Menopause Benefits Went From 28% of Big Employers to 58%. Next Year They Get Audited

Employers spent two years adding menopause, doula and postpartum benefits. In 2027 they start checking who used them.

Perimenopause starts in her late 30s or 40s, menopause follows, and after that come decades of aging she intends to spend feeling well.

Solve one problem properly, and you have a customer for thirty years. Every deck in the category runs on some version of it.

For two years, the employers writing the cheques agreed.

Business Group on Health surveys large US employers annually, the kind that pay their workers' medical claims out of their own money rather than buying insurance from a carrier.

Its 2026 survey found that 58% of them would provide a menopause support program, against 28% who had one in place in 2024, with a further 25% planning to add or expand one by 2028. The same survey put employer coverage of postpartum depression treatment at 55%, support for high-risk pregnancies in under-resourced populations at 43%, doula services at 36%, and group-based prenatal care at 30%.

Expansion of women's preventive care rose 22 percentage points in two years.

On August 25 the group published what those employers plan to do next year.

They expect medical costs to rise 9.2% in 2027, and think they can hold it near 8% by changing what their plans cover and what employees pay.

This year they projected 8.5% and expect to land around 7% after the same kind of changes. The survey covered 127 companies and 11 million people worldwide, 8.7 million of them in the US, and was filled out in June.

Business Group on Health has flagged the gap itself. For 2025 employers projected 6.8% and costs came in at 8.8%, a two-point miss that Axios reported as the largest the group has recorded outside the first year of the pandemic.

Ellen Kelsay, chief executive of Business Group on Health, told reporters the current forecast may still be too optimistic, and that costs across 2018 to 2027 are on track to rise about 76% against general inflation of roughly 32%.

95% of employers have already put at least one category of vendor out to bid. 83% have widened the performance guarantees they require. More than half say they will end relationships with vendors that are not delivering.

Brenna Shebel, a vice president at the group, gave the clearest measure of the mood on a different line item: not one employer surveyed will add GLP-1 coverage for weight management in 2027.

Menopause support, postpartum depression treatment, high-risk pregnancy programs, doula coverage and group prenatal care all grew inside a two-year window. They now sit in the same budget cycle as a vendor review that more than half of employers say will end at least one relationship. Business Group on Health does not name any of them.

From January, obstetric care stops being paid as a single bundled fee covering the whole pregnancy and comes apart into separately billed visits.

Kelsay named it directly, saying the transition is expected to increase cost uncertainty and administrative complexity, and that employers are concerned maternity costs will rise and become harder to forecast and manage.

The American Medical Association says the change is intended to be budget neutral. Mercer, writing in June, noted that final coding guidance was still pending and that many stakeholders were waiting to model the financial impact, while some women's and family health vendors expect increases.

A STAT opinion piece in July made the arithmetic case for restraint, pointing out that professional fees are only about a fifth of total maternity costs, which would make the effect on total medical spend modest.

Most employers renew benefits on January 1, the same date the billing change takes effect, which means the 2027 conversations are happening now with the financial modeling unfinished.

Three companies have already moved. Maven published a post in July arguing that it does not change the codes, it changes how many high-cost codes ever get billed, and that employers putting maternity care management in place now will be best positioned when the change lands. That is a clinical product being presented as a cost-control product.

Carrot made the same case in a deal. On August 19 Healthcare Management Administrators named it the preferred fertility and family care benefit for self-funded employer clients in the Pacific Northwest and Michigan, covering more than 140,000 enrolled employees.

Carrot is replacing HMA's existing maternity program, and it is selling on managing and reducing high-cost claims rather than adding them, with outcomes it has had checked outside the building, including a single embryo transfer methodology validated by Milliman and a member IVF live birth rate of 55.4%.

Midi moved earlier. In February it raised $100M at a valuation over $1B, led by Goodwater Capital, and announced an expansion past menopause into metabolic health, weight management and musculoskeletal care. The August 18 relaunch brought that expansion live.

The eligible population widened well before the 2027 review was on the calendar.

Two moves are common to all three. Broadening from one condition into a life stage raises the share of the workforce eligible to use the benefit, which is the number a utilization review looks at.

Publishing an externally validated outcome answers a performance guarantee before it is written into the contract.

That is the shape of what next year rewards.

The employers cutting what goes unused and the employers widening their performance guarantees are the same employers, described twice, and the field of companies able to produce utilization and outcome data against a contract is much smaller than the field currently selling into it.

The thirty-year customer may well be real. Getting her adopted took two years and doubled the market.

Keeping her is a different exercise, and it starts in January.

Nothing here is medical advice.