New Industry Research from Nonfiction, in partnership with Paytient

Your employees have insurance. That doesn’t mean they can access care.

A new study of 1,500+ workplace-insured Americans reveals a silent crisis hiding in plain sight — one that’s costing employers $50–140 billion a year.

What you'll find inside:

brown_checkThe three hidden costs of delayed care — personal, organizational, and cultural.

brown_checkWhy employees with household incomes up to $125,000 are still unable to access care.

brown_checkThe exact behaviors employees hide from their managers (and the productivity drain they cause).

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Most benefits leaders assume that if employees have coverage, they’re covered. The data says otherwise.

Forty percent of insured workers are skipping or delaying the care they need because they can’t afford the out-of-pocket costs. They’re not telling you. They’re showing up anyway — distracted, unwell, and quietly disengaging.

This report gives you the full picture: the personal toll, the business cost, and the surprisingly small gap standing between your workforce and real access to care.

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1,516 survey respondents 

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6 months of in-home
qualitative immersions

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Expert interviews across the healthcare industry 

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95% confidence level,
3% margin of error

What the data reveals.

Six months of research. 1,500+ voices. The findings will change how you think about benefits.

40%

of insured employees skip or delay necessary medical care — not because they lack coverage, but because they can’t afford the out-of-pocket cost.

6.3 hrs

of productivity lost per employee, per week, due to untreated health conditions. That’s nearly a full workday — every single week.

$50-$140B

drained from the employer market annually because of the ripple effects of delayed and avoided care.

3-to-1

For every $1 employers save by not addressing the affordability gap, they pay back $3–$10 in avoidable claims, ER visits, and lost productivity.

45%

of workplace-insured Americans never met their deductible in 2023. They’re paying for coverage they can’t actually use.

342%

increase in total family premiums since 1999. Worker wages? Up just 119%. The math has never worked — and it’s getting worse.

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What you'll find inside:

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The three hidden costs of delayed care — personal, organizational, and cultural.

checkmark_orangeWhy employees with household incomes up to $125,000 are still unable to access care.

checkmark_orangeThe exact behaviors employees hide from their managers (and the productivity drain they cause).

checkmark_orangeHow the “professional facade” is masking a retention crisis.

checkmark_orangeThe liquidity gap: why the barrier to care is often smaller than employers realize.

checkmark_orangeA framework for understanding what true access to care actually requires.

The coverage exists. The care doesn’t always follow. This report explains why — and what benefits leaders can do about it.

These aren’t outliers.
They’re your employees.

Over six months, Nonfiction Research sat in the homes of insured Americans and listened. What they heard was a pattern — of shame, sacrifice, and silence. Here are just three of the stories inside the report.

“Both my parents died in their 40s from heart attacks. I had been having some chest pain and was ordered to have a stress test. I was told I would have to pay $250 upfront. I still haven’t had the test.”

WORKPLACE INSURED 42-year-old

“This is one of the jobs I’ve loved the most. But the doctor told me to try a new medication for my diabetes, and it was $285 a month with this insurance. It’s one of the main reasons I’m looking for a new job.”

WORKPLACE INSURED 32-year-old biomedical engineer

“I can’t 100% be the mom I want to be. I would love to just grab her and walk with her to make her feel better. But I can’t because I’m in too much pain.”

WORKPLACE INSURED 36-year-old mother

These employees aren’t disengaged. They’re desperate. And they’re in every workforce in America.

Built for the people shaping benefits.

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HR and 
benefits leaders


You already know your employees are stressed about healthcare costs. Now you’ll have the data — and the language — to make the case for closing the gap. This report gives you the research to act on and the narrative to bring to leadership.

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Benefits consultants
and brokers


Your clients trust you to bring them what’s next. This original research puts hard numbers to what you’ve been hearing in the field. Use it to open conversations, challenge assumptions, and recommend solutions backed by data.

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CFOs and
finance leaders


Every delayed deductible has a downstream cost. This report maps the full financial picture — from presenteeism and productivity loss to avoidable ER visits and the 3-to-1 cost ratio of inaction. The ROI of acting is real and it’s in here.

 

Get the full report.
Free.

See the data. Hear the stories. Understand what’s really happening inside your workforce — and what it takes to build benefits that actually work.

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About Paytient

Paytient is redefining the currency of care. We give employees the purchasing power to say yes to the treatment they need — and pay over time, on their own terms. Because true access to care requires more than an insurance card. It requires the ability to afford what the card doesn’t cover.

Today, Paytient partners with 6,000+ employer health plans serving 23 million+ members. When employees can access care without financial fear, they show up healthier, more present, and more loyal to the organizations that made it possible.