A salaried job
Jessica Balcerzak, a 33-year-old nurse who works for a hospital in Buffalo, New York, decided to waive her employer's insurance in 2025. Her job covered 55% of the plan's premiums, deducting $585 every two weeks for insurance for herself, her self-employed husband and their three kids. Balcerzak said that $15,000 in annual wages would be better used in the family's high yield savings account or
"I was spending so much money and we don't even use this because we're healthy," said Balcerzak. Instead, she opted to join medical cost-sharing cooperative Zion HealthShare with her husband for $297 each month. Such groups help members pool money to cover each other's healthcare expenses. They don't have the same consumer protections requirements as traditional health insurance and don't guarantee coverage of claims. She signed the kids up for New York State's Child Health Plus plan, which provides low-cost coverage for children without other insurance. In all, she's paying $970 less per month than she would have on her company plan.
"I'm literally a nurse," Balcerzak added. "I wish we were given some benefit from the healthcare that we do have to work for."
Most Americans get medical insurance from their employers, with the average worker paying 26% of the total premium for family coverage. Companies cover the rest.
With premiums rising 6% in 2025 for company family plans alongside the growing cost of living, some workers are questioning whether their benefits are worth the cost. The share of workers covered by their firms' benefits has remained relatively stable for the past twenty years, but has fallen to 61%, down from 64% in 2020, according to surveys of employers by KFF, the health policy research firm.
"It really is this perfect storm right now where everything has increased and people that normally would have just re-enrolled are starting to look at every single dollar they're paying for their daily life, including their health insurance," said Myranda Cleary, a Kansas City-based insurance consultant.
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Risks for employees and employers
Forgoing major medical insurance is not without risks, however. The plan that Balcerzak joined allows members to "share," or be reimbursed for costs over $5,000, though she has not yet needed to file a claim. But a 2023 study on health insurance alternatives conducted by the Government Accountability Office found that share plans can restrict coverage for pre-existing conditions and mental health services.
The workers leaving corporate plans tend to be young and healthy. Employers rely on those workers to pay premiums and file few claims to keep plans sustainable for insurance carriers. Human resources executives say that because insurers negotiate premiums based on previous claims, a substantial exodus could result in higher costs for other employees.
"Every single person that opts out creates this lopsided situation where they cannot sustain the costs and at some point it breaks," Cleary said.
It is a trend employers should be watching as they begin the renewal process with insurers ahead of the conventional open enrollment period in the fall, said Tawanda Johnson, a human resources chief for several venture capital and private equity startups. She formerly served as senior vice president of people at The Knot.
"There's strength in numbers," Johnson said. "When it's a larger group, you have more bargaining power with the insurance companies."
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Both employers and employees are looking for ways to manage stark increases in healthcare costs in recent years. Medical care premiums comprised 7.7% of total compensation for U.S. workers in March 2025, according to the Bureau of Labor Statistics. Those costs to employers are set to rise even further. Benefits consultant Mercer forecasts that the total cost of health plans per employee will grow at the highest rate in more than a decade in 2026 at 6.5%. About half of large employers said that the increases are pushing them to raise deductibles or exclude pricey treatments such as GLP-1 drugs for weight loss.
"Having healthcare benefits you can't afford is like unlimited vacation, it's a false promise," said the chairperson of Carnegie Mellon University's Health Care Policy and Management program Denise Rousseau. She said that redesigning policies to force employees to pay thousands of dollars out of pocket before their insurance coverage kicks in shifts the financial risk for health crises onto employees and could prompt some to leave.
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A search for better options
Insurance brokers and consultants including Cleary said that while they once primarily sold plans to self-employed workers, they have been overwhelmed with calls from corporate employees seeking other options. Others are working with employers to find ways to win workers back.
Tommy Gaffney, vice president of employee benefits consultancy Evolved Benefits, said he is working with clients to introduce plans with limited coverage that emphasize low-cost preventative care. As many as 40% of workers at Gaffney's clients waived major medical benefits due to cost last year, especially at firms with large blue-collar or front-line workforces.
After a "disastrous" year with an unusually high number of medical claims, New York communications firm KCSA faced doubled premiums for its 63 employees even after the firm shared some of the cost, said Chief Human Resources Officer Katie Roland.
"People were screaming," Roland said. Workers explored plans on the open marketplace and pushed Roland to consider switching carriers for the company's group, before she resorted to doing individual consultations to help workers find affordable policies.
In the end, most employees stayed on the plan, and she worked to offer the strongest coverage for the most-used benefits. "We are finding that medical insurance is more important to people than salaries," she said.
When his wife, Paige, started a new job in March, Daniel Wilson, 40, pushed her to prioritize flexibility over employee benefits. Paige, also 40, ultimately accepted an offer from a Detroit startup that would allow her to work remotely and covered 70% of its health plan's annual premium for their family of 5. The plan was expensive and had a high deductible, so they wondered if they would be better off without it.
"For my family, it's a $40,000 question," Wilson said. They joined a health share cooperative $550 each month and waived the employer plan.
"Our decision is driven by economics, and it's just not a good deal."
