Employer health plans leave many workers skipping needed care due to costs

• Key Insight: Learn how bridging out-of-pocket liquidity unlocks actual use of employer-sponsored insurance.
• What's at Stake: Rising avoidable claims and diminished productivity threaten benefits ROI and workforce stability.
• Supporting Data: 40% of employees delay care; non-adherence drives about $100B in hospital costs annually.
  Source: Bullets generated by AI with editorial review

A large portion of U.S. employees with health insurance are skipping or delaying care because they can't afford it, jeopardizing their well-being and productivity at work.

That's according to a new study by Paytient, which examines the impact of insured employees delaying or forgoing care due to cost. Forty percent of workers with employer-sponsored plans say they have put off medical treatment because it was too expensive. 

The study, titled "The Hidden Lives of Workplace Insured Americans," also found that 39% of employees delayed primary care due to cost, while 56% went without dental treatment and 48% put off specialist referrals. 

The downstream financial impact of these decisions can be significant: Non-adherence is estimated to account for up to 69% of medication-related hospitalizations, which costs the healthcare system roughly $100 billion per year, according to the report.

"When nearly half of a workforce is forced to choose between a doctor's visit and a grocery bill, employers aren't just managing a benefits plan — they are unwittingly underwriting a less productive, less engaged, and increasingly vulnerable organization," Paytient Chief People Officer Iveta Brigis said in an email interview. 

The good news for employers and benefit leaders, Brigis said, is that the gap between what an employee can pay and what their deductible requires is solvable, oftentimes under $1,500. 

"Bridging this financial hurdle is no longer just a perk. It's a necessity for a functional, healthy workforce and the best way to unlock the full potential of the benefits you already provide," Brigis said. 

Brigis recently spoke with Employee Benefit News via email about the new study and how employers should rethink benefit design in response to the findings. 

Why do so many insured Americans have trouble affording care? 
It comes down to a fundamental disconnect between benefit design and the financial reality of the modern household. Over the last 25 years, the cost of employer-sponsored health insurance has become disconnected from worker pay at a staggering rate — total family premiums rose by 342% and worker contributions increased by 308%. During that same period, average worker earnings grew by only 119%. Think about the compounding effect of that. While we often look at plan competitiveness through a market lens, the lived experience for many is a "broken math" problem: according to KFF data, the median household savings is roughly $1,000, yet deductibles can frequently exceed $6,000.

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We've reached a saturation point where the system assumes employees have a level of liquid cash that simply doesn't exist for most people. However, fixing this doesn't require a total systemic overhaul. By providing employees with tools to manage out-of-pocket costs on their own terms, you bridge the gap between what a plan covers and what a worker can actually afford. It's a strategic shift that makes the health plan you're already underwriting actually usable for the people who need it most.

How widespread is this problem across income levels?
This is not just a struggle for entry-level or low-wage workers. Financial hesitation and delayed care are prevalent even among employees earning up to $125,000 annually. The sample for this study included a diverse cross-section of income levels, proving that the affordability gap reaches deep into the middle and upper-middle class. For HR leaders, this is actually a unifying insight: it means that solutions aimed at healthcare affordability and access will resonate with and support a very broad and diverse cross-section of your workforce. 

What solutions are actually working right now?
The most effective fix is giving employees a way to pay for their care immediately, on their own terms. Our research shows the roadblock is usually less than $1,500. When you clear that hurdle, people start taking their medications, seeing their doctors, and managing their health properly again. By empowering your team with this kind of "on-demand" liquidity, you're essentially giving them the keys to actually use the insurance card in their pocket. 

How should employers rethink benefit design in response to this report?
Employers should start thinking about health benefits as a two-part system: insurance for coverage and a liquidity, or payment, solution for access. It's time to stop viewing benefits as a fixed line item and realize that shifting out-of-pocket costs to employees actually creates expensive "variable" costs elsewhere, like catastrophic claims and high turnover. Rethinking your design to include financial tools at the point of care ensures that the major investment you're already making in premiums results in a healthier, more loyal workforce. 

How can benefits leaders better identify hidden employee struggles?
It starts with a mix of empathy and data. Leaders need to look past standard enrollment numbers and "stable" HR metrics because employees go to great lengths to maintain a "professional facade." Because there is a profound stigma attached to financial insecurity, many people will hide their struggles rather than ask for help.

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For instance, 31% of employees have lied to their boss about why their performance dipped or why they missed work, and 19% are even working second jobs during work hours just to generate cash for medical bills. Recognizing that many employees may be managing symptoms in silence or "quiet quitting" because of health costs allows HR to lead with compassion.

What's the return on investment case for closing the affordability gap?
It's much cheaper to help an employee pay for a $50 prescription today than to pay for a $20,000 hospital stay later. For every dollar an employer saves upfront by shifting costs to employees, they eventually pay back $3 to $10 in avoidable medical claims down the road. By making it easier to pay for healthcare when it's needed, you're not just doing the right thing for your people; you're protecting your bottom line by reducing expensive emergency room visits and major surgeries that happen when care is delayed.