Healthcare affordability remains a significant pressure point for American workers, with more than one in three delaying or avoiding care due to cost, according to new research from HealthEquity, the nation’s largest independent health savings account (HSA) custodian by account volume. The findings, released today as part of HealthEquity’s second Healthcare Affordability Pulse, show how these pressures are shaping care decisions, workplace productivity, and financial preparedness across American households.
HealthEquity’s Spring 2026 survey found that healthcare-specific pressures show no signs of easing. A recent Gallup poll cites healthcare affordability as Americans’ top domestic concern and HealthEquity’s data underscores why. Over a third of respondents (36%) reported delaying or avoiding needed medical care due to cost in the past six months. Despite a 16-point jump in benefits understanding since the Fall 2025 wave, the share of consumers who feel financially prepared for healthcare expenses fell from 50% to 42%, showing that knowledge alone isn’t enough to close the financial gap.
The Real Cost of Delayed Care
Among the 36% of respondents who reported delaying care, the most commonly skipped services were specialist visits, prescription medications, and diagnostic tests, precisely the care tied to early detection and ongoing condition management. The impact is sharpest among those with the least margin for error:
Chronic condition patients: 44% delayed care, compared to 25% of those without chronic conditions
Lower-income households: 46% of those earning under $50,000 delayed or avoided care
Younger workers: Gen Z (45%) and Millennials (42%) delayed at significantly higher rates than Gen X (30%) or Boomers (29%)
Workers may also be skipping care they’re already entitled to receive. Despite most health plans covering preventive visits at no additional cost, one in three respondents don’t fully understand this benefit, a knowledge gap that likely keeps people from seeking care that could catch problems early.
Skipping care merely defers costs and often multiplies them. Commonwealth Fund research shows that more than half of adults with employer coverage who delayed care reported their health problems worsened as a result. The financial consequences follow at every level: studies have shown that medication non-adherence alone adds more than $5 billion annually to the U.S. healthcare system, a figure that reflects only what’s visible at the system level, not the compounding burden individuals carry.
“Healthcare costs are forcing Americans to make tradeoffs no one should have to face: skipping a test, delaying a specialist visit, or going without a prescription,” said Scott Cutler, HealthEquity President and CEO. “For employers, this is more than a benefits issue –it is a workforce health, productivity, and financial resilience issue. The urgency here cannot be overstated.”
Delayed Care As a Workforce Productivity Issue
The ripple effects of healthcare affordability pressure don’t stop at the doctor’s office. Nearly half of all respondents (48%) say they are more financially worried now than six months ago. Among younger workers, the anxiety is following them to work: Millennials are four times more likely than Boomers to report being highly distracted at work due to financial strain (32% vs. 8%).
The cost to employers is significant as workers lose an average of 7.3 hours of productivity each week due to financial stress, costing U.S. employers an estimated $183 billion annually. Healthcare affordability fuels a vicious cycle: employees under financial stress are not only distracted but more likely to delay or skip care, leading to worse health outcomes, higher absenteeism, and additional costs that ultimately land back on the employer’s balance sheet.
HSAs Make a Measurable Difference
Having an HSA correlates with a fundamentally different relationship with healthcare costs. The Spring 2026 Pulse illustrates the real changes in how people think about, plan for, and absorb medical expenses. Across every metric, HSA holders demonstrate meaningfully stronger financial readiness:
Affordability: HSA holders are 43% more likely to say their healthcare expenses are mostly or completely affordable than non-HSA individuals
Preparedness: 49% of HSA holders feel prepared to cover routine healthcare expenses, compared to 36% of non-HSA individuals
Sense of security: 88% of HSA holders say their account helps them feel financially prepared for healthcare expenses — at least somewhat — and 54% say it helps a great deal or quite a bit
Benefits literacy: 72% of HSA holders understand their benefits very or extremely well, versus 64% of non-HSA individuals
Control: HSA holders with strong benefits understanding are three times more likely to report “quite a bit of control” over healthcare costs (27% vs. 9%)
“When 88% of HSA holders say their HSA helps them feel more financially secure, the message is clear: HSAs fundamentally change how people experience healthcare costs,” Cutler continued. “The challenge now is scale. Employers should think about HSAs the way they think about retirement readiness, not as a benefits line item, but as a core part of workforce financial resilience.”
The HealthEquity Healthcare Affordability Pulse tracks American consumer sentiment on healthcare costs, financial preparedness, and economic wellbeing on a biannual basis. The Spring 2026 edition surveyed 1,031 full-time, part-time, and self-employed Americans who were primary or shared healthcare decision makers enrolled in employer-sponsored health plans between Feb. 11 and Feb. 26, 2026.
The full report, including detailed demographic breakdowns and methodology, is available for download at https://www2.healthequity.com/research/spring-2026-healthcare-affordability-pulse/.
## About HealthEquity
HealthEquity and its subsidiaries administer HSAs and various other consumer-directed benefits for over 17 million accounts, working in close partnership with employers, benefits advisors, and health and retirement plan providers who share our unwavering commitment to our mission of saving and improving lives by empowering healthcare consumers. Through cutting-edge solutions, innovation, and a relentless focus on improving health outcomes, we empower individuals to take control of their healthcare journey while ultimately enhancing their overall well-being. For more information, visit www.healthequity.com.
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