18% Small-Business Renewal Hikes for 2027: The Premium Is Just the Messenger
If you own a small business, you already know what's waiting in the renewal envelope.
North Dakota's Insurance Department just approved 2027 rates. Small-group plans, the kind local employers buy, are going up by average amounts ranging from 9.5% to 18.34%. Sanford Health Plan: 18.34%. Medica: 17.49%. UnitedHealthcare: 11.28%. Blue Cross Blue Shield of North Dakota: 9.5%.
On the individual side, BCBSND plans are up an average of 19%. Medica's are up 13.27%.
This isn't a one-year spike. In 2025, the state-approved average for BCBSND individual plans rose 15.94%, and Sanford's rose 16.5%.
And it isn't just North Dakota. The Commonwealth Fund reports that insurers nationally proposed a median 15% increase for 2027 marketplace plans, after raising premiums by more than 20% in 2026. Those back-to-back double-digit increases are the highest the marketplace has seen since 2018. Some analysts expect medical costs to grow faster in 2027 than in nearly 2 decades.
North Dakota Insurance Commissioner Jon Godfread was blunt about the root cause: "Labor is costing more. Products and services are costing more." He noted that regulators can track almost every dollar inside an insurance company, right up to the moment it leaves to pay hospitals and health systems.
"When you go to the hospital, it's one of the only services where you don't have any idea what that bill is going to be," Godfread said. "We're not going to solve health insurance premiums if we don't solve the health care cost issue."
That's the clearest summary you'll hear from a state regulator. The premium is just the messenger.
If you run a shop with a renewal packet on your desk this month, you have two choices. You can sign the renewal, absorb another 18% hike, and raise the deductible your people have to clear. Or you can change how the benefit is built.
Split the job in 2. Put primary care in a direct care membership: a flat monthly fee, a doctor your team can call or text, same- or next-day visits, and transparent prices on labs and prescriptions. Then pair that membership with a higher-deductible or wrap-around plan built for hospital stays and major events.
Your employees get a physician they can actually reach. You stop paying insurance overhead for strep tests and blood pressure checks.
The Commonwealth Fund warns that workers who "buy down" to higher-deductible plans often end up underinsured and skipping visits. Funding a direct primary care membership alongside the plan closes that exact gap. The deductible stops standing between your team and their doctor.
You can't control what the carriers file with the state. You can control what you buy.
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