Health plans are projecting a 9% medical cost trend for the commercial group market in 2027 — the highest in nearly two decades, according to PwC. A rapidly emerging driver: AI-enabled documentation and coding tools.
For health plans, the concern is that more detailed documentation is triggering higher-paying billing codes, even when care levels remain essentially the same. Just two years ago, PwC noted that health plans had not yet factored generative AI into projections. For 2027, 70% now rank provider AI tools among their top three cost inflators.
PwC recommends stronger validation of claims before payment, which makes MedBen’s physician-led forensic claims review even more important to identify inaccurate charges and other issues before dollars are released. In 2025, the service delivered record average savings of $22.38 per employee per month.
PwC’s forecast shows the value of addressing specific cost drivers rather than relying on broad controls. MedBen’s 2026 Client Report includes detailed results and a checklist of solutions to address cost inflators and strengthen plan performance, such as:
- Provider reimbursement pressure: Direct-to-employer contracting, reference-based pricing, and fair market pricing help employers control payments. In 2025, MedBen clients using these alternative reimbursement strategies spent an average of 17.3% less than those relying solely on standard PPO networks.
- Rising pharmacy spending: MedBen Rx combines transparent pricing, formulary management, specialty oversight, and patient assistance. MedBen Rx clients spent 25.1% less per employee than clients using other PBMs in 2025.