Employers Say They're Helping With Medical Costs in 2026. Workers Disagree.

For workers reading their open enrollment booklets this fall, a new study lands with uncomfortable timing. Prudential Financial surveyed 3,096 employees in January and found a yawning gap between what employers think their benefits are doing and what workers feel in their checking accounts. Three-quarters of employers say they are doing enough to help with rising medical costs. Under half of employees agree. The cost spikes are not theoretical. Seven in ten workers reported at least a 5% increase in their medical expenses, and one in five said the bill jumped 15% or more. That kind of pressure changes how people work, how they shop for jobs, and whether they take the care their plan supposedly covers.

What the New Prudential Survey Actually Shows

The Prudential Group Insurance team surveyed 3,096 U.S. employees in January 2026 and published the findings on May 11. The headline number is the perception gap. Seventy-five percent of employers said their benefits package was doing enough to help workers manage medical costs. Fewer than 50% of employees agreed. That alone qualifies as a meaningful disconnect, but the survey goes further and quantifies how the gap shows up in everyday financial behavior.

Workers said climbing medical expenses now significantly influence three connected outcomes: financial stress, mental health, and physical health. Seventy-plus percent reported at least a 5% increase in their medical costs over the past year. Twenty-two percent said the increase was 15% or more, which is the kind of jump that pushes household budgets into rationing mode. Eighteen percent of employees told Prudential they have already delayed medical care or procedures because of financial stress, a behavior that tends to convert short-term savings into longer-term claims and lost workdays.

The most striking number in the study may be the perception split on benefits packages specifically. Thirty-eight percent of companies said their benefits package brought greater stability during periods of financial stress in the past year. Only 17% of workers said the same thing. Employers are convinced the package is doing emotional work. Workers are not feeling it.

A lot of this comes down to plan design. The 2026 Mercer National Survey of Employer-Sponsored Health Plans pegged the average per-employee health benefit cost increase at roughly 5.8%, and Aon and WTW projected similar 6 to 9 percent gross trend rates before plan changes. To blunt that, large employers leaned hard on consumer-directed health plans (CDHPs). In a typical 2026 CDHP, the worker carries a deductible of $1,650 or higher for self-only coverage, pairs it with a Health Savings Account, and pays the first several thousand dollars of care before coinsurance kicks in. HMO and PPO enrollees see a softer hit on the deductible but a sharper one on premium share, while HDHP enrollees see the opposite. The cost shift is real in every flavor, just routed differently. Employers count the HSA seed contribution as part of the benefit. Workers count the deductible they have to clear before the seed is useful.

"Rising medical costs are putting pressure on employers and employees alike, intensifying financial stress across the workforce," said Jon Trevisan, vice president and head of distribution at Prudential Group Insurance, in the company's release. "The most successful organizations will likely take a holistic approach that balances managing costs with delivering meaningful benefits that support overall employee financial health."

The study is consistent with a broader pattern Healthcare Dive and HR Dive have tracked across the spring. Mercer warned in November of a "healthcare affordability crunch" hitting both sides of the table, and a recent ADP report found workers are responding by skipping care or skipping medications. The 2026 Prudential numbers are not an outlier. They are the latest data point in a year of worker pay stagnating while employer-sponsored health insurance premiums climb.

Why the Perception Gap Keeps Widening

There are two structural reasons employers and workers see this so differently, and both have gotten worse in 2026.

The first is that employer cost containment in 2026 has been heavy on shifting expenses to workers rather than reducing total spend. When a company moves its medical plan to a higher deductible, raises the employee premium share, narrows the network, or reroutes elective procedures through a third-party navigator, the HR department books that as "managing costs." The worker books it as "my paycheck shrunk and my care got harder." Both descriptions are correct. They are describing the same line item from opposite sides. The accounting framing is what creates the perception gap in the first place. Benefits leaders measure total spend on a year-over-year basis and report a flat or modestly improved number to the C-suite, which gets coded internally as a win. Workers measure their own out-of-pocket spend in the same period and watch it climb, which gets coded as a quiet pay cut. Both teams are reading honest numbers and arriving at opposite conclusions. We have seen this play out across companies slashing worker benefits in 2026 while quietly insisting the package is unchanged, and across the parental leave and benefits pullback at Deloitte and Zoom that workers loudly contested even as employers framed the changes as modernization.

The second reason is that benefits are increasingly competing with AI investment and other capital priorities inside the company. Throughout the spring, Metaintro reporting has documented employers cutting compensation and benefits to fund AI investments, and the AI productivity-versus-pay gap that has workers producing more while wages flatten. When the CFO is choosing between matching a 7% premium increase and buying GPU capacity, the worker rarely wins. Prudential's study captures the downstream emotional cost of those decisions without naming AI directly.

The behavioral consequences are exactly what Prudential warns about. Companies could see lower productivity from financially stressed workers, increased absenteeism, and higher turnover. None of those are abstract. They show up in the job market as workers being willing to take half-salary pay cuts to switch into roles with better health coverage, and as candidates skipping job postings entirely when the salary and benefits picture is unclear. The 2026 candidate is reading benefits summaries like a forensic accountant, and the gap between the recruiter's pitch and the actual coverage is starting to cost employers offers.

There is also a generational layer. Younger workers are explicitly trading pension-style retirement commitments for bigger paychecks now, in part because they assume employer health and retirement benefits will keep erasing under them. They are budgeting for the medical inflation they expect, which makes the Prudential survey numbers feel less like news and more like confirmation. Meanwhile, young workers are picking up second and third jobs to cover cost-of-living gaps, and the OECD's wage tax data shows real take-home pay at decade lows. The household is being squeezed from medical, tax, and wage angles simultaneously, and the benefits package is one of the few employer-controlled variables left.

What Workers Can Demand in Open Enrollment

Open enrollment runs in most companies from October through November. Workers preparing for the 2027 plan year have a stronger negotiating posture than they realize, because employers are now publicly aware that their own perception is out of step with workers'.

First, ask for the actuarial value of the plan, not just the premium. Premiums tell you what you pay each pay period. Actuarial value tells you what share of your total medical costs the plan will cover after deductibles, copays, and coinsurance. If your premium dropped 5% but your actuarial value dropped 12%, your employer "managed costs" by making your coverage worse. Workers are entitled to ask. Many HR teams will hand the number over if pressed, because they have it for their own planning.

Second, push on the specific line items that are doing the most damage to your budget. Specialty drug copays, mental health visit caps, out-of-network coverage for emergency travel, and physical therapy session limits are the four most common places where 2026 plans have tightened without changing the headline premium. GLP-1 weight loss medications are a particular flashpoint this year. A growing share of self-funded employers excluded Wegovy, Zepbound, and similar drugs for non-diabetic indications in 2026 plan documents, citing per-member annual costs above $10,000. Workers who counted on coverage are finding the exclusion buried in the plan summary, and many are paying out of pocket or switching to compounded alternatives. If your employer is offering a Health Savings Account match or a Flexible Spending Account top-up, that is real money. Ask for it in writing. The Prudential study makes clear that 38% of employers think these tools are working. If they think it is working, they should be willing to expand it. The Employee Benefits Security Administration (EBSA) under ERISA also requires plans to disclose material modifications, and workers who suspect a quiet exclusion can request the Summary Plan Description and the Summary of Material Modifications directly.

Third, treat your benefits package like a salary negotiation. The HR salary expectation gap data shows employers and workers are also misaligned on base pay, and the smart move is to negotiate compensation and benefits together. If your company is freezing salaries but pointing at "rich benefits," ask them to quantify the richness. Always-on compensation conversations are how the most successful workers stay ahead of stealth cuts. Open enrollment is one of two annual windows where the company is contractually required to disclose every benefit change in writing. Use it.

Fourth, if your employer's benefits package is genuinely thin and the company will not move, that information should change your job search. Roles with strong HSA matches, low-deductible PPOs, and full mental health parity are still out there, particularly in healthcare, public sector, and large enterprise tech. The functional unemployment data shows wages declining across many sectors in 2026, but total compensation, including benefits, is where strong employers are still competing. The healthcare cost question is now one of the top three factors workers cite in job decisions, and recruiters know it. A serious benefits package is a serious recruiting tool, and the companies still investing in one are easier to find than they were a year ago.

The Prudential study lands with one quiet but useful implication. Employers know there is a perception gap. The data is published. The cover story that workers simply do not appreciate their benefits no longer holds. That gives workers something to point at in a negotiation, in a benefits committee meeting, or in a one-on-one with a manager. The 17% versus 38% number is the conversation starter.

People Also Asked

Q: How big is the gap between employers and workers on medical costs in 2026?

A: Prudential Financial surveyed 3,096 U.S. employees in January 2026 and found 75% of employers think they are doing enough to help workers manage medical costs, while fewer than 50% of workers agree. On benefits packages specifically, 38% of employers say their package brought stability during financial stress in the past year, but only 17% of workers say the same.

Q: How much have workers' medical costs actually gone up?

A: More than 7 in 10 workers told Prudential they experienced at least a 5% increase in medical costs over the past year. Twenty-two percent reported increases of 15% or more. Eighteen percent of workers have already delayed medical care or procedures because of financial stress, which can translate to higher long-term claims and lost workdays.

Q: What can workers do about it during open enrollment?

A: Ask HR for the actuarial value of the plan, not just the premium. Compare specialty drug copays, mental health visit caps, and physical therapy limits year over year. Push for an HSA or FSA match in writing. Treat the benefits package as part of your total compensation negotiation, especially if the company is freezing base pay while pointing to "rich benefits" as the offset.

Wondering what you should earn, and what your benefits should actually cover? Join Metaintro to get real-time pay and benefits intelligence, weekly job market reports, and the open enrollment playbook the rest of your office is not reading.