Do Health Benefits Actually Keep Drivers? What the Turnover Data Says

Benefits vendors will tell you health insurance fixes turnover. The research says something more useful and more complicated: you already retain better than the big carriers, pay and home time still matter more, and benefits work best on a specific kind of driver.

The Size Gap Nobody Talks About

Start with the number that should reframe how a small carrier thinks about this.

Those long-run averages come from the National Academies' 2024 review of driver retention in long-distance trucking. The 15-point gap between large and small truckload carriers has held for nearly three decades — through booms, busts, capacity crunches and freight recessions.

If you run a small fleet, you are not the underdog in this fight. You are structurally advantaged and probably don't know it.

One caveat on the data: the American Trucking Associations' quarterly turnover series appears to have been discontinued, so the most recent widely-cited quarterly figures date to 2020. The long-run averages from the National Academies are the more reliable reference point.

What Drivers Actually Rank First

Here is where we depart from what a benefits salesperson would tell you.

Driver surveys consistently produce the same ordering: home time first, weekly pay guarantee second, with benefits typically landing around fourth. The National Academies' review found pay and home time to be the dominant retention factors and did not isolate health insurance as a primary one.

That is not an argument against offering benefits. It is an argument against expecting benefits to fix a problem they did not cause.

Where Benefits Actually Work

Benefits do specific, measurable work in three situations.

1. Competing for experienced drivers with families

This is the clearest case. A 15-year driver with a spouse and two kids is not evaluating carriers on cents per mile alone. Family coverage on the open market is expensive — KFF put the average annual family premium at firms with 10 to 199 workers at $26,054 for 2025. A driver in that situation weighing you against a carrier with a health plan is doing arithmetic that pay alone does not resolve.

These are also, generally, the drivers you most want: experienced, stable, low-incident, and expensive to replace.

2. Keeping drivers whose medical card depends on ongoing care

An underappreciated retention mechanism. A driver managing hypertension, sleep apnea or diabetes needs continuous care to stay certified. Without coverage, that care is out of pocket — and drivers skip it, then fail or barely pass a physical, then get a three-month card, then sit out.

A driver who loses certification is gone whether or not they wanted to leave. Coverage that pays for blood pressure medication and CPAP supplies is retention spending, even though it never shows up in a retention survey.

3. Signaling what kind of company you are

Drivers talk. In a market where most small carriers offer nothing, offering something is a differentiator out of proportion to its cost — particularly when paired with the things that cost nothing, covered below.

What It Costs

National benchmarks from KFF's 2025 survey, for firms with 10 to 199 workers:

Look at what that table actually says. Premiums at small firms are nearly identical to those at large firms — but employees at small firms pay a much larger share and face deductibles roughly 58% higher.

That is the real competitive gap, and it is also the opening. A small carrier that covers 75% of the employee premium instead of 50% is offering something measurably better than the small-firm average, at a cost that is knowable in advance.

Structures That Fit Small Fleets

Fully insured group plan

Florida requires guaranteed issue and the small employer definition starts at one employee. The obstacle is usually participation — carriers commonly want 70% or more of eligible employees enrolled, which is a carrier rule rather than Florida law. In a fleet where several drivers are on a spouse's plan, that can be fatal.

Level-funded

Medically underwritten, fixed monthly cost, possible surplus refund, and aggregate claims data. A younger fleet can underwrite well below the community rate. A fleet carrying the health profile common in long-haul work may underwrite poorly — in which case guaranteed-issue community rating is protecting you and you should take it. More here.

ICHRA

Fixed tax-free allowance, drivers buy their own coverage. Two features fit trucking unusually well: no participation requirement, and the ability to set different allowances by rating area for drivers living across a wide geography. The constraint is that a driver accepting the allowance forfeits any marketplace subsidy — which for lower-paid drivers can be a net loss. Full detail here.

Dental, vision and supplemental

Not a substitute for major medical, and nobody should pretend otherwise. But drivers use dental and vision, which makes them visible in a way a high-deductible medical plan is not. Short-term disability matters in a job where a back injury ends earning immediately. Accident and critical illness products are common in trucking for good reason.

Moves That Cost Almost Nothing

If benefits are genuinely out of budget this year, these still move the needle:

• Pay for the DOT physical. $50 to $150, not covered by health insurance, and a recurring irritation drivers pay out of pocket. Covering it is cheap and noticed every two years.
• Explain what occ-acc actually is. A one-page handout at onboarding stating plainly that occupational accident insurance covers on-duty accidents only and does not cover illness. Costs nothing. Prevents a driver discovering it at the worst possible moment.
• Refer drivers to a broker. Owner-operators and uninsured company drivers need help — particularly with estimating self-employment income for subsidy purposes. A referral costs you nothing and reads as a carrier that gives a damn.
• Tell drivers about the open enrollment window. November 1, 2026 through January 15, 2027 for 2027 coverage. Drivers miss it constantly because nobody reminds them. A text in late October is free.
• Point out the self-employed deduction to your owner-operators. IRC § 162(l) lets them deduct health premiums above the line on Form 7206, subject to limits. Many don't know.
• Get consistent about home time. Not free, but it is the top-ranked factor in every survey. If you are going to spend effort on retention, spend it here first.

The Bottom Line

Small carriers retain drivers better than large ones and have for thirty years. That is your starting position.

Benefits will not fix pay or home time — nothing will except fixing pay and home time. What benefits do is widen an advantage you already have, specifically with the experienced, family-having, expensive-to-replace drivers you most want to keep. And they quietly prevent the retention loss nobody counts: the driver who loses certification because they couldn't afford the care that keeps their card valid.

If you want to know what it would actually cost for your fleet rather than for a national average, send us your driver census. We price group, level-funded and ICHRA side by side, we work with Florida carriers of every size, and it costs you nothing because the carriers pay our commission.

Driver Benefits and Retention: FAQs