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

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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…

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.

"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.

The findings support that when employees have a reliable, structured way to pay for out-of-pocket costs over time, plan design can…

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