Covered workers at smaller firms pay an average of $9,687 a year toward family health coverage, $2,847 more than the $6,840 paid by workers at larger employers, KFF found in its 2026 survey of employer plans. The gap runs against the sticker price, because small-firm family premiums are actually lower. The difference comes down to who carries the premium.
A cheaper plan with a bigger worker bill
KFF puts the average family premium at $27,288 at small firms, which it defines as employers with 10 to 199 workers, against $28,592 at firms with 200 or more. That is $1,304 less in total cost. Yet the workers’ own share goes the other way: $9,687 at small firms and $6,840 at large ones. The figures come from 1,937 randomly selected employers with ten or more workers, surveyed by Davis Research between January and July.
Measured as a share of the premium, the split is starker. Workers at small firms cover 37% of the family premium, KFF reports, while workers at large firms cover 25%. Employers under 200 workers pass along more than a third of the family bill, and big employers pass along a quarter.
KFF also counted how many workers carry the heaviest load. Among covered workers at small firms, 32% pay more than half of the family premium, compared with 6% at large firms. For nearly one in three covered small-firm workers, the employee is paying for most of the plan.
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A worker at a firm with fewer than 200 employees choosing a family plan this fall should look for the line showing what the employer pays toward the family premium. KFF’s averages put the worker’s share at 37% at small firms and 25% at large ones, so a plan asking for much more than that sits above the norm.
Deductibles stack on top
Cost sharing at the clinic widens the gap. The average single-coverage deductible among covered workers who have one is $2,624 at small firms, KFF says, against $1,772 at large firms. Across all firms the average is $1,955.
Fifty-five percent of covered workers at small firms have a single-coverage deductible of $2,000 or more, compared with 33% at large firms. The single-coverage figures show the direction: the smaller the employer, the more of the first dollars of care land on the worker.
Across all firms, 38% of covered workers face a single-coverage deductible of $2,000 or more, so the small-firm share of 55% sits 17 percentage points above the overall figure.
Single-coverage premiums barely differ by firm size, $9,593 at small firms and $9,865 at large ones. The wide gap in what workers pay appears in the family tier, where the small-firm contribution runs $2,847 higher.
Up $798 in a year
The small-firm family contribution was $8,889 in KFF’s 2025 survey. The $9,687 in 2026 is $798 more, about 9%, a pace in line with the 9% rise in the all-firm family contribution to $7,471.
Offer rates moved the other way from affordability. Two-thirds of firms with ten or more workers (67%) offered coverage in 2026 against 61% a year earlier, KFF reports, which puts more small-business staff in front of a $9,687 family bill.
Across all employers, the average family premium reached $28,303 this year, 5% higher than in 2025, and workers contribute 27% of it. The small-firm contribution is the one sitting furthest above that all-firm average.
Wages are not keeping pace. The Bureau of Labor Statistics’ Employment Cost Index put private-sector pay growth at 3.1% for the year to June, with employer benefit costs up 3.8%. Small-firm family contributions grew far faster than either, from $8,889 in 2025 to $9,687.
The one federal offset for the smallest employers
Small employers do have a federal offset. The IRS says its small business health care tax credit is open to employers with fewer than 25 full-time-equivalent employees and average annual wages below an inflation-adjusted limit, which the agency’s page lists as $62,000 for tax year 2023.
To qualify, the employer must offer coverage through a SHOP Marketplace, with limited exceptions, and pay at least 50% of employee-only premiums. The maximum credit is 50% of premiums paid for small business employers and 35% for small tax-exempt employers, for two consecutive years.
The credit’s 25-employee cutoff sits far below the 199-worker ceiling KFF uses for small firms, so it reaches only the smallest payrolls. It does nothing directly for a worker whose employer is just under 200.
KFF’s figures do not say why small-firm workers carry more of the bill. They show the result: a premium $1,304 lower in total and a worker contribution $2,847 higher.
For a family weighing a small-firm plan against other coverage, the comparison that counts is the all-in yearly cost: the contribution, the deductible and the cap on cost sharing, set beside what the household would pay elsewhere.
Paying more than $9,687 for the family plan?
A household that hands most of a health premium back to the plan has less left for the bills that benefit programs can offset, from heating and groceries to prescriptions, and those programs pay only after someone applies.
The Benefits Checklist is a downloadable guide that scans 11 benefit programs retirees most often miss, sets out the 2026 income limits for each, and adds a 50-state phone directory plus a printable application tracker to keep every date in one place.
Check 11 benefit programs against the 2026 income limits in this checklist →
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This article was produced with AI assistance and edited for accuracy against the sources linked above.
