More than half of American workers with employer benefits spent four hours or less reviewing enrollment materials last year, according to new research from the Employee Benefit Research Institute (EBRI) and Lincoln Financial. Those same workers are regularly absorbing medical bills they cannot afford. The coverage that could offset those costs exists at many of their employers, but they don't know it.
That gap is the central finding of EBRI Issue Brief No. 663, the third installment in a three-part series examining employer, broker, and employee views on voluntary benefits. The employee survey covered 1,130 benefits-eligible workers, fielded in October 2025.
Seventy-three percent of respondents had experienced at least one medical event costing more than $500 in the past five years. Among those with a recent event, 53 percent paid at least $1,000 out of pocket. Only 28 percent said they were very prepared for a $1,000 expense, and 44 percent had nothing saved for unexpected medical costs at all.
Supplemental health products - including accident, critical illness, and hospital indemnity insurance - are designed to offset exactly this kind of exposure. Most employees at smaller employers don't know they're available. Employers offering accident insurance report a 46 percent offer rate, but only 28 percent of employees say they have access. EBRI found the awareness gap was widest at organizations with fewer than 500 employees.
The EBRI data points to a specific, replicable fix. When employees were shown plain-language descriptions of what each supplemental health product covers and how it pays out, interest in enrolling rose substantially. Seventy-one percent expressed interest in accident insurance after reading a clear description, 76 percent in critical illness, and 63 percent in hospital indemnity.
Employees who chose not to enroll most often cited cost as the barrier. But the report found they were unlikely to have weighed the incremental premium against the out-of-pocket exposure the coverage would offset - a gap the plain-language descriptions closed. When the tradeoff is stated explicitly, interest rose across all three supplemental health products tested.
The EBRI broker survey, published earlier in the series, found that brokers see enrollment and communication as the main areas where carriers can better support them, and three in four expected carriers to supply digital enrollment tools for the annual enrollment window.
The awareness and preparedness gaps EBRI documents are widest at companies with fewer than 500 employees. Workers at smaller organizations reported lower access to benefits information across every communication channel: email, websites, apps, and social media. They were also more likely to report being unprepared for a $5,000 unexpected expense.
Among employees who were aware they had access to accident insurance, 70 percent enrolled. The product is not the barrier. Awareness is.
