New survey: why younger employees are more stressed about healthcare costs—and how HSAs can help

Key takeaways: Healthcare affordability continues to shape how employees think about care, spending, and financial stability. HealthEquity’s Spring 2026 Healthcare Affordability Pulse shows that economic anxiety remains widespread, cost pressure is changing care decisions, and employees with Health Savings Accounts (HSAs) generally feel better prepared for routine and unexpected expenses.

• Economic anxiety is widespread. Eighty percent of respondents said they were at least somewhat concerned about the economy, and 48% said they are more worried about their personal finances than they were six months ago.
• Cost pressure is changing healthcare behavior. More than one-third of consumers said they delayed or avoided needed care because of cost, with younger workers especially likely to postpone treatment.
• HSAs can improve readiness. Compared with non-HSA holders, HSA holders were more likely to feel prepared for healthcare expenses and to have savings available for unexpected bills.

Healthcare costs remain a growing burden for U.S. families and employers. Recent research shows that about four in ten adults carry medical or dental debt and roughly one-third say they have skipped or postponed needed care because of cost.¹

And it’s not only employees who are struggling. Mercer reports that employer health benefit costs rose 6.0% in 2025 and are projected to rise another 6.7% in 2026, pushing the average cost above $18,500 per employee.²

To better understand how rising healthcare expenses are affecting employees, HealthEquity surveyed 1,031 people to build a snapshot of how consumers are adjusting spending, evaluating benefits, and preparing for healthcare costs in a period of continued uncertainty. Read the full research paper here.

Key insight: Nearly half of healthcare consumers are more worried about their personal finances than they were six months ago.

The survey shows that financial concern is now a mainstream employee experience, not a niche issue. Eighty percent of respondents said they were at least somewhat concerned about the economy, and 48% said they are more concerned about their personal finances than they were six months earlier.

“I don’t feel confident at all about my personal finances. The price of goods has skyrocketed and I can’t afford any sort of emergency expense.” Gen Z male from Illinois

Younger workers stand out in several ways:

• 59% of Millennials have HSAs, the highest of any generation.
• Gen Z is the most likely to skip or delay healthcare due to cost (45%).
• Millennials are 4 times more likely than Boomers to report being highly distracted at work due to financial strain (32% vs. 8%)

For employers, that means affordability concerns are showing up as both a financial and workplace issue. Employees who are worried about prices, debt, and medical costs may be less confident, less focused, and less able to plan ahead.

Key insight: More than one-third of consumers report delaying or avoiding needed medical care due to cost.

When budgets get tighter, healthcare is one of the places many households cut back. In the survey, 36% of respondents said they delayed or avoided needed medical care because of cost.

Those with chronic conditions are hit especially hard by rising healthcare costs, and 55% of them said they had skipped care due to cost.

“There’s not much I can do. I cannot afford the cost my employer wants for my coverage [from] each paycheck.” 63-year-old lower-income female with two chronic conditions

Employers may consider chronic condition management programs to help these employees access care before it becomes more costly or impactful to overall health. These findings highlight the value of year-round education around preventive care, mental health resources, and other benefits that can help employees seek care earlier.

Key insight: HSAs are linked to stronger healthcare financial readiness.

One of the clearest themes in the research is the difference HSA ownership can make.

• HSA holders are 36% more likely to feel “very prepared” compared to those without an HSA.
• HSA holders are 31% more likely to have $500 or more saved for unexpected healthcare expenses.

However, most people still have limited cash on hand for an ER visit, hospital stay, or diagnostic procedure. 39% of people said they had to use a payment plan for an unexpected medical bill in the last 6 months. Millennials are the most likely to use a payment plan (45%), while Gen X was the least likely (31%).

HSA holders were more likely to say they understand their employee benefits very well, and respondents with stronger benefits understanding were more likely to pay surprise medical bills in full rather than let them go to collections.

Only 63% of employees knew that preventive care visits were 100% covered by their insurance, and lower-income employees are the least likely to know this. And not everyone knows how exactly payment works for preventive care.

HSA ownership is an advantage, but there is still a tremendous opportunity for employers to help build benefits literacy and financial wellbeing for their employees.

“HSAs fundamentally change how people experience healthcare costs. They are a core part of workforce financial resilience. Employers can help by making it easier to save, plan, and pay for care with confidence.” Scott Cutler, HealthEquity CEO

What can employers do to build financial readiness?

The data points to a clear mandate: benefits teams can help employees prepare earlier, understand their options better, and make more confident healthcare spending decisions.

Here are some tips to address employee financial readiness:

How can I tailor my benefits education to different generations?

• Younger workers may respond better to shorter, mobile-first, on-demand content, while older employees may need prefer longer, more detailed guidance on preparing for retirement, catch-up contributions, preventive care, or plan comparisons.

What can I do to incentivize preventive care?

• Help employees build an understanding of what preventive services are covered. Consider programs, like providing employer HSA contributions, to incentivize preventive care activity, reduce downstream costs, and support better health outcomes for employees.³

How can benefits teams modernize their HSA contribution strategy?

• Employers should consider seed contribution amounts, deductible trends, and tiered contributions based on income to help employees save for healthcare.

Why should my company offer a Health Payment Account (HPA)?

• HPAs are interest-free, no-fee alternative payment options that can help employees pay for care without incurring long-lasting financial penalties.

How HSAs can help address healthcare affordability

HealthEquity’s Spring 2026 Healthcare Affordability Pulse paints a clear picture of how employees are experiencing this moment: they are worried about the economy, feeling the strain of healthcare costs, and making difficult tradeoffs in response.

But the findings also suggest a path forward. When employers pair stronger education with savings tools and more thoughtful plan design, they can help employees feel better prepared to save, spend, and pay for care with greater confidence.