Research Insights

The hidden costs of unaffordable healthcare

Uncover the link between health plans and financial wellbeing.

In 2024, HealthEquity surveyed more than 600 working Americans enrolled in
employer-provided health insurance to better understand how different health plan types affect their ability to cover healthcare costs.

Respondents were enrolled in one of the following

High-deductible health plan (HDHP) with Health Savings Account (HSA)

1

The findings offer valuable insights into employees' concerns about their health benefits and reveal how health plan choices may influence physical and financial wellbeing.

2

HDHP without HSA

Health plan other than HDHP (PPO, HMO, etc.)

3

Employees are most
concerned about costs when it comes to their health benefits, regardless of health plan type.

1 in 3 employees with HDHP + HSA or a non-HDHP say that out-of-pocket (OOP) costs are their greatest concern.

Yet, employees with an HDHP but no HSA spend the greatest amount of household income (HHI) on healthcare.

Percentage of employees spending more than 10% of HHI on healthcare

This may suggest employees with an HDHP would improve their financial health by taking advantage of the HSA tax savings.¹

65%

47%

42%

HDHP, no HSA

HDHP + HSA

Non-HDHP

Across all health plan types, 52% of employees surveyed took drastic measures to pay for their healthcare.

Many of these measures, like juggling expenses and taking on debt, can be highly stressful and potentially add to employees' financial strain.

Actions taken due to healthcare costs

Put off another planned expense

36%

Delayed
care

33%

Borrowed from
friend or family

21%

Took out
a loan

10%

Employees with an HDHP but no HSA were more likely to delay expenses or borrow money to cover healthcare costs.

In contrast, those who have been putting money away in their HSA were less likely to run into out-of-pocket expenses outside of their budget.

HDHP, no HSA

HDHP + HSA

33%

Borrowed money

14%

46%

Put off a
planned expense

30%

32% of employees surveyed avoided treatment due to cost.

1 in 3 employees decided against getting treatment due to out-of-pocket costs.

Foregoing necessary treatment may highlight the importance of building savings. By setting aside funds in an HSA, employees can potentially avoid delaying critical care.

40%

Those with HDHP, no HSA declined treatment —the highest of any plan type.

Those with an HDHP but no HSA are especially interested in their employer providing a Health Payment Account (HPA) to help with medical costs.

An HPA is an employer-sponsored benefit that provides an interest-free line of credit to help employees pay for healthcare expenses, making it a smart choice for employers committed to helping offset rising healthcare costs.²

% of employees who desire an HPA

43%

All plan types

60%

HDHP, no HSA

Financial stress combined with skipping care can create a vicious cycle, worsening health and increasing financial problems.

To help break the cycle of financial stress and enhance employees’ overall wellbeing, consider offering:

Health Savings Account (HSA)

Health Payment Account (HPA)³

Contributions to an HSA are tax-free, which means more savings for your employees.

HPAs give employees quick access to funds, making it easier to get medical care.

Employees can use HSA funds to pay for qualified medical expenses.

An HPA lets employees pay for medical expenses over time without interest or fees.

The account encourages positive long-term savings habits.

A healthcare safety net may help employees feel less stressed about unexpected costs.

Ready to act?

Get a free benefits plan design review and discover more ways to boost health and financial security.

¹ HSAs are never taxed at a federal income tax level when used appropriately for qualified medical expenses. Also, most states recognize HSA funds as tax-deductible with very few exceptions. Please consult a tax advisor regarding your state’s specific rules.

²The HPA card is a line of credit that is subject to approval and works with providers in approved merchant categories. All charges made to the HPA card must be repaid according to the terms outline in the cardholder agreement.

³Not available in all states. HealthEquity Payments, LLC is a wholly owned subsidiary of HealthEquity, Inc. with Nationwide Multistate Licensing System (“NMLS”) ID 2564416.

HealthEquity does not provide legal, tax or financial advice.