Only 28% of US workers say they are very prepared to cover an unexpected $1,000 expense, according to new research from the Employee Benefit Research Institute. Among employees who experienced a recent medical event, more than half paid at least $1,000 out of pocket. The figures point to a financial gap that voluntary benefits — accident, critical illness and hospital indemnity insurance — exist to close.

EBRI published its findings August 20, 2026 in the "Expanding the Benefits Horizon" issue brief. The brief is the final installment of a three-part research program funded by Lincoln Financial. The study draws on a survey of 1,130 benefits-eligible workers and identifies understanding and perceived cost as the primary enrollment barriers, EBRI said.

Which supplemental products do workers actually understand?

Self-rated comprehension of supplemental health products lagged core coverage. Forty percent of employees reported a high understanding of critical illness insurance, and 35 percent reported high understanding of hospital indemnity. By contrast, 54 percent said they had a high understanding of health insurance. Reported offer rates also stayed low: 28 percent of workers said their employer offered accident insurance, 21 percent critical illness and 17 percent hospital indemnity.

Those offer rates may understate what employers actually provide. In earlier surveys within the same EBRI program, employers were more likely than employees to report offering several benefits. Workers at organizations with fewer than 500 employees reported lower access to benefits information across email, websites, smartphone apps and social media.

Why are voluntary benefits still skipped?

Cost ranked as the top reason employees passed on voluntary coverage. EBRI suggests many workers may not have weighed the added premium against the out-of-pocket costs the coverage could offset after a medical event. When respondents read brief, plain-language descriptions of what each benefit covers and how it pays out, their interest in enrolling rose materially. EBRI cautions that stated interest does not guarantee enrollment.

Premium cost is partly within employer control. A pending class action alleges broker commissions consumed 37 percent of Macy's supplemental benefit premiums. Plaintiffs are using employer Form 5500 data to build similar voluntary benefits lawsuits. The litigation underscores how broker economics can shape what employees actually pay.

How deeply are medical bills cutting into worker finances?

The strain extends well beyond a single $1,000 bill. Forty-seven percent of employees reported at least moderate financial difficulty from a medical event, and 37 percent saw a medical bill sent to collections. Fifty-seven percent have delayed medical care, with 26 percent doing so in the past year. Cost was the main reason cited by just under six in 10 of those who postponed care.

Among employees already enrolled in supplemental health coverage, 57 percent described it as very important. Many said losing the coverage would mean more worry, lower productivity, more absences and greater reliance on loans or retirement savings. Those effects echo findings from a Zurich study linking financial resilience to employee performance and retention, which reported that only half of workers could cover a few months without income.

What can employers change about the enrollment process?

EBRI points back to the enrollment materials themselves. Plain descriptions of each supplemental product, a clear comparison between premium and a typical out-of-pocket bill, and benefits communication that reaches workers at smaller sites could shift enrollment behavior. Employees could weigh voluntary coverage more seriously once they understand what each product pays out and what it costs relative to the bills they already absorb.

The August 20 brief leaves open whether improved messaging will translate into sustained enrollment gains; EBRI and Lincoln Financial have signaled continued tracking of voluntary benefits adoption through 2027.