According to Bank of America Merrill Lynch’s 2018 Workplace Benefits Report, health care costs are a huge blind spot for employees when it comes to increasing financial wellness.

The newly published report suggests that employees understand most of the inputs that directly affect their financial wellness, and yet the majority ignore one of the biggest factors when they are setting long-term goals and savings priorities—health care costs. In fact, just 7% of employees surveyed identified health care as “an important building block of financial wellness.”

Researchers call this somewhat puzzling, as more than half of the work force reports having foregone health care-related spending for financial reasons. Notably, 32% of employees have skipped medical appointments for financial reasons, 21% have foregone medical tests, 14% have put off the purchase of medications, 10% have delayed hospital visits or stays and 7% have skipped out on health insurance premiums. Overall, 53% of employees say they have skipped or postponed at least one of these activities to save money.

The report suggests these figures are made more troubling by the fact that employees lack an understanding of one of the most powerful planning tools they can use to help them save for and manage health-related expenses—health savings accounts (HSAs). According to the survey, 76% of employees say they understand the salient features of HSAs, yet only 12% could correctly identify the common attributes of an HSA in a simple quiz.

“What is the implication? HSAs are a missed opportunity,” the report explains. “Education is key for employees to better manage health care expenses and fully utilize their health care benefits, including HSAs.”

The report goes on to cite some astronomical health care cost projections for healthy couples retiring today: $688,000 for women and $494,000 for men. These figures are based on data from the Centers for Disease Control and include the cost of long-term care.

Men and women show different levels of financial stress

In other ways beyond health care cost projections, the report suggests, women face a more challenging retirement planning picture than men, based on the twin facts of longer life expectancies and lower lifetime earnings expectations.

“While helping women improve their financial wellness, employers need to make a concerted effort to understand the unique challenges women face,” the report suggest. “For example, women are 14% more likely than men to feel stress from their current financial situation. At the same time, women are 13% less likely to be very optimistic about their financial outlook.”

According to the report, women on average have $119,000 in investable assets, compared with $196,000 for men. They also trail men when it comes to the amount contributed to a 401(k).

Along with their relative savings shortfall, women are more likely to fear all of the following financial wellness factors compared with men: running out of money in retirement; having to work longer than planned; becoming ill and not being able to work; being able to pay for children’s education; and needing to support family members financially. It should be noted that, while men are less likely to report that these factors cause stress, still more than half of men report all these factors stress them out regularly, except for “needing to support family members,” which is cited by 38% of men and 46% of women.

Related findings show that, across the sexes, younger people tend to struggle and worry more about financial stress.

“Employee needs are not all the same,” the report concludes. “The onus is on employers to make sure their financial wellness programs are designed to address a wide range of employee needs—not just planning for retirement.”