American workers are stressed about understanding what health insurance they need and enrolling for benefits. They also are less satisfied with their overall benefits packages but factor family history into health insurance decisions. These are key findings from the 2019 Aflac WorkForces Report, a national online survey of 1,200 benefits decision-makers and 2,000 employees across the U.S., released today by Aflac, the leader in supplemental insurance sales at U.S. worksites.

"After many signs of optimism last year, including record highs in employees' benefits and job satisfaction, the 2019 Aflac WorkForces Report found that American workers largely are stressed about critical health insurance decisions and less satisfied with their benefits offerings," said Matthew Owenby, senior vice president, chief human resources officer at Aflac. "Given the high importance both employees and employers place on benefits, we feel the report's findings offer valuable insights to understanding the most pressing issues and the unmet needs that can be addressed."

Employee Stress High, Especially for Millennials and Gen Z

According to the Aflac study, nearly 6 out of 10 (58%) employees say understanding what insurance or benefits they need is somewhat or very stressful, with levels even higher for Gen Z (68%) and millennials (64%). In addition, more than 6 in 10 (62%) say negotiating medical billing is somewhat or very stressful. These figures increase with generations, with 66% of millennials and 63% for Gen Z finding that medical billing is stressful, compared to 59% for those 39 and older. Finally, 43% of all employees say enrolling in health insurance is somewhat or very stressful; percentages that increase to 51% for millennials and 55% for Gen Z.

Benefits Satisfaction Declines

A strong connection exists between benefits and happy workers, with more than 8 in 10 (83%) employers that offer benefits agreeing that their company's benefits offerings increase employee satisfaction. However, a year after reaching a high (61%) since the initial Aflac WorkForces Report released in 2011, benefits satisfaction has declined to 52% among workers. The same percentage of employees surveyed would be at least somewhat likely to accept a job with lower compensation but a more robust benefits package. More than 6 in 10 (61%) American workers are extremely or very satisfied in their jobs, down from 65% in 2018. Additionally, one quarter of employees report having left a job or turning down a job offer due to the benefits offered, similar to 25% in 2018.

Family History Matters

The new finding from the Aflac survey reveals the importance family history plays in workers' health insurance decisions. Almost three-quarters (73%) of employees, including 80% of millennials and 75% of Gen Z, said their family history is somewhat to extremely influential in guiding their health insurance decisions. In addition, 84% would be likely to purchase insurance to help cover costs associated with a serious illness in their family history (e.g., cancer, heart attack or stroke). This is especially true for Gen Z (95%) and millennials (89%).

Debate Helping Younger Workers

Another new finding from the Aflac survey conveys the impact that the national debate on health care has had in affecting workers' approaches to health care benefits decisions. While moderately more employees (38%) said the ongoing national debate about health care has helped them to better understand their health care options—compared with 24% who said it has made them more confused about choices—these figures increase significantly for younger generations. In fact, 78% of Gen Z and almost half (49%) of millennials said the debate has helped them better understand options.

Knowledge and Confidence Wane

Demonstrating slight setbacks compared to 2018, less than half of workers (46%) have a solid understanding of their total annual cost for health care coverage and care, compared to 50% in 2018. Also, more than one-third (35%) surveyed have a full understanding of their health insurance policy, according to the Aflac study, down from 39% in 2018. More than 1 in 5 (22%) did not feel confident they understood everything they signed up for after their most recent benefits enrollment, up from 19% in 2018.

Similar to past years, an evaluation of employees' benefits enrollment patterns provides likely explanations behind shortcomings in understanding health care insurance. For example, the vast majority (93%) of employees still choose the same benefits each year. And more than half (56%) of employees surveyed spent less than 30 minutes researching their benefits options during the last open enrollment, including 14% who didn't do any research at all. Finally, more than half of workers (54%) would rather be subjected to some form of discomfort such as bungee jumping off a bridge or singing the national anthem at a sporting event than research their open enrollment benefits. These feelings are highest among younger workers, including 84% of Gen Z and 66% of millennials who would choose some discomfort rather than research open enrollment benefits.

"Adequate information remains the leading unmet need employees cite to being confident about their benefits selections, followed by more money and more help," said Owenby. "Understanding the continued trends of workers choosing the same benefits year after year and spending less than 30 minutes researching benefits options, employers need to continue simplifying information across channels and offering resources for one-on-one assistance."  

Financial Preparation Better, Still Daunting

Given the importance of benefits decisions, an uninformed choice now could affect a worker's financial well-being in the year ahead, leading possibly to more serious implications like draining a savings account or 401(k) to pay deductibles and other uncovered costs. Despite progress compared to 2018, still more than half (52%) of workers would not be able to cover unexpected out-of-pocket medical costs of $1,000 or more, and almost one-third (29%) would not be able to cover an unexpected out-of-pocket medical bill greater than $500.

Rising Medical Costs Drive Need for Supplemental Insurance

The Aflac study shows more high-deductible plans being offered to employees, requiring those employees to increasingly take on more of the cost-sharing ratio for health insurance. However, almost three-quarters (74%) of employers believe their employees have enough options available to help them meet their health care financial obligations, up from 68% last year. With many aware of their financial challenges, a strong majority of employees (85%) also see a growing need for supplemental insurance benefits, a sentiment that has grown significantly and is up from 63% in 2014.  

In addition to helping workers cover the costs that health insurance may not cover, supplemental coverage can help reduce financial risk. The Aflac study found that nearly one-third (32%) of employers who offer benefits report offering supplemental insurance benefits to employees, up from 24% last year.