Expand the Number of Plans
In some cases, Schaefer has had to point out to clients that while a partner can afford the firm’s PPO plan, other employees might be more comfortable with another one.
HMOs, for instance, typically involve lower out-of-pocket costs — $750 for individual plans in 2025, compared to $2,200 for high-deductible PPO plans, according to Aon.
“[Firms] will have this amazing PPO plan they want everyone on because it's really good coverage; however, they're not paying [for] it all,” Schaefer says. “Your employees may choose to spend less so they have more money for their car insurance. It's not always possible for people to put their family on a plan and spend $9,000 a year.”
Law firms don’t have to offer an extensive number of plans; two or three is manageable, Schaefer says.
“[It’s] also [important to] make them different enough that it's obvious to make them worthwhile,” she says. “And you need to have people explain them regularly to employees so they have a good grasp of what they're looking at when they go into open enrollment.”
If a firm can only provide a high-deductible option, supplemental gap insurance coverage may help offset employees’ medical expenses, Schaefer says.
“[With] smaller firms, we’ve used gap insurance to help mitigate costs, where an employer will take a larger deductible [plan] to keep the rate down, and then take away that deductible with gap coverage,” she says. “That's been cost-effective.”
Establish Employer Expense
Offering more than one employee health plan can potentially also reduce law firms’ costs, Schaefer says.
They can pay a percentage of a baseline plan or subsidize employee health insurance premiums with a fixed dollar contribution — and allow firm members to choose a plan with specific features for an additional expense.
“The firms we work with offer multiple plans quite often,” Schaefer says. “That is also a way to keep costs down because if [employees] take a higher deductible plan, [the firm is still] paying [its] percentage on it, so it saves the firm and the employee money.”
A number of firms have been fairly generous about funding a percentage of the deductible for staff members — and partners ... have shown a considerable interest in HSAs.
Employers sometimes aren’t aware they can have an array of plans.
“One [of my] law firm [clients] didn’t want to add a plan,” Schaefer says. “I sat with the owners and said, ‘You can [determine] what you’re willing to pay. Let employees have a better plan if they want it that doesn’t hurt your cost; and they did.”
Incorporate Tax Breaks
Plan options such as a health savings account could also help keep costs down. Many of the Am Law 100 and 200 firms Alliant works with have some form of a consumer-directed health plan with an HSA, according to Arlen.
A number of firms have been fairly generous about funding a percentage of the deductible for staff members — and partners, he says, who face different tax considerations than W-2 employees, have shown a considerable interest in HSAs.
“The only way for a partner to pay for an out-of-pocket healthcare expense with pre-tax income is to use a health savings account,” Arlen says. “They contribute money, it creates a tax deduction for them and then the money inside that HSA grows on a tax-deferred basis and can be withdrawn tax-free for qualified medical expenses.”
HSAs have also been well-received at Thompson Hine, says the firm’s Senior Director of HR Cathleen Baskey. Deducted funds go into HSA participants’ accounts, and they can use an associated debit card to pay medical costs.
As part of the national 400-attorney firm’s contract with its medical insurance provider, Cigna, a separate external entity handles much of the oversight, Baskey says.
“For the individual accounts, we’re not spending money that stays on our balance sheet,” she says. “We fund things as people have claims; that’s all outsourced, [using] qualifications for health benefits.”
Thompson Hine, which has a self-insured structure, has been able to meter rate spikes over the years, Baskey says; in 2024, rates didn’t increase at all.
“Looking at the data, 2027 may be different, but we have been very successful at keeping a low-cost increase,” she says. “Based on salary, we pick up [a] large share of medical coverage.”
Alves Law, which specializes in family and criminal law, introduced an HSA in 2021 that’s paired with a high-deductible health plan and helps keep premiums low, according to founder Emma Alves.
The Canada-based firm, which employs five attorneys and 17 staff members, gets a tax break for a small match it contributes.
“Unused funds roll over year to year, so nobody loses money by not spending it all,” Alves says. “It's been a straightforward way to soften the cost of health coverage without raising salaries across the board.”
Address Medication Costs
Prescription drug spending has been elevating U.S. employers’ health benefits costs for years; in 2025, large companies’ per-employee expense rose an average of 9.4%, according to Mercer.
Growing GLP-1 medication use was a factor — which is prompting law firms to contemplate how to approach covering it, says Arlen.
“GLP-1s for diabetic treatment have been covered for a long time,” he says. “But figuring out what to do about GLP-1 for weight loss, given the rise in popularity of those drugs, has been probably the most debated topic we've had. In the last couple years, law firms that are covering them have seen massive increases in spending on GLP-1s with an uncertain ROI, in terms of health improvement.”
Research indicates the medications’ effectiveness can depend on consistent use; 50% to 75% of patients who start taking them, though, stop within a year.
Findings published in The BMJ medical journal suggest patients who ceased taking two specific GLP-1 drugs gained weight monthly and within less than two years had returned to their initial weight.
Although wellness initiatives can require a monetary investment and may not directly reduce insurance costs, they can potentially boost employee satisfaction — and positively affect firm members’ physical and mental health.
“Some firms are just not putting those on [plans] if a provider writes a script for a GLP-1 in the absence of diabetes diagnosis,” Arlen says. “Others are now putting in more restrictive requirements, where there might be a higher threshold to hit to have the drugs covered by the firm's prescription drug plan.”
Revisit Plan Terms
While firms may assume insurance providers will never negotiate, trying to when it’s time to renew a level-funded plan doesn’t hurt, Schaefer says.
“This morning, I received an email from Aetna with a 3% discount on [a client’s renewal rates],” she says. “United, Cigna do it — and these are small groups; in mid-market [scenarios], that happens regularly.”
To gauge employee benefit sentiment and the current market status, Thompson Hine gathers insight from digital surveys and other sources.
“We don’t necessarily go out to bid every year, but we’re looking at the benefits annually,” Baskey says. “As far as seeing what’s out there, we have a broker for medical, dental, vision, and on the life and disability side; and we’re able to take advantage of having a robust benefits compensation practice.”
Alves Law has periodically updated its health benefit elements; in 2023, after observing signs of burnout, Alves added a $150 quarterly wellness stipend employees can use on gym memberships, therapy sessions, massages and other items.
“The stipend was really a response to what the HSA couldn't cover,” she says. “It came after a particularly brutal trial season where I watched two of my associates run themselves ragged. I wanted something in place before the next busy stretch hit.”
Although wellness initiatives can require a monetary investment and may not directly reduce insurance costs, they can potentially boost employee satisfaction — and positively affect firm members’ physical and mental health.
Alves Law’s wellness stipend, for instance, helped alter morale at the firm, according to Alves.
“People started taking actual breaks instead of pushing through exhaustion, which changed the tone in the office,” she says. “I noticed fewer short tempers during high-pressure weeks, and associates seemed more willing to speak up when they were overwhelmed. It built trust that we meant what we said about their well-being.”
