Costs, Availability, and Take-Up of Health Benefits for Low-Wage Workers: Insights from 100+ U.S. Employers and 250,000+ Employees

Employer-sponsored health insurance remains a critical source of coverage for most Americans, but significant gaps persist for workers earning lower wages, according to a new analysis from the Kaiser Family Foundation (KFF) released on April 20, 2026.

The analysis, which draws on survey data and focus group discussions with more than 100 U.S. Employers employing over a quarter of a million workers, finds that while about three in four employees are offered health insurance on average, only 44% of workers in lower-wage jobs have access to coverage through their employer, compared to 94% of those in higher-wage positions.

Even when lower-wage workers are offered health insurance, they are far less likely to enroll. The study reports that 72% of those offered coverage in higher-wage jobs enroll in the benefit, while only 49% of eligible lower-wage workers do so.

On average, health insurance makes up 8% of total employee compensation across all workers, though the dollar value varies significantly by occupation. The report notes that service workers — who represent a large share of lower-wage employment — are offered less in health insurance compensation and are less likely to be extended the benefit, with only 52% receiving such offers.

These disparities have real-world consequences for workers’ health and financial stability. As noted in related research cited by KFF, uninsured or underinsured low-wage workers are more likely to delay necessary medical care, accumulate medical debt, and experience poorer health outcomes compared to their insured peers.

However, the analysis also highlights emerging strategies some employers are using to improve access. According to a 2023 survey by the International Foundation of Employee Benefit Plans, 68% of large U.S. Employers now offer premium assistance programs specifically designed for hourly or seasonal employees — up from 52% in 2020. These programs typically cover a portion of the monthly premium based on income level or job classification.

Other approaches include tiered contribution models, partnerships with Medicaid and state-based insurance marketplaces, and targeted outreach efforts in industries such as retail, hospitality, and healthcare, where low-wage work is prevalent.

The KFF analysis is part of the Peterson-KFF Health System Tracker, an online resource dedicated to monitoring trends and performance within the U.S. Health system. Researchers emphasized that as health care costs continue to rise, employers face ongoing challenges in balancing affordability, employee needs, and sustainable benefit design — particularly for their lowest-paid staff.

Addressing these gaps remains important not only for individual worker well-being but also for broader efforts to promote equity in health access. With an estimated 41 million Americans earning less than $15 an hour and often lacking alternatives to job-based coverage, workplace-based solutions are seen as a practical avenue for reducing disparities in health insurance coverage.

The findings underscore the persistent role of income in determining access to employer-sponsored health insurance and the need for continued innovation in how employers structure and support benefits for their most vulnerable workers.