The Indicator from Planet Money

No healthcare premiums? In this economy?! Here's how.

March 9, 2026

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  • Some U.S. employers, inspired by systems like Canada's, are choosing to cover 100% of employee and family health insurance premiums, offering a significant benefit despite rising costs. 
  • Employers offering no-premium health insurance plans, like Bartesian and BCG, report benefits in recruitment, retention, and workforce productivity, viewing it as a worthwhile investment. 
  • No-premium health insurance does not mean entirely free healthcare; employees often still bear costs through deductibles, co-pays, and potential trade-offs in salary or other benefits like parental leave. 

Segments

US Healthcare Cost Shock
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(00:00:21)
  • Key Takeaway: The U.S. maintains the most expensive healthcare system globally, leading to significant sticker shock for immigrants from countries like Canada.
  • Summary: The United States has the most expensive healthcare in the developed world, and insurance prices are increasing. Immigrants from countries like Canada experience severe sticker shock upon encountering U.S. healthcare costs. This high cost structure is the backdrop for exploring potential employer-based solutions.
Bartesian’s Generous Benefits
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(00:01:10)
  • Key Takeaway: Bartesian, a Canadian-founded startup, offers employees zero upfront cost for medical, dental, and vision insurance premiums, plus an annual $1,000 FSA contribution.
  • Summary: Ryan Close, founder of the cocktail machine startup Bartesian, implemented benefits stemming from his Canadian background, covering all health insurance premiums for employees and their families. The company also provides employees with a $1,000 annual flexible spending account for out-of-pocket medical costs. Despite having only about 30 employees, this represents a significant, growing annual expense for the small business.
Employer Premium Surges
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(00:04:14)
  • Key Takeaway: Employer-sponsored health insurance premiums have increased by approximately 26% over the last five years, averaging $27,000 annually for a family of four.
  • Summary: Employer-sponsored health insurance premiums have surged about 26% over the past five years, according to KFF data. For an employer covering a family of four, this cost averages around $27,000 per year. Most employers typically require employees to cover about $7,000 of this cost through paycheck deductions, but they are not legally required to pass along any of these expenses.
BCG’s Large-Scale Coverage
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(00:05:35)
  • Key Takeaway: Boston Consulting Group (BCG) covers all insurance premiums for nearly 20,000 U.S. employees and most family members, including low copays.
  • Summary: BCG offers no-premium medical plans for its employees and covers insurance plans that keep other costs, like doctor copays, low for employees and their families. HR overseer Alicia Pittman notes that these benefits aid in employee retention, reduce turnover, and simplify recruitment efforts. The company views this as an investment in a productive workforce.
Trade-offs of No-Premium Plans
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(00:06:58)
  • Key Takeaway: No-premium plans often shift costs to deductibles or co-pays, and employers may compensate by offering lower salaries or lacking other benefits like formal parental leave.
  • Summary: No-premium health insurance is distinct from totally free coverage, as employees usually remain responsible for deductibles and co-pays. Some employers cover premiums but increase deductibles or co-pays to balance the expense. Bartesian, for instance, currently lacks a formal parental leave policy, a trade-off potentially linked to prioritizing premium coverage.