strikingly low. Across every year we measured, only about 6% of employers — fewer than one in sixteen — kept the same medical carrier, the same lead broker, the same benefit line-up, and a medical premium that moved less than 2%. The other 94% changed something.

Break the population into three groups and it stays remarkably stable from year to year. Just under half of employers make a structural change — they switch medical carriers, change their lead broker, or alter the benefits they offer. Roughly the same share keep the structure intact but see their medical premium move by more than 2%. Only the small remainder sits still.

What changes: carrier, broker, and the offering itself

“Something changed” can mean very different things. A renewal where the employer moves to a new medical carrier is a different event from one where the premium simply drifted up. Pooling 128,602 matched employer-years from 2019 through 2023, here is how often each structural element moved:

Medical carriers turn over more than most people assume

About one in five employers changes its medical carrier from one year to the next. That is not a fringe event — it is a routine feature of the market, and it is remarkably steady: the medical-carrier-change rate held near 21% in every year we examined, straight through the pandemic and the inflation spike that followed.

The “offering” changes about as often as the carrier

Roughly one employer in five changes the actual shape of what they offer — adding or dropping a benefit line such as dental, vision, life, or disability, or changing the number of plans they run. That is nearly as often as they change their medical carrier.

Brokers are stickier — but far from permanent

The relationship employers keep longest is with their broker. Measured as the lead commission recipient on the filing, about 15% of employers change their lead broker in a given year, and roughly 7% move to a broker they had no prior relationship with — a clean broker-of-record switch. Across the full market that churn runs into the thousands of employers every year; the companion study, “The Broker of Record Is Always Up for Grabs,” follows it in depth.

The takeaway for anyone selling, retaining, or advising: the book is in motion constantly. One employer in six is re-evaluating its carrier, its offering, or its broker in any given twelve-month window — and the great majority of the rest are absorbing a price change.

The premium story: how often, and how much

The most universal change is price. Among employers with a fully-insured medical plan and a reported premium in both years, 64% saw their medical premium rise year over year. The median employer's medical premium climbed about 5.6% a year over the 2019–2023 window — and increases are heavily concentrated at the steep end of the range.

Read the buckets from the bottom up: about half of employers absorb a medical increase above 5% in a typical year, two in five see more than 10%, and nearly one in three see more than 15%. These are not tail events — double-digit medical renewals are a mainstream experience.

It isn't just headcount

A rising total premium could simply mean an employer hired more people. To control for that, we recomputed every change on a per-employee-per-month (PEPM) basis. The picture barely softens: the median per-employee medical premium still rose about 4.2% a year, and roughly three employers in ten still faced a per-employee increase above 15%. The cost pressure is real, not an artifact of growth.

And the pressure is accelerating

The trend has steepened sharply. Medical premium growth ran at a median near +3.5% in the 2019–2020 renewals, then jumped to a steady +7.0% in each of the last three transitions. In the most recent completed year (2023 to 2024), the median medical premium rose +7.0% and 43% of employers saw an increase above 10% — the highest readings in the five-year window.

Does shopping pay? Switchers vs. stayers

Because the data links carrier choice to premium movement for the same employer, it can answer a question a single filing never could: do employers who change medical carriers actually fare better? The answer is a clear yes. Employers that switched medical carriers posted a median per-employee premium change of +2.1%, versus +4.6% for those that stayed put — a gap of roughly 2.5 points at the median. Switching is no guarantee, and some moves are forced rather than chosen, but in aggregate the employers who went to market held their cost growth to less than half the rate of those who renewed in place.

Geography: where medical premiums climb fastest

Premium pressure is not evenly distributed across the country. Measuring the median per-employee medical increase by the employer's home state (states with at least 300 matched employers), the spread runs from roughly 5.5% at the top to just over 1% at the bottom — several times the difference in typical cost growth.

Sorting the market on those dimensions — state, premium band, funding model, renewal month — is what Smart Filters in Hillwinds is for.

Does your broker matter for premiums?

It is tempting to assume some brokers deliver systematically better renewals than others. The data supports a more measured conclusion. Among the 67 largest brokers by medical client count, the share of clients hit with a double-digit per-employee medical increase ranged from about 33% to 42%, clustered around a median of 37%. There is genuine variation across a broker's book — several points of difference is not nothing when it is playing out across hundreds of employers — but the dominant story is that steep increases are broad-based. No large broker insulates its clients from the underlying medical-cost trend; the difference between the best and worst books is measured in single-digit percentage points, not in kind.

Why this is only visible in the aggregate

Not one of these findings can be read off any single filing. A snapshot tells you who an employer's medical carrier and broker are today. It cannot tell you that a fifth of employers will change medical carriers next year, that half will absorb a 5%-plus increase, that switching carriers tends to halve cost growth, or that an employer in Washington faces materially steeper trend than one in Alabama. Those answers only exist when you connect millions of filings into a single longitudinal picture and follow each employer through time.

That is the difference between a document and a dataset. The value is not in any one record — it is in the movement between records: who is about to renew, who tends to switch, whose premium is on an unsustainable path, and which relationships are quietly coming loose. Read at that scale, Hillwinds data turns a compliance artifact into a forward-looking signal — a way to find the right conversations before anyone else knows to have them.

For brokers, carriers, and anyone who serves the employer-benefits market, the strategic implication of this study is a single sentence: in any given year, the overwhelming majority of employers are changing something — and the ones who aren't are the rare exception.