Is your carrier delivering real value? 5 questions to ask.
Ask these 5 questions to ensure your health carrier helps to reduce costs, support members and drive better outcomes.
Medical costs continue to rise with an increase of 8.5% projected for 2026.1 Employers must deliver the quality, affordable health care their team members expect, while controlling organizational costs. It’s quite a balancing act and they don’t want to go it alone.
That explains why employers are demanding more from carriers or vendors, increasingly tasking them with bringing forward bold ways to improve care outcomes while strengthening the employee experience.2
What’s the best approach for finding a health benefits carrier that can provide strategic support? Here are 5 questions to help vet prospective carriers, and what to look for in their answers:
- How can you help our organization reduce health care costs?
- What types of plans and benefits do you offer?
- What support can you offer members to more easily navigate their health care journey?
- How can you assist our team in administering benefits and addressing member challenges?
- In what ways are you working to improve the health system as a whole?
1. How can you help our organization reduce health care costs?
Beware of answers that focus too narrowly on discounts. While a competitive negotiated rate can lower costs, it tells only half the story. Utilization data, what services employees are using and how efficiently they receive that care, significantly contributes to overall plan cost.
Quantifying that savings can be a challenge, as traditional consultant analyses often overlook utilization. However, a March 2026 study by Milliman found that UnitedHealthcare’s total cost of care was more than 11% lower than national benchmarks, and up to 17% lower in certain regions.3 These cost savings may be attributed to UnitedHealthcare's strategic approach to network design and utilization management.
Takeaway: When addressing potential savings, be sure plan your plan reps address total cost of care. Ask about their review processes — pre-claim to post-payment — that root out ineffective care delivery and correct pricing failures. An ongoing effort to manage costs can help prevent surprise premium increases during plan renewal.
2. What types of plans and benefits do you offer?
The majority of employers (59%) will make cost-cutting changes to their plans in 2026, according to a Mercer survey.4 While that often means higher employee deductibles or other cost-sharing provisions, many employers favor cost management strategies that avoid shifting costs to employees.
New models emphasize flexibility, data-driven insights and integrated care to support employee well-being and reduce costs. Carrier representatives should be able to articulate initiatives that:
- Give employees visibility into cost and quality – For instance, UnitedHealthcare members have access to enhanced provider search capabilities, like Smart Choice, designed to help personalize care options and make it easier to find quality care and make more informed choices. Some plans, such as Surest®, further enable members to make more informed decisions with clear upfront copays that empower members to explore more cost-effective providers.
- Recognize the value of primary care providers (PCPs) – From encouraging preventive care to coordinating complex issues, PCPs can help members navigate their health journey. That often results in more high-value care and a better health experience, according to a study in the Journal of the American Medical Association (JAMA).5 Among UnitedHealthcare members, PCP engagement has been linked to improved decision-making, better treatment adherence and lower claims trends.6
In addition, employers are looking to focused networks and other value-based models to help control costs. Centers of Excellence (COEs) help chart care for complex conditions, such as cancer, joint replacement or bariatric surgery, making care more efficient and improving outcomes. Providers in high-value networks must meet specific standards for care quality, patient-centeredness and the use of evidence-based medicine. Nearly 9 out of 10 surveyed employers say they are investing in some type of value-based strategy in 2026, with high-value models and Centers of Excellence (COEs) among the most common.7
Takeaway: Transparent pricing and clear incentives can be used to maintain quality care while lowering costs. Consider plan designs that require or encourage members to see a PCP before seeking additional care or those that rely on specialty networks to improve the delivery of high-value care.
3. What support can you offer members to help them more easily navigate their health care journey?
Employees continue to value health care as their most important job benefit. This resulting loyalty to employers can erode quickly in the face of confusion over benefits or unexpected billing issues. In fact, 61% of Americans view navigating the U.S. health system as a hassle.8
In evaluating health insurers, consider those with a focus on improving member experiences by simplifying and personalizing care. Some important aspects to address:
- High-quality digital experience including online resources, apps and interactive tools. With access to quick health plan information and support across devices, members can make better care decisions, especially younger workers who, while often tech-savvy, may have less experience with employer-based health plans.
- Personalized support – A one-size-fits-all approach is insufficient to address diverse health needs. Look for carriers that leverage their data to proactively share next-best actions with members, such as prompts to enroll in a wellness program, schedule a follow-up appointment or insights to manage chronic conditions. Such interventions can help streamline care and prevent unnecessary costs.
- Member advocates – While self-service tools are important, the availability of personal, compassionate care advisors, dedicated to serving the needs of members and their families, can add additional satisfaction. The UnitedHealthcare Advocacy program serves 12M members, earning high satisfaction ratings from members engaged by UnitedHealthcare Advocates.9
Takeaway: Low employee satisfaction was cited as a top reason for switching health plans by 20% of surveyed employers.10 They recognize the value of exceptional member experiences to promote healthier, happier and more engaged employees. Learn more about supporting employees with a simpler health care experiences.
4. How can you assist our team in administering benefits and addressing member challenges?
Plans that use technology, robust networks and personalization to serve members can naturally ease the burden on benefits administration. Some examples, offered by UnitedHealthcare, include:
- UHC Hub provides employers a more streamlined way to select offerings that can complement their UnitedHealthcare offerings, offering access to a portfolio of 20+ selected vendors that can billed through a single contract
- UHC Store allows members to choose and purchase additional health and wellness offerings that may matter most to them and their individual health goals, with no added administrative burden or cost to their employer
- Prior authorization streamlining –UnitedHealthcare is leveraging standardized electronic prior authorization systems and real-time approval technology to reduce prior authorization volume by up to 30% for qualifying providers, with a goal of delivering 80% of electronic prior authorization approvals instantly by 2027
While innovative initiatives like these can reduce day-to-day pressures, carriers also need to address the unexpected. In a complex system like health care, issues inevitably arise, so employers need assurance they will get prompt and strategic solutions.
Whether managing member needs in a crisis, navigating care disruptions or analyzing utilization trends, employers expect more than simple explanations of rules from their carrier or account team — they want actionable solutions that make a tangible difference.
Takeaway: Evaluate carriers on their ability to provide technological solutions as well as personalized and compassionate support from a seasoned team. The right collaboration works to ease benefits administration while addressing any challenges that arise.
5. In what ways are you working to improve the health system as a whole?
Carriers that are committed to innovation, transparency and efficiency are effectively transforming our health system one claim at a time. These transformations occur every time they connect a member to a dedicated Advocate or case manager, or shield a patient from unneeded prior authorization that may delay care.
The above questions can help identify which health care carriers are dedicated to containing costs, building expert networks, improving administrative efficiency and providing compassionate member support. Employers who choose such carriers are not only making a wise investment in their workforce, but also contributing to a healthier, more sustainable future for health care.
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