Why You Cannot Afford Care With Insurance

Having health insurance in the United States no longer means health care is affordable. In September 2026, 44% of adults told KFF^[1] that health care costs are difficult to afford, and 28% said they had skipped or postponed care they needed in the previous year because of cost. The problem is no longer framed correctly when we talk only about the uninsured. The sharper story is about the insured.

Insurance is not the same as affordability

The clearest current measure of this comes from the West Health-Gallup Healthcare Affordability Index^[4], fielded in late 2024. It classifies adults into three tiers. Only 51% were "Cost Secure," defined as able to afford care and medicine without cutting back. That is the lowest Secure share since 2021. Roughly 29 million adults, 11%, fell into "Cost Desperate," a record high, meaning they could not access needed care because of cost. An estimated 91 million people, 35% of adults, said they could not get quality care if they needed it today.

Coverage blunts the problem but does not solve it. KFF found that 82% of uninsured adults under 65 had difficulty affording care, but so did 42% of insured adults. Among insured adults under 65, three in ten still skipped or postponed needed care because of cost (KFF^[1]).

The deductible is the front door to this problem

Most people with insurance must spend a large amount of their own money before the plan pays for most services. In the 2025 KFF Employer Health Benefits Survey^[2], 88% of covered workers faced a deductible before most services were covered. The average deductible for single coverage was $1,886. A third of covered workers, 34%, had a deductible of $2,000 or more, up from 18% a decade earlier.

The deductible on its own explains a lot of skipped care. If a visit costs $200 before the deductible is met, that visit is $200 out of pocket, not $25. It is rational for a person to delay a $200 visit they cannot afford. KFF reports that 15% of adults say their health got worse because they delayed care, rising to 27% among people with multiple health conditions (KFF^[1]).

Premiums and deductibles rise together

Being insured is expensive before any care happens. Average annual premiums reached $9,325 for single coverage and $26,993 for family coverage in 2025, and the average worker paid $1,440 for single coverage or $6,850 for family coverage out of their paycheck (KFF 2025 EHBS^[2]). That is money spent before the first dollar of care.

On top of premiums, the out-of-pocket maximum, the safety net that is supposed to cap total spending, is now $10,600 for an individual and $21,200 for a family for 2026 plans, up from $9,200 and $18,400 the year before, and rising to $12,000 and $24,000 in 2027 (healthcare.gov^[3]). A family can pay nearly $27,000 in premiums and still be on the hook for another $21,200 in out-of-pocket costs before insurance covers 100% of covered in-network care.

"Underinsured" is the missing category

The word for a person with coverage that is too thin to actually protect them is "underinsured." The scale is documented most vividly in the KFF Health News "Diagnosis: Debt"^[5] investigation, built on the 2022 KFF Health Care Debt Survey. It found six in ten working-age adults with coverage had gone into debt getting care in the prior five years, a rate only slightly lower than that of the uninsured. More than 100 million people, 41% of adults, carried some form of health care debt.

The debt data make the same point from the other direction. KFF's analysis of federal survey data put total medical debt at at least $220 billion^[6], with about 14 million people owing more than $1,000. Debt is not confined to the poor: the KHN investigation found nearly half of adults in households earning more than $90,000 had gone into health care debt in the prior five years (KFF Health News^[5]).

What this means for a specific person

The mechanics above translate into predictable, ordinary decisions. KFF found 43% of adults took some step to cut prescription costs in the past year, including 19% who cut pills in half or skipped doses. About half of adults say they could not easily absorb an unexpected $500 medical bill, and 19% could not pay it at all (KFF^[1]). Those are not abstract statistics. They are people choosing between a co-pay and groceries.

For a patient, the practical takeaways are concrete. Know what your deductible and out-of-pocket maximum actually are, because that is what a visit will cost early in the plan year. Know whether a service runs through the deductible or is covered with a flat co-pay. And before assuming insurance is always cheaper, know that a cash price for a routine visit can in some cases cost less than running that same visit through a high-deductible plan, a comparison worth a dedicated look.

The through-line is this: coverage is a starting point, not a guarantee. A person with insurance can still be hundreds of dollars from the next doctor visit, and the data show tens of millions of them are.

This is patient education, not financial or legal advice. Figures are tied to their primary sources and year, because the underlying numbers change every plan year. Reviewed October 3, 2026.

Sources

• KFF, Americans' Challenges with Health Care Costs (September 2026)^[1]
• West Health, Inability to Pay for Healthcare Reaches Record High (April 2025)^[4]
• KFF, 2025 Employer Health Benefits Survey (October 2025)^[2]
• HealthCare.gov, Out-of-pocket maximum/limit^[3]
• KFF Health News, Diagnosis: Debt (June 2022)^[5]
• KFF, The Burden of Medical Debt in the United States (February 2024)^[6]