As a small business owner, you decide what benefits to offer your employees. But without some guidance, this might feel like you’re ordering dinner off a menu before your guests arrive, without knowing what they’re in the mood for. So it's worth knowing: what actually makes an employee look at a benefit and decide to enroll?
To find out, we surveyed 500 employees who are recent benefits enrollees. Across medical, dental, vision, HSA, FSA, and DCFSA, we asked people what made them more likely to enroll, and asked the ones who skipped a benefit why they passed. The patterns were consistent enough to shape some recommendations on how to make decisions about benefits.
Employees value prevention, not just a low price tag
For medical, dental, and vision, the messaging that resonated the most with employees wasn't the cheapest premium- it was preventive care. Employees are drawn to the concept of catching small issues before they become expensive ones. That framing outranked "low cost" messaging across all three lines of coverage (48% for medical, 52% for dental, 52% for vision).
What this means for plan selection: the lowest monthly premium isn’t the whole story. Focus on plans with strong preventive coverage— routine checkups, cleanings, and eye exams are often covered at no additional cost on qualifying plans— which may garner more enrollment and more perceived value than emphasizing low upfront cost. Price still matters, but as part of a larger value equation.
Tax-advantaged accounts represent value, with or without employer contributions
HSA, FSA, and DCFSA all function quite differently. But they have one thing in common: the tax advantage is the most frequently cited reason employees value these accounts- 63% for HSA, 62% for FSA, 57% for DCFSA- ahead of other factors, including how much the employer contributes. For HSAs specifically, portability and rollover (the funds remain the employee's, subject to IRS rules on qualified use) matter too.
What this means for plan selection: if budget is tight, your dollars may go further by simply making these accounts available (paired with an HSA-eligible medical plan, as needed) rather than stretching to fund employer contributions to them. Employees are already motivated by the tax structure alone.
When employees think coverage is "not worth it", financial education is what’s needed
Among people who skipped a benefit they were offered, "not worth it" was the top or co-top reason for dental (52%), vision (40%), HSA (49%), and FSA (42%). (Note: Vision and HSA sample numbers are robust; Dental and FSA are based on smaller samples and are directional.)
When employees prefer to have their dollars in their pockets rather than going into these benefits, what does that tell us? They may plan to be low-utilizers or to “roll the dice” for a year. Premium costs can feel like a guaranteed financial loss for healthy individuals. Depending on their financial situation, immediate liquid cash can take priority over mitigating a hypothetical future medical cost risk.
What this means for plan selection: high waive rates are worth treating as a signal to revisit plan options with your advisor. Consider variables like deductible levels, network breadth, and how well preventive care is covered. Better communication and benefits education, including demonstration of real-world financial equations, can help change behavior.
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Not every benefit fits every workforce
68% of DCFSA-eligible employees who don't enroll say it's simply not relevant to them, which makes sense if they don't have dependent care costs. But 47% of employees with a child under 13 said the same thing- suggesting a real gap in whether parents realize the benefit applies to them at all. (Note: directional finding based on a smaller sub-sample; see methodology.)
What this means for plan selection: before prioritizing DCFSA, look at your workforce composition. It can be a strong fit for a team with young families, and less relevant for a team without. Plan for an educational need to create understanding of how these benefits work, since eligibility and value is not understood by employees.
A one-size-fits-all lineup may undersell itself to parts of your team
Two patterns held up consistently: income and life stage. Lower-income employees respond more to low-cost messaging; higher-income employees respond more to plans they see as “paying for themselves”. Similarly, relevance mattered more than plan quality for benefits tied to life circumstances- DCFSA for parents, vision for employees over 35 are more likely to need it.
What this means for plan selection: if your team spans a range of incomes or life stages, a single medical plan (or a single framing of "value") won't land the same way for everyone. Offering tiered options- for example, a high-deductible plan alongside a richer PPO- gives different segments of your team a plan that actually fits how they think about value.
The bottom line for offering the right benefits
At the end of the day, you know your employees best. Or, if you feel like there are gaps in your understanding- tap into your employees’ opinions by doing a quick survey on their benefits priorities. Seek to uncover whether financial or coverage misunderstandings are getting in the way of your employees understanding benefits value.
The businesses that get the most out of their benefits spend aren't necessarily the ones spending the most- they're the ones choosing benefits that match what their employees actually weigh when deciding whether to enroll. Gusto benefits advisors are ready anytime to help you review your business needs and priorities and understand your options.
If you want to offer benefits for the first time, or have benefits you haven’t yet integrated into your Gusto account, speak with a Gusto benefits advisor to explore your options.
Methodology: 500 recent benefits enrollees were surveyed and asked to pick their top statements per line of coverage (top 2 for most lines, top 1 for DCFSA). Barrier questions were asked to non-enrollees who were offered but did not elect coverage. Some line-of-coverage barrier samples (medical, dental, FSA, DCFSA) are smaller and should be treated as directional; vision and HSA barrier samples are more robust. Percentages cited for smaller-sample lines reflect directional patterns rather than statistically precise rates.
This content is not to be taken as tax, legal, benefits, financial, or HR advice. Since rules and regulations change over time and can vary by location, consult a lawyer, tax, or HR expert for specific guidance.
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