Employees Increasingly Prioritize Lower Health Care Premiums

Rising health care costs are reshaping how employees choose workplace benefits, even when those selections expose workers to significant future financial risk.

Nearly two-thirds of employees reported cost as their top priority during open enrollment, according to Securian Financial’s annual workplace benefits study, “The Affordability Trap: Why Cheaper Choices Cost Employees More.” The focus on cost leads many employees to choose lower-premium plans with higher deductibles; skip supplemental coverage; or scale back voluntary benefits, a pattern identified by the report as an “affordability trap.”

While these decisions may reduce payroll deductions in the short term, the study found they often leave employees vulnerable to sizable out-of-pocket expenses when medical events occur.

In the past year alone, 22% of surveyed employees received a medical bill that was higher than expected. An average of one in five tapped savings or emergency funds to pay medical costs, while 17% reported taking on medical debt.

Nearly one-third of respondents experienced significant financial stress tied to health care expenses, and 13% delayed or avoided care altogether because of cost concerns. For 3% of surveyed employees, medical debt even pushed them to consider or file for bankruptcy.

These findings align with broader national trends identified by West Health and Gallup’s Affordability Index, which found U.S. workers’ ability to afford health care has deteriorated in recent years. According to the report, with the expected expiration of some Affordable Care Act subsidies and upcoming reductions in Medicaid enrollment, millions of U.S. residents may face higher premiums and out-of-pocket costs in 2026.

Based on its recent nationwide survey of nearly 20,000 U.S. adults, West Health–Gallup estimated that roughly one-third of U.S. adults—about 82 million people—have made trade-offs with everyday expenses such as utilities, transportation or food in order to afford health care. Some respondents reported stretching prescription medications, borrowing money or cutting back on other essentials.

Securian’s study suggested employers can play a critical role by reframing open enrollment to include total cost and risk, rather than just monthly premiums.

Recommended strategies include showing real-dollar scenarios that account for premiums, deductibles and out-of-pocket maximums across different health care utilization levels. When employees elect high-deductible health plans, those options should be paired with education about supplemental coverage such as accident, critical illness or hospital indemnity insurance to help mitigate potential exposure. While only 30% of employees surveyed said they are enrolled in supplemental coverage, more than two-thirds of enrollees said it was helpful.

The research also highlighted the growing value of decision-support tools. Seventy percent of employees surveyed said they used artificial intelligence-based or scenario-driven tools when available, yet an average of one in five reported feeling pressured to make enrollment decisions quickly. Clear, transparent communication about plan changes, trade-offs and priorities can help employees make more informed choices under time constraints, according to the report.

“The affordability trap isn’t about employees making bad decisions. It’s about employees making rational decisions with incomplete information—and paying for it later,” said Emma Thomas, Securian Financial’s director of marketing, who heads its workplace benefits research, in a statement. “Employers can’t eliminate the trade-offs, but they can make those trade-offs visible.”