Cost pressures are driving health care tradeoffs

ROSELAND, N.J. - New research from ADP reveals more than 4 in 5 people feel valued because their employer provides access to benefits beyond medical.

Employees are navigating one of the most complex benefits landscapes in a generation. Health care costs are rising, out-of-pocket expenses are climbing, and the gap between what workers have saved and what they feel prepared to cover is widening.

In its eighth year, the ADP TotalSource Benefits Survey is shedding insight into how people feel about benefits at work.

The survey revealed five trends impacting people across the U.S.

1. Employers have become the anchor of trust in a changing benefits environment. As external confidence in the health care system weakens, employees increasingly look inward to their employers for stability and reassurance. Almost three-quarters of workers continue to believe their employer will provide benefits that meet their needs, even amid legislative and economic uncertainty. This reflects a broader shift in expectations: employers are now viewed as navigators of complexity, not just sponsors of plans
2. Cost pressure is driving employees to make healthcare tradeoffs. Cost has become the main way employees evaluate their benefits. Health insurance premium affordability now outweighs plan features, optional coverage, and the range of benefits offered. This cost-first approach is not just shaping preferences, it is influencing real decisions and pushing employees to make decisions that can affect their health
3. Employees have more money set aside yet feel less secure. Employees are setting aside more money for unexpected healthcare expenses, reflecting greater awareness and intent to prepare for potential costs. However, this progress has not led to greater peace of mind. Instead, nearly 40% of employees say they feel unprepared to handle out-of-pocket expenses, suggesting that rising costs and ongoing uncertainty are outpacing individual financial gains.
4. Employees are spending more time evaluating and choosing benefits. Compared to this year, employees in 2024 spent less time reviewing benefits and reported growing confidence, supported by improved digital enrollment experiences. However, by 2025, average review time increased to nearly two hours (119 minutes), and more than half (55%) reported spending one to three-plus hours. Fewer people are spending less than an hour, while more are spending more than eight hours.
5. Retirement anxiety is rising faster than health care anxiety. Medical insurance remains the most valued benefit for employees, but concern about long-term financial security is rising quickly. Retirement savings are quickly moving to the center of employee priorities, reflecting growing awareness of longevity risk, economic uncertainty and the need for stability beyond today’s health care needs. Increasingly, employees see financial wellness and health security as closely linked, viewing retirement readiness as essential to overall well-being.

Employees are not asking for more benefits, but for better outcomes

Across the findings, one message stands out: employees want clarity and relevance. They want benefits that are easier to understand, aligned with their needs and supported by guidance that helps them make sound decisions.

The 2026 benefits landscape is defined less by a lack of options and more by a lack of certainty. Employees are saving more, researching more and spending more time evaluating their choices, yet many feel unsure about the results. This dynamic places employers at the center of the experience, with a growing responsibility to reduce complexity and support informed decision-making.

As healthcare costs climb and financial pressures extend further into the future, strategies that emphasize guidance, personalization and human support alongside technology will be best positioned to build trust, strengthen engagement and deliver sustained value for both employees and employers