Employee preferences in health plan design: results from a national survey

Introduction Employer-sponsored health insurance covers over 60% of the U.S. population under age 65 and represents a significant expense for employers, yet employees’ views on benefit design remain understudied. Methods We conducted a nationally representative survey of 1200 U.S. adults using employer-sponsored insurance to assess preferences for benefit trade-offs, including narrower provider networks. The survey used stratified sampling and weighting to ensure demographic representativeness. Results Nearly half (49.9%) preferred retaining the current balance of salary and benefits. However, 45.9% would accept a narrower network in exchange for higher compensation, and 30.9% supported narrow networks if savings were redirected to other benefits. Trade-off preferences varied by age, sex, race, parental status, and political ideology. Most respondents (74.8%) trusted employers to select plans and believed any cost reductions should be returned to employees (72.0%). Many also supported excluding high-cost providers without demonstrated quality advantages. Conclusion The findings suggest that employees are open to cost-efficient plan designs if savings are shared transparently, although other data suggest that few employers are doing this.