New research from the Employee Benefit Research Institute (EBRI) underscores an important reality about healthcare spending: most insured individuals use relatively little care in a given year with employment-based coverage.

In 2023, 50% of individuals with employment-based health coverage used no or very low claims spending.¹

• 20% had no claims at all.
• 20% had total claim spending under $500.
• 10% spent between $500 and $887, the median level of spending

Meanwhile, just 20% of the population accounted for 84% of total healthcare spending.

These numbers aren’t totally surprising; they reflect how risk pooling works in health insurance. Still, they highlight some important considerations for benefits administrators.

One core function of health insurance is risk pooling that protects against high-cost, low-probability events. That’s why it’s expected that many people will have little or no utilization in any given year.

Low utilization isn’t a sign of system failure or disengagement. It’s evidence of a functioning risk pool, where broad participation makes financial protection possible for those who experience serious illness, injury, or complex conditions. Many covered individuals may have low or even zero claims in a year, yet they are essential to the stability and sustainability of coverage.

Understanding that dynamic is critical for employers and health plans. The distribution of spending shapes everything from premium strategy to benefit design, but it should also shape how we think about member experience.

Benefit strategies often focus heavily on the highest-cost members. While those individuals need thoughtful care management and coordinated support, they represent a relatively small share of the population.

Most members have low or even zero claims in a given year. In practice, many may only engage with their benefits at key moments (for example, filling a prescription, seeking urgent care, completing a preventive screening, or facing an unexpected medical event). In those moments, complexity becomes a barrier. If account balances are difficult to find, reimbursement processes are confusing, or eligibility rules feel opaque, trust erodes quickly.

When members don’t interact with their benefits often, the experience has to work immediately and intuitively. Simplicity isn’t just a convenience; it’s a requirement.

For Alegeus partners, these findings reinforce the importance of designing consumer-directed benefits for the entire population, not just the highest-cost members.

First, access and clarity must be foundational. Members should be able to easily view account balances, understand eligible expenses, and navigate payments and reimbursements without friction. A mobile-first, integrated experience helps even infrequent users feel confident the moment care is needed.

Second, low annual claims spending doesn’t eliminate future risk. Preventive care and early engagement remain essential. Consumer-directed benefit platforms can help connect financial readiness with proactive health decisions, encouraging members to address small issues before they escalate into more complex and costly events.

Finally, financial protection must remain central to the value proposition. For many individuals, one core value of coverage is protection against unpredictable, high-cost events. High-deductible health plans paired with savings vehicles like HSAs can reinforce this role, helping position health benefits into a broader financial wellness strategy that spans both short-term expenses and long-term savings.

The concentration of healthcare spending is well established. What this data reinforces is the scale of claims spending among individuals with employment-based coverage. Half of covered individuals had no or next to no healthcare spending in a single year, yet their participation is fundamental to the system.

For employers and health plans, the goal is not simply managing high-cost claims; it’s also creating benefit experiences that preserve the strength of the risk pool, encourage appropriate utilization, and build financial confidence across the entire population.

The opportunity for Alegeus and our partners is to ensure that protection is supported by clarity, accessibility, and meaningful engagement for every member, in every moment that matters.

¹Source: All stats used in this article are from the EBRI study featured here.