U.S. companies across industries are offering generous 401(k) plans to retain employees. Can healthcare keep up?
Companies in specialized fields often conduct benchmark surveys to assess what other employers are offering and what benefits staff value most, The Wall Street Journal reported July 19.
Costco, for example, contributes an amount equal to 4% of pay to workers’ 401(k) accounts after one year of service, regardless of whether the employee contributes, rising to 9% for those with 25 or more years of tenure. It is a structure that has helped many of the retailer’s front-line, hourly workers accumulate more than $1 million in their accounts, the Journal reported.
The average organization’s 401(k) match is roughly 4.7% of eligible salary, according to a Vanguard analysis cited by the Journal, and only 6% of plans offered a match of 7% or higher in 2025. A handful of employers go well beyond that: Southwest Airlines matched up to 9.3% of salary in 2024, while Boeing’s match reaches 10%, and Visa and Mastercard both exceed a dollar-for-dollar match on the first several percentage points of pay, according to the Journal.
Health systems themselves largely fall within that average range. Phoenix Children’s offers a 401(k) with a 100% match up to 4% of pay, Scottsdale, Ariz.-based HonorHealth offers a 403(b) with a 4% match and Falls Church, Va.-based Inova offers a 5% match from day one. Houston-based Memorial Hermann Health System, Oklahoma City-based OU Health and Chicago-based Rush University System for Health each offer matches up to 6%, and Bellevue, Wash.-based Overlake Medical Center & Clinics tops that group with a 403(b) match of up to 7%, according to Becker’s 2026 ranking of top places to work in healthcare.
For health systems, matching that kind of structure runs into the same cost pressure already reshaping wage and retention strategy.
Workforce costs across U.S. hospitals rose 5.6% in 2025 and remain the industry’s largest expense, at 60% of all costs, according to the American Hospital Association. That is before accounting for HR 1’s projected $90.9 billion cut to federal Medicaid spending in 2029 alone, per the Commonwealth Fund. A richer 401(k) match adds a new fixed cost on top of an already-strained labor budget, at a time when advertised registered nurse salaries have grown 26.6% faster than inflation over the past four years, per AHA data.
Some employers are turning to nonelective, rather than matching, contributions instead — a lever that does not require employees to contribute anything themselves to receive it. Unionized workers at Ford and General Motors get a 10% nonelective contribution, up from 6.4% under 2023 contract negotiations, after both automakers phased out pensions for new hires roughly 20 years ago, the Journal reported. Sentara Health is a rare exception among health systems, offering both matching and nonelective retirement contributions, according to Becker’s reporting.
It is a structure a health system could theoretically apply to nursing or other healthcare roles, though it would mean committing to a fixed cost, regardless of turnover. It is a bigger gamble in an industry where full-time RN turnover alone cost $60,090 per nurse in 2025.
A growing group of employers — including Boeing, Verizon, Chipotle, Comcast, Walgreens and News Corp — have also begun matching employees’ student loan payments through their 401(k) plans, a benefit enabled by the 2022 Secure 2.0 Act, according to the Journal. That model could carry particular relevance in healthcare, where new graduates often enter the workforce already carrying significant student debt.
Student debt is already a workforce lever health systems are pulling. Rochester (N.Y.) Regional Health launched a program in March offering eligible CRNAs up to $180,000 in loan repayment support, along with $30,000 for radiologic technologists and $25,000 for surgical technologists, tied to a commitment to work at the system after graduation.
Boone, N.C.-based UNC Health Appalachian followed in April with up to $30,000 for early-career nurses, physical therapists and imaging staff who commit to 2-3 years of employment. Neither program routes the benefit through a 401(k) match the way Boeing’s does, leaving the Secure 2.0-enabled structure largely untested in healthcare.
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