Buncombe County projects 2026 health plan cost rise of about $1.7 million; no premium increase for employees
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Summary
County consultants told commissioners Thursday the self-funded medical plan ran below budget year-to-date and that county-funded increases for 2026 will absorb an estimated 5% rise (about $1.7 million) so employees will not see higher premiums; several plan design and benefit changes were outlined for next year.
Larry Reese of USI Insurance Services told the Buncombe County Board of Commissioners the county's self-funded medical and pharmacy program is "about 9% favorable to budget, almost $2,000,000" through the first seven or eight months of the plan year.
The presentation, delivered by Larry Reese and Roberta Ferdinand of USI, provided a year-to-date account of claims, described utilization drivers and wellness programs the county uses to control cost, and previewed the program's 2026 forecast and modest plan design changes.
Reese said the county has roughly 1,800 covered employees and their dependents and noted 19 large claimants (claims of $125,000 or more through the period reviewed), with four claims that have exceeded the plan's reinsurance attachment point of $250,000. He also credited ongoing wellness, physical-therapy and chronic-condition programs for helping keep the plan favorable to budget.
Roberta Ferdinand said the forecast for plan-year 2026 assumes a little over a 5% increase in cost, estimated at about $1,700,000, and that "the county is picking up all of that" so there will be no increase to employee medical premiums for 2026. Ferdinand added there will be "a little bit of a plan design tweak" to the county's high-deductible health plan to remain compliant with annual IRS HSA limits.
Ferdinand outlined specific 2026 changes required by federal guidance and internal plan decisions: the deductible and out-of-pocket limits for the high-deductible plan will rise (individual deductible to $1,700 and family/"plus one" deductible to $3,400; individual out-of-pocket $4,700; family $9,400). To help employees, county seed contributions to health savings accounts will increase to $850 for individuals and $1,700 for employees covering dependents. The dependent care flexible spending account maximum will increase from $5,000 to $7,500.
The consultants told the board the dental plan will see a 6% increase for 2026 but that Delta Dental agreed to a two-year rate guarantee (2026 and 2027). Vision remains under rate guarantee with no change. Ferdinand also said several low-utilization voluntary programs will be discontinued (for example, a pregnancy app, a nurse hotline and optional whole-life insurance through Trustmark) and that open enrollment will be Nov. 3'17, with health risk assessments due Oct. 31.
Reese and Ferdinand emphasized the county will present plan-year recommendations earlier in 2026 for the 2027 budget cycle, and noted that whether employees will continue to avoid premium increases beyond 2026 will depend on claims experience and market developments.
Commissioners asked questions about dental enrollment and behavioral-health referrals; USI staff said the employee assistance program (MyStrength) and EAP clinicians offer immediate short-term support and can refer members to in-network Blue Cross Blue Shield providers if longer-term care is needed.
The presentation did not propose immediate votes; commissioners received the update and were told staff and USI will return with detailed recommendations during the next budget cycle if changes are needed.
