The Benefit Blindspots Report - Zillennials and the Health Insurance Struggle

In a new report, Justworks shares exclusive data on how Zillennials approach health insurance decisions. In a survey conducted in partnership with The Harris Poll of over 4,000 U.S. adults ages 18 and older, new trends emerge on research methods and confidence levels during the open enrollment period. 

Key Findings 

As health insurance prices for the average American are on the rise, open enrollment time can be more stressful than ever. In fact, nearly a quarter of Zillennials (23%) would rather wait at the DMV than go through open enrollment for health insurance, and 1 in 5 (20%) would rather sit through a 3-hour work meeting. Key findings among Zilennials include: 

1. Pricing is the biggest fear: 26% of Zillennials say cost and affordability is their primary concern when it comes to selecting health insurance. 

2. Confidence in selecting a plan is low: Over half of Gen Z adults (55%) admit they don’t know much about choosing an insurance plan because they’ve never had to choose their own plan. 

3. Research methods vary depending on generation: Zillennials stand in stark contrast to their Gen X/Boomer counterparts when it comes to sources of health insurance information. 

4. Knowledge gap between offerings and understanding: Only about one in five Zillennials (19%) use an FSA or HSA and actually understand the benefits of it.

Pricing is the Biggest Fear

According to a study by KFF, the amount health insurers charge for coverage on the ACA Marketplaces is rising by an average of 26% in 2026. These rising premiums are translating into stressors for young adults participating in open enrollment. Gen Z and Millennials have the same primary concern when it comes to selecting health insurance — 26% of Zillennials say cost and affordability.

Other concerns include worries about finding the right coverage for their needs (18%) and not knowing if they are choosing the right plan (12%) – the latter being of particular concern for Gen Z (14% vs. 10% Millennials).

Confidence in Selecting a Plan is Low

Selecting an insurance plan on the open market can be daunting, especially for those young adults who are on their own health insurance plans for the first time. About one in five Zillennials (21%) are not confident in their ability to choose a suitable health insurance plan for themselves, including nearly 3 in 10 Gen Z adults (29% vs. 17% Millennials). In fact, over half of Gen Z adults (55%) admit they don’t know much about choosing an insurance plan because they've never had to select a plan themselves. This lack of confidence could be stemming from an unwillingness to prioritize planning ahead - More than 2 in 5 Zillennials (44%) acknowledge that they don’t put a lot of thought into choosing their insurance plan.

And although selecting health insurance is something most Americans have to do every year, Zillennials may not be  getting any better at it. Nearly 2 in 5 (39%) report problems stemming from their most recent insurance selection, and over 2 in 5 Gen Z (44%) do not feel prepared to handle more complex health insurance decisions as they get older.

Research Methods Vary Depending on Generation

Despite the concerns over pricing and the lack of confidence in choosing a plan, worries don’t seem to translate into increased research or investigation. Almost 3 in 5 Zillennials (59%) say they spend an hour or less researching and selecting their health insurance plan. 

For those who do prep with independent research, the methodology  varies widely generation to generation. Millennials rely heavily on the internet, with 47% saying they use Google as their main source. The younger Gen Z is picking up the phone to facetime Mom -  41% say parents and family are their top advisors.

In line with their tech-first upbringing, and in stark contrast to their Gen X/Boomer counterparts, there is significant engagement among Zillennials with AI tools for medical or insurance information - over 3 in 5 (62%) have used them for this purpose, compared to half that among Gen X/Boomers (29%). Reliance on online communities is high - Gen Z adults are just as likely to use social media for research (28%) as they are employer/HR resources (23%). 

The trend towards using technology as a research tool could be on the rise; nearly 1 in 5 of Zillennials (19%) who are not currently using AI for this purpose are open to doing so in the future.

Knowledge Gap Between Offerings and Understanding

Perhaps unsurprisingly given the lack of confidence and research time, there’s a significant knowledge gap between offerings and understanding. Despite broad awareness of Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) among Zillennials (80%), actual usage and understanding are much lower. While 30% of Zillennials have an FSA or HSA, only about 1 in 5 (19%) use one and understand the benefits of it. 

Millennials are more familiar with these accounts than Gen Z (53% vs. 35%), indicating a generational gap in financial literacy around health benefits. When selecting health insurance, Gen Z are also more likely to express concern about not knowing what questions to ask (10% vs. 6% Millennials) or who to ask them to (7% vs. 3%).

Looking Ahead: Simpler, Smarter Explainers Welcome

As health insurance prices are expected to continue to rise, being informed and confident when selecting your plan is more important than ever. Americans want access to clear communication and education materials - all generations said a simple comparison tool that explains differences would be most helpful from employers during open enrollment. And with growing use of AI tools — and openness to use them in the medical/insurance space — there’s a clear opportunity to integrate AI-driven resources into the open enrollment process, such as in chatbots or plan recommendation engines.

Research Method

The consumer survey was conducted online within the United States by The Harris Poll on behalf of Justworks from October 16-20 and 21-23 among 4,156 U.S. adults ages 18 and older. Respondents for this survey were selected from among those who have agreed to participate in our surveys. The sampling precision of Harris online polls is measured by using a Bayesian credible interval.  For this study, the total sample data is accurate to within ± 1.8 percentage points using a 95% confidence level. These credible intervals will be wider among subsets of the surveyed population of interest.