4 Key Trends Impacting Self-Funded Health Plans in 2026

What 2025 Changed for Self-Funded Plans

As we start 2026, the healthcare landscape for self-funded organizations has never been more complex, and more full of opportunity for brokers who can navigate it.

Last year brought seismic shifts: federal funding cuts, remote workforce challenges, and growing scrutiny over every dollar spent.

For consultants working with self-funded plans, 2025 made one thing clear: your clients aren’t just looking for plan selection anymore. They need strategic partners who can anticipate disruption, manage risk, and build sustainable solutions.

At MagnaCare, we work with self-funded organizations of all types—from labor unions to private employers—and we’ve seen firsthand how the best advisor relationships are built on deep expertise, transparency, and proactive guidance. Here’s what defined 2025 and what it means for you.

1. Cost Pressures Hit Self-Funded Plans Hard: Budget Cuts & Market Response

2025 was defined by a massive recalibration of healthcare funding at both the federal and state levels.

The “One Big Beautiful Bill” brought the most significant cuts to Medicaid and ACA subsidies in a decade. With the elimination of automatic re-enrollment, many people faced a “subsidy shock” or coverage gaps in 2026, putting even more pressure on self-funded employers and their benefit programs.

Organizations responded differently based on their structure. Labor unions fought back at the state level. For example – in California, SEIU-UHW supported proposals like the 2026 Billionaire Tax Act and the Healthcare Executive Compensation Act. Private employers, meanwhile, accelerated cost-containment initiatives.

What It Means for You

Self-funded organizations entered 2026 with tighter budgets and a clear mandate: protect employee benefits without breaking the bank.

In 2026, advisors who can help organizations offset legislative and market pressure through smarter plan design, alternative funding strategies, and tighter cost controls will be viewed as indispensable partners, not interchangeable vendors.

2. The Pharmacy & Ancillary Pivot: Moving Beyond “Basic” Coverage

In 2025, the definition of a “competitive benefit package” shifted across all self-funded organizations. Although GLP-1 medications dominated the headlines, the real story for advisors was the broader explosion in specialty drug costs and the rising demand for robust ancillary benefits.

As core medical costs continued to rise, many organizations turned to enhanced ancillary offerings to provide “total care.” Dental, vision, and supplemental health benefits evolved from “nice-to-have” add-ons to essential pillars of member retention. In 2025, we saw a record number of employers and funds lean into ancillary-medical integration to streamline administration and boost engagement.

What It Means for You

In 2026, winning strategies go beyond managing medical spend. Advisors who take a holistic approach—connecting pharmacy management with ancillary benefits to identify at-risk members early—will deliver the proactive, integrated value that plan sponsors and trustees demand.

Whether working with a labor fund or a private employer, the ability to demonstrate integrated benefit design as a retention and cost-management tool will set you apart.

3. Remote Workers Exposed Critical Network Gaps

As more employees worked remotely or relocated, many self-funded organizations discovered their networks couldn’t keep up. Regional, in-person networks failed to match how younger workers actually lived and sought care.

Our 2025 Network Rental Study revealed the scope of the problem:

• 59% of Millennial and Gen Z remote workers rely on out-of-network providers
• 54% report frequent access issues with in-network care
• 79% have considered switching jobs due to inadequate healthcare access

What It Means for You

In 2026, network adequacy can’t be measured by ZIP codes alone. You need to evaluate coverage through the lens of how younger, remote members actually access care and that means integrating virtual care, national networks, and digital-first navigation tools.

Advisors who solve the network access problem for mobile workforces will help unions protect engagement, reduce turnover, and demonstrate real member value, whether serving a multi-state employer or a geographically dispersed union.

(Source: MagnaCare Network Rental Study, 2025)

4. Technology Became a Trust Differentiator

Self-funded plans increasingly expected real-time visibility into claims data, faster reporting cycles, and clearer insights into cost drivers. At the same time, employees expected consumer-grade digital experiences, including easier navigation, faster issue resolution, and better communication across channels.

Technology became a differentiator not just in administration, but in trust. Plan sponsors wanted fewer blind spots, clearer accountability, and systems that supported proactive decision-making rather than reactive problem-solving.

What It Means for Brokers and Consultants

Technology is no longer just about back-end administration—it’s about the client experience. In 2026, advisors who understand and leverage technology to improve visibility, coordination, and responsiveness will stand out.

When you can help organizations adopt solutions that eliminate blind spots and enable proactive decision-making, you strengthen your credibility and deepen long-term relationships.

MagnaCare has invested heavily in technology that enhances partnership: clearer insights, stronger communication, and better experiences for advisors, funds, and members alike.

Let’s Build on This Momentum Together

The market is changing quickly, but the opportunity for consultants has never been clearer.

If you’re rethinking plan design, ancillary strategy, network access, or technology for your self-funded groups in 2026, MagnaCare can help you build solutions that protect trust and sustainability.

Connect with our team to explore what partnership can look like this year.

Let’s Talk Strategy for 2026