Paytient-Greenwald Study Finds 61% of Insured Workers Have Paid for Healthcare Entirely in Cash Without Filing a Claim

In a new study of over 2,000 employer-insured workers, 68% said they would prefer predictably paying cash for a major healthcare expense through small paycheck deductions. These findings put payment experience alongside plan design as a cost and experience lever for employers and benefits advisors.

COLUMBIA, Mo., Nov. 12, 2026 /PRNewswire/ -- Employers are projecting healthcare cost increases of 11% or more without plan changes. Against that backdrop, a new national study commissioned by Paytient and conducted by Greenwald Research points to a plan design tenet that can lower premiums year over year and improve the employee experience: payability, or a person's ability to self-pay or cash-pay for care. The data shows that when employers build payability directly into plan design, they create patient-centered health plans. Those plans allow employers and employees to move to lower-cost plan designs with confidence, in a way that improves, rather than impairs, the employee experience.

Payability, Measured is the second in Paytient's Payability Papers, a four-part series examining how the out-of-pocket payment experience shapes health plan performance and the employee experience. Surveying 2,024 full-time, employer-insured workers, the study finds that two-thirds of employees prefer a $2,000 cost spread over six months to a $1,000 copay paid in full upfront to receive care. Greenwald's research is the first of its kind to reveal this behavioral preference in how consumers pay for healthcare, and it highlights real opportunities for employers and insurers to design health plans around how people prefer to pay for care.

These findings that have direct implications for employers stand out:

• Employers who solve for payability gain on both sides of the ledger. When employees have a reliable way to pay out-of-pocket costs over time, more than 80% say they'd view their employer as more innovative and more attuned to their financial realities. The plan efficiency case is equally strong: employees who can pay for care seek it sooner, reducing the severity of deferred claims.
  
  
• Employers have less visibility into benefits usage and employee experience than they realize. Sixty-one percent of employees have paid for healthcare or medication entirely in cash without filing a claim — a workaround almost completely invisible to employers. Only 29% believe their employer fully understands what paying for care out of pocket is like.

"Insurance was built to protect people from the financial risk of rare, catastrophically expensive care. Over time, we've stretched it to cover nearly everything, which drives up premiums and makes the system harder to navigate. This research shows that people want to pay for healthcare the way they pay for almost everything else in their lives: upfront, in-full with a clear cash price or predictably, over time to fit their household budget. A smarter plan design pairs lower-cost coverage for rare, high-cost care with the payment tools "Paytients" have told us they want for everything else. Employers already use payroll to collect premiums (and smooth the payment of taxes) over the life of employment. Using payroll to smooth out-of-pocket costs is the plan design opportunity hiding in plain sight, and it can help employers save substantially on plan costs," says Joe Gabler, Chief Operating Officer of Paytient.

The findings support that when employees have a reliable, structured way to pay for out-of-pocket costs over time, plan design can become more efficient without becoming less supportive — and that changes the calculus on deductible architecture, total cost of care, and the actual value delivered by healthcare benefit.

"What stands out in this data is how universal the preference for payability in healthcare is. It holds across income levels, from workers earning under $50,000 to those earning over $100,000.

"This isn't a low-income affordability story. It's a structural preference that cuts across the entire workforce, and can be a universal strategic advantage for employers," says Lisa Weber, Chief Research Officer and Head of Healthcare Insights at Greenwald Research.

Payability, Measured is available for download here. For more information, visit www.paytient.com. If you're attending HLTH 2026, stop by Paytient's booth (#2824).

About Paytient
Paytient is the leader in innovative healthcare payment solutions. Our Healthcare Payability Platform has put over $50 billion of purchasing power into the hands of 26 million individuals across employer, ACA and Medicare plans. In doing so, Paytient is helping shape more accessible, equitable, and lower-cost health plans across commercial, individual, and regulated healthcare markets. To learn more, visit www.paytient.com and join us on LinkedIn.

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SOURCE Paytient Technologies