Your company pays for comprehensive preventive care. Under the Affordable Care Act, annual wellness visits and recommended screenings are covered at 100%—no copays, no deductibles, no out-of-pocket cost for employees. It is, by any reasonable definition, a free benefit.

And yet, roughly 70% of the working-age adults on your medical plan don’t use it.

That’s not a rounding error. That’s seven out of ten employees leaving a fully-funded preventive benefit on the table while undiagnosed conditions quietly drive up your claims costs, ER visits, and medical trend. The gap between the benefit you offer and the benefit your people actually use may be the single largest source of waste in your healthcare budget.

The question isn’t whether preventive care works—the data on that is overwhelming. The question is why participation is so low and what you can do, as a benefits leader, to close the gap.

The Friction Nobody Talks About

When benefits leaders see low engagement numbers, the instinct is usually to communicate harder—more emails, more intranet banners, more open-enrollment messaging. But communication isn’t the only barrier. In many cases, the system itself makes it difficult for people to follow through.

Start with access. According to an AMN/Merritt Hawkins survey, the average wait time to see a family practice physician for a physical exam is approximately 21 days. For employees juggling work schedules, childcare, and commutes, that wait alone kills momentum. In some regions, the problem is worse—many primary care providers aren’t accepting new patients at all. Employees without an established PCP relationship face an even steeper climb.

Then there’s the experience itself. Adult prevention in the U.S. is typically delivered in disconnected pieces: a wellness exam with a PCP, a separate flu shot, cancer screenings scheduled months later, and risk assessments that may miss cardiovascular and mental health issues entirely. When patients are left to coordinate all of these services on their own, important steps get missed.

And perhaps the most frustrating barrier of all is the benefit itself. Employees engage in preventive care expecting 100% coverage, only to be surprised when their health plan treats some services as diagnostic rather than preventive—subjecting them to deductibles, coinsurance, or copayments. In some cases, the exact same service is coded as “preventive” for a healthy patient but “diagnostic” for someone with an existing condition, even when both were performed during the same annual exam. That kind of inconsistency doesn’t just cost employees money—it erodes trust in the benefit entirely.

What “Average” Engagement Actually Means

Here’s the number that should make every benefits leader uncomfortable: when carrier reports show your adult preventive engagement is “average,” that typically means about 30% of the adults on your plan received an annual preventive visit. The word “average” makes it sound acceptable. It isn’t.

Consider what 30% participation means in practice. For every employee who gets screened for early-stage hypertension, diabetes, or cancer, there are more than two who don’t. Those undiagnosed conditions don’t disappear — they surface later as emergency department visits, inpatient admissions, and high-cost claims. EHE Health’s multi-employer claims analysis found that comprehensive preventive care users had approximately 26% fewer ER visits and over one-third fewer non-maternity inpatient admissions compared to the general population. The people skipping prevention today are the high-cost claimants of tomorrow.

Yet many employers continue to accept the industry average as a benchmark, rather than treating it as the red flag it is. The problem with benchmarking against other employers is that everyone else’s engagement is equally poor. You’re measuring yourself against a broken standard.

A Playbook for Closing the Gap

The employers achieving meaningful improvement in preventive care engagement aren’t doing one big thing differently—they’re doing several things systematically. Based on best practices documented across employer programs, here’s what the playbook looks like.

Know your baseline and set real targets

Before you can improve engagement, you need to know where you stand—not just overall, but by location, age group, and sex. Different populations have different barriers, and a single aggregate number hides critical gaps. Once you have a baseline, set an overall target that isn’t tied to industry benchmarks. Organizations that have successfully increased adult prevention participation have generally added 15 percentage points in year one (moving from 30% to 45%) and then 10 additional points per year until reaching their goal.

Remove the friction, don’t just message around it

Self-insured employers have more leverage than they may realize. They can set geographic access standards (primary care within a defined distance), create availability targets (appointment wait times under a defined number of days), and work with their TPAs to eliminate the diagnostic-vs.-preventive coding traps that surprise employees with unexpected bills. Some employers have removed limits on annual preventive services entirely. Others use bundled payment approaches that eliminate separate billing codes altogether, ensuring all services performed during a preventive exam are covered at 100% without the coding ambiguity.

Apply the Rule of 7 — with variety

Marketing research suggests that people need to encounter a message approximately seven times before acting on it. For benefits teams, that means the annual open-enrollment email isn’t enough. Effective programs deploy a mix of communication channels—direct mail, email, phone outreach, on-site events, videos, topical webinars, and incentives—and track which tactics are actually converting non-users, not just reaching people who were already engaged.

Connect prevention to everything else

Many large employers offer 20 to 30 separate wellness and point-solution programs—covering everything from mental health and nutrition to chronic condition management and fertility. The problem is that most employees don’t engage with them because the programs are disconnected from the care experience. A well-designed prevention program can serve as the front door to those investments, connecting the clinical findings from an annual exam directly to the employer’s benefit ecosystem. That requires maintaining a program inventory, creating referral pathways from the preventive exam to available solutions, and tracking whether those referrals actually convert to engagement.

The Bottom Line

A 70% non-participation rate in a free, ACA-mandated benefit isn’t a communication problem—it’s a systems problem. The employers making real progress on engagement are the ones treating preventive care as a strategic priority with measurable targets, not a checkbox on a benefits brochure. They’re removing barriers rather than talking around them, and they’re connecting prevention to the broader health and benefits infrastructure they’ve already built.

The data is clear: when adults actually participate in comprehensive, evidence-based preventive care, costs go down, high-cost claims decrease, and employees get healthier. The challenge isn’t proving that prevention works. It’s getting people through the door.

For a deeper look at the guiding principles and tactical playbook, download the full white paper: Guiding Principles and Best Practices in Preventive Care.