Medical practices face the affordability crisis from both sides: they provide health care to Americans, but they are also employers that help pay for their workers’ coverage. Rising premiums are forcing some independent practices to have to reconsider how much they can absorb, how much employees must pay, and whether they can continue offering insurance in itself at all.

Jack Dillon, executive director of the Association for Independent Medicine, told Fortune he has heard more concern about insurance costs this year than in a long time. His own practice faced a 22.5% increase, forcing it to choose between taking on the added expense and raising employees’ share of their premiums.

“It’s a bigger struggle this year that I’ve heard than in previous years, and it’s getting louder and louder,” Dillon said.

This kind of pressure extends beyond medical practices. More than 165 million Americans rely on employer-sponsored health coverage, but it’s getting more expensive for employers to provide. Health benefit costs per employee are expected to jump 8.2% in 2027, the steepest increase since 2003 and the fifth consecutive year of elevated growth, according to a Mercer survey of 1,800 employers. Two-thirds of companies with at least 500 employees plan to raise workers’ share of premiums.

“The reality is this does eat into money that could be invested in wages,” Nick Stefanizzi, CEO of Northwell Direct, which provides health benefits to self-insured employers, told Fortune earlier this month.

That is the same tradeoff Dillon said some independent practices are considering: dropping health benefits and offering higher wages instead. Others may reduce benefits or consolidate staff, potentially limiting their ability to treat and serve patients.

Health insurance already accounts for nearly a quarter of what private employers spend on benefits. Employers paid an average of $3.48 per employee hour toward health insurance in June, out of $14.07 spent on benefits overall, according to Bureau of Labor Statistics data.

Caregivers making tradeoffs

For some health care workers, those pressures have followed them out of hospitals and clinics and into their own homes.

Samantha LeGault, an Idaho nurse practitioner, saw the monthly premium for covering herself, her husband, and their four children rise from $700 to $1,500 this year, she told KFF Health News. Because LeGault has Crohn’s disease and two of her daughters also have medical conditions, dropping health insurance just wasn’t an option. Instead, she had to give up dental coverage to prioritize her children’s dental appointments over her own. 

“I know how the clinics work, that I am an expensive patient,” LeGault said to KFF Health News. “At the end of the day, healthcare is a business in the United States.”

Also in Idaho, a primary care physician and his pharmacist wife made the opposite calculation. Joshua and Ashley Durham, who run a family practice, dropped coverage for themselves and their two children after premiums for a similar plan climbed several hundred dollars to nearly $1,600 a month, according to KFF Health News. The family is paying for care out of pocket using a health savings account that held $50,000. 

Working in health care doesn’t guarantee coverage. In 2024, 10.5% of health care support workers were uninsured, more than twice the 3.8% recorded among health care practitioners and technical workers, according to the Census Bureau. The uninsured rate among all adult ages 19 to 64 was 11%. 

Even the cost of buying insurance independently also rose sharply just in this year. Enhanced Affordable Care Act tax credits expired at the end of 2025, and average monthly payments among marketplace customers increased 58%, from $113 to $178. The average marketplace deductible also rose 37%, from $2,759 to $3,786, as more consumers selected plans that traded lower monthly payments for higher costs when they needed care.

More than a household expense

The American Nurses Association warned that the consequences of rising costs may eventually reach patients, too. About 15% of nurses reported holding more than one job in the 2024 National Nursing Workforce Study. In separate ANA survey data collected from working nurses between June 2024 and September 2026, roughly 42% said they worked more than 40 hours a week. Among that group, the most commonly cited reason for working additional hours or overtime was the need for more income.

“Rising health insurance costs are more than a household budget concern for healthcare workers,” ANA President Jennifer Mensik Kennedy said in a statement to Fortune. “They are a workforce, patient-care, and patient-safety issue.”

The association said nurses who feel compelled to add shifts or jobs to keep pace with premiums and other medical expenses can experience greater fatigue, stress, and burnout—adding pressure to a profession already facing worker shortages.

For Dillon, the hardest part is what those choices could mean for the people caring for patients. “You’re trying to take care of the people that are helping you take care of patients,” he said.