Three-quarters of US workers believe an insured cancer patient pays less than $2,000 out of pocket in the year after diagnosis, according to a new Aflac report. The actual average total medical cost in the first year of treatment, according to a July 2026 study by the American Cancer Society (ACS) and the National Cancer Institute (NCI) published in the Journal of the National Cancer Institute, is $45,063. The ACS/NCI study, however, used Medicare cost data from 2013 to 2019, meaning the figure likely understates current costs.
And nearly half (47%) of those same workers say they could not cover $1,000 in unexpected out-of-pocket costs, and among Gen Z, that figure climbs to 61%.
The 16th annual Aflac WorkForces Report, based on a Kantar survey of 1,000 employers and 2,001 employees conducted April through May 2026, finds that misperception worsening heading into open enrollment season.
Workers who believe their out-of-pocket exposure is under $2,000 are not just underestimating what they will pay. They are also underestimating the total cost of care their coverage will be asked to absorb, and they cannot cover even the amount they think they owe.
The misperception is not new, but it is worsening. Last year’s Aflac report found 72% of workers held the same belief about cancer costs. The 2026 figure is 75%, a three-point rise that moves in the opposite direction of the rising public discourse about healthcare affordability. Employers are also shifting more financial responsibility to workers through higher premiums (35%), deductibles (32%) and copays (26%), compressing the margin further.
"Benefits remain one of the most important investments employers make, but the goalposts are shifting,” said Matthew Owenby, chief human resources officer and chief administrative officer at Aflac Incorporated. “Employees need more than coverage. They need financial protection that reflects real-world risks, information they can understand and guidance they can trust.”
Workers who believe a serious illness will cost less than $2,000 have no reason to ask about critical illness, accident, or hospital indemnity coverage. Ninety-five percent of workers in the Aflac survey said supplemental insurance can help protect their financial security. That sentiment, however, comes from a vendor-commissioned survey and does not translate into enrollment when the underlying risk is invisible to the worker.
EBRI research on voluntary benefits enrollment and financial vulnerability, published in August 2026, found that supplemental health products received about 9% of the average worker’s enrollment review time. Workers who did not enroll most often cited cost as the reason. EBRI found, however, that when the same workers were shown plain-language descriptions of what supplemental products cover and how they pay out, their interest rose markedly. EBRI interprets that result as evidence that awareness and communication gaps shape the enrollment decision, even among workers who cite cost. The cancer cost data gives that explanation a specific and concrete entry point.
The Aflac report finds that 37% of Gen Z and 40% of millennials now use AI tools to research benefits options, compared to 21% of Gen X and 4% of baby boomers. The Hartford’s 2026 Future of Benefits Study adds weight to that shift. It finds that 94% of Gen Z workers who used AI during enrollment trusted the recommendations they received. The Hartford’s research flagged the risk embedded in that trust. Workers using general-purpose AI tools that lack access to employer plan specifics face a higher chance of confusion or misguided coverage decisions.
A worker who asks an AI whether they need supplemental health insurance may receive a generic answer based on average costs rather than their employer’s plan design. That worker may be no better informed than before. The misperception problem and AI reliance are not separate issues. They reinforce each other.
Gen Z’s broader approach to benefits reflects a generational shift in priorities. Only 30% of Gen Z workers in the Aflac survey list salary as their primary job criterion, compared to 49% of employees overall. Fifty-three percent say they would trade some salary for stronger benefits, an all-time high in 16 years of Aflac data. Ninety-two percent contacted HR about healthcare benefits at least once in the past 12 months. That combination of financial exposure, AI reliance and high engagement is where the advisory role carries the most weight, and where miscommunication carries the highest cost.
