4 in 5 Americans feel unprepared for surprise medical costs

New York – October 9, 2025 – Equitable  announced new findings from a national survey of more than 1,000 consumers, highlighting key financial trends shaping how Americans engage with their workplace benefits.

The survey revealed that 80% of Americans worry that an unexpected medical expense could derail their financial goals, with more than a quarter of this group indicating that a bill under $1,000 would cause financial hardship. Younger generations are especially anxious — 89% of Gen Z and millennials said an unplanned medical cost would disrupt their financial plans, compared to just 56% of baby boomers.

Since employer-sponsored health insurance often does not cover the full cost of medical care, workers frequently pay out of pocket for uncovered expenses. When respondents were asked how they would pay for a costly and unplanned medical bill, 48% said they would set up a payment plan, 31% would use general savings, and 28% would rely on credit cards. Notably, 12% would take a hardship withdrawal from their retirement account, with millennials (20%) and Gen Z (16%) more likely to do so than Gen X (6%) or baby boomers (3%).

“Americans’ health and wealth needs are inextricably connected. An unplanned visit to the hospital can put a person’s long-term financial security at risk — especially if they need to tap into retirement savings to cover a costly medical bill,” explained Stephanie Shields, Head of Equitable’s Employee Benefits business. “While some approach open enrollment as a chore each year, it is important to take the time to understand all the benefit options offered by your employer. This investment can protect your health and your financial well-being.”

As employees look to better understand and maximize their workplace benefits, Equitable’s survey revealed the following key insights:

• Younger workers are reshaping how employees learn about benefits – While 55% of employees still rely on HR materials and information sessions from employers to understand their workplace benefits, younger generations are embracing less traditional digital tools. The survey found that 37% of Gen Z use platforms like TikTok, Instagram, Reddit and YouTube for benefits information — more than any other generation. Additionally, millennials lead all age groups in their use of AI, with 30% using the tools for benefits guidance.
• Financial professionals are an untapped resource in benefits selection – Despite 80% of survey respondents saying it’s important to have a financial advisor when selecting and managing benefits, only 20% actually consult one during open enrollment. Those who do report feeling more confident in their choices. While financial professionals are often associated with investing and retirement planning, they can also help individuals make smarter benefits decisions by viewing them as part of a broader financial strategy.
• Employees need more education on voluntary benefits to unlock their value – Voluntary benefits, which are supplemental health solutions that help cover out-of-pocket expenses not included in major medical or other insurance, remain misunderstood by many workers. The survey found that upwards of 40% of employees lack confidence in their understanding of these benefits. Yet, once informed, more than 80% said they consider them highly valuable. For example, while only 41% were initially confident in their knowledge of hospital indemnity insurance, 87% found it very valuable after learning more about it.

Unlocking the full potential of voluntary benefits is also important to employers — especially small businesses — which often face similar challenges in understanding these additional offerings. To explore this topic further, Equitable recently published a white paper titled: “The power of voluntary benefits for small to midsize businesses.”opens in a new tab Based on a survey of more than 500 small to mid-sized businesses, nearly all respondents indicated that voluntary benefits are key to attracting and retaining employees. Further, nearly three-quarters (73%) of small business owners believe that offering voluntary benefits sends a clear message of care and commitment. Yet, nearly four in 10 cited low employee participation as a key barrier to offering or expanding voluntary benefits. Additionally, more than a quarter (27%) of respondents said they struggle to understand the solutions themselves, often finding them overly complex.

“Voluntary benefits are no longer just a checkbox option — they’re a competitive advantage,” said Shields. “As small to mid-sized businesses look to attract and retain top talent, it’s essential they understand the strategic value of these cost-effective solutions. With the right support from benefits providers and brokers, employers can improve education, tailor communications and drive meaningful utilization — ultimately, helping employees protect their financial well-being and helping small businesses stand out in today’s competitive job market.”

About the survey:

The survey was conducted by an independent, global consumer and B2B panel provider. Respondents include 1,000 U.S. adults (ages 18 and older), with the total survey population representative of U.S. demographic data. The online survey was fielded from August 28, 2025, through September 4, 2025. Survey participation was anonymous.