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Helping Employees Manage Out-of-Pocket Medical Expenses

By May 30, 2025No Comments

The rising cost of health care—including prescription drugs—has made it increasingly difficult for employees to afford medical services. Many forgo care to avoid out-of-pocket expenses, even when it’s recommended or necessary. Others who do seek treatment may struggle to pay their bills. While high deductible health plans (HDHPs) help keep premiums low, they can increase financial risk until the deductible is met.

To help employees manage their medical expenses, employers can consider the following strategies:

  • Offering a health plan option with a low deductible

  • Contributing to a health savings account (HSA), flexible spending account (FSA), or health reimbursement arrangement (HRA)

  • Allowing hardship distributions from 401(k) accounts for medical expenses

  • Educating employees on how to navigate their health benefits

  • Providing an employee assistance program (EAP) with financial advising resources

Offer a Low Deductible Health Plan

HDHPs are popular for their lower premiums and HSA compatibility. But when employees are unable to cover upfront medical costs, offering a low deductible plan—or adding one to your benefits lineup—can be an impactful solution.

These plans help employees better manage and predict their spending, especially those who take costly medications or have chronic conditions. While premiums are higher, they reduce exposure to large, unexpected bills. Keep in mind: employees with fewer medical needs may end up paying more overall if they don’t use the plan frequently.

Comparison of high vs low deductible health plans

Offering multiple plan options allows employees to select the coverage that best fits their health needs and budget. This approach can boost your overall benefits appeal, especially for organizations with a diverse workforce.

Contribute to an HSA, Health FSA, or HRA

Employers can ease the burden of out-of-pocket costs by contributing to a tax-advantaged medical savings account. These accounts help employees pay for expenses not covered by their health plans. Here’s a quick overview of each option:

  • HSAs: Individually owned, portable, and flexible. Contributions can be made by the employer, employee, or others. Must be paired with an HDHP. Unused funds roll over year to year.

  • Health FSAs: Employer-sponsored. Funded by employee pre-tax contributions, with optional employer contributions. Must be used during the plan year (some exceptions apply). Requires more employer involvement.

  • HRAs: Employer-funded only. Also employer-sponsored and may allow rollover of unused funds depending on the plan design. More structured than HSAs.

Comparison chart of HSA, FSA, and HRA options

Contribution rules and rollover comparison

Allow Hardship Distributions From Retirement Accounts

Employers may allow hardship distributions from 401(k) or 403(b) accounts to assist with medical expenses. These are not loans and do not require repayment, but must meet strict IRS criteria.

Employees must demonstrate an immediate and heavy financial need, such as medical care for themselves or their dependents, and confirm they lack other resources. These withdrawals are typically taxed and may incur a 10% early withdrawal penalty unless an exemption applies.

Educate Employees About Health Coverage

Many employees struggle with plan literacy. Offering education can empower them to make cost-effective decisions and better use their benefits. Important topics to address include:

  • Basic terms like deductible, copay, and coinsurance

  • In-network vs. out-of-network care

  • Choosing the right providers and utilizing preventive care

Distributing this information via emails, handouts, videos, or live Q&A sessions can help reach all employee types.

Consider sharing these smart consumer tips:

  • Use HSAs or FSAs for tax-free savings on medical costs

  • Always choose in-network providers

  • Take advantage of free preventive services

  • Opt for telehealth when appropriate

  • Visit primary care doctors over urgent care or ER when possible

  • Request generic drug options

  • Compare prices before filling prescriptions

  • Look for drug manufacturer coupons

Offer an EAP

Employee assistance programs (EAPs) offer confidential support for personal challenges that may affect well-being or job performance. These programs often include:

  • Mental health counseling

  • Financial and legal advising

  • Support for substance use or family issues

Most EAPs are provided through third-party vendors and are free for employees to use.

Links and Resources

This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice. ©2025 Zywave, Inc. All rights reserved.