Higher premiums, deductibles and medical bills are forcing families to cut care, drain savings and take on debt, even when they have insurance.
Health coverage no longer protects many families from financial strain. Premiums and deductibles are rising alongside medical prices, leaving people with insurance still postponing care, rationing prescriptions and borrowing to pay bills. For some, the cost has reshaped decisions about housing, work and family life.
Bill McAdams, a 45-year-old travel nurse in Holiday, Florida, was uninsured when he had a stroke last year. His agency’s plan would have cost $3,600 a month to cover him and his wife, so he went without it. The hospital billed him $93,000.
Janet Marx, 56, of Milford, Connecticut, has coverage through her husband’s employer and Medicare. She also receives disability income because lupus and fibromyalgia limit her ability to work. Even with two sources of insurance, the couple struggled to pay out-of-pocket medical costs. After a run of $80 copayments for in-home physical therapy, Marx and her husband sold the house where she grew up and moved into an apartment.
“Things are just getting too expensive to afford the house and health problems,” she said.
Sheila Robinson, 61, of District Heights, Maryland, pays $659 a month for an Affordable Care Act marketplace plan with a $10,000 deductible. To manage the bill, she puts the premium on a credit card, knowing that carrying a balance means paying interest. When she needs an appointment, she asks about lower self-pay prices.
Robinson has arthritis, a pinched nerve in her neck and high blood pressure. Even so, the costs make her wary of seeing a doctor. “I am just afraid to even go to the doctor,” she said. “Every month, I am in the hole.”
Costs reach beyond premiums
These experiences reflect a broader strain. KFF Health News has heard from more than 130 people across the country who are trying to cover premiums, copayments, prescriptions and medical bills while also paying for housing, energy and food. Some have dropped coverage; others have reduced medication use, skipped appointments or delayed procedures.
“We’re not talking about the uninsured or those who are low-income who are struggling now,” said Rebecca Kirch, executive vice president at the National Patient Advocate Foundation. “Now it’s become an all-of-us issue.”
Health spending has grown faster than the overall economy for decades, and recent increases have been especially sharp. In 2023 and 2024, spending posted its highest growth rates in two decades, excluding the pandemic surge in 2020. Hospitals, doctors and other clinicians have raised prices, while people have also received more care. Total U.S. health spending reached nearly $5.3 trillion in 2024, up from $3 trillion a decade earlier.
Health spending is projected to rise from just under 19% of the nation’s economic output today to 20% by 2032. That growth matters to households because the bill is spread across premiums, charges at the point of care, taxes that support health programs and costs passed through by employers.
Low-income and middle-income people with health conditions are particularly exposed. A plan can keep a person insured while still leaving them responsible for substantial charges before coverage pays more, or for services and medicines that the plan does not fully cover.
The typical American family spends about $5,600 a year, or 9% of its income, on premiums, out-of-pocket care and taxes that fund health programs, according to the Peterson-KFF Health System Tracker. Across the country, annual health spending works out to more than $15,400 per person.
High prices and a complicated payment system
The basic driver of high costs is the amount charged for care. U.S. doctors perform about a third as many inpatient knee replacements as doctors in other wealthy countries, yet the price per operation is higher than in most of those nations. Higher use contributes to the total bill, but price differences are a major part of the story.
Health economists and researchers point to several forces behind recent increases. Hospital mergers can give health systems more bargaining power to demand higher prices. New treatments and technologies, including GLP-1 medicines used for weight loss and diabetes, can carry high costs. Inflation and tariffs add expense to supplies ranging from latex gloves to medical devices. When more people lack coverage, fewer people share the costs through insurance.
“It’s really everything all together at once,” said Christopher Whaley, a health policy researcher at Brown University.
The way care is financed also matters. Unlike systems that set prices centrally, the U.S. relies heavily on negotiations between insurers, hospitals, clinicians and drugmakers. The resulting prices can vary by provider, insurer and network. Patients may encounter a different charge for the same service depending on where they receive it and what coverage they carry.
More than half of health payments were based on fee-for-service in 2022, according to a research brief in the journal Health Affairs. Under that arrangement, providers bill for each test, procedure or medicine. The model can reward the volume of services delivered, without necessarily tying payment to whether a patient’s health improves.
Billing complexity adds another layer. Providers and insurers must manage different rates, networks and paperwork. The administrative work involved in sending bills and processing payments can cost hundreds of billions of dollars. Insurers attempt to limit spending partly by deciding which services they will reimburse, and they also retain a share of the money flowing through the system.
“There’s profit margins everywhere, and there are varying degrees of financial incentives throughout the healthcare system,” Whaley said.
Those financial incentives do not always favor prevention or lower-cost care. Steven Ullmann, director of the Center for Health Management and Policy at the University of Miami Business School, said the system often rewards expensive treatment over preventive services. Patients may also be steered toward clinicians within their plan’s network, though network status alone does not tell a patient which provider will deliver better results.
Higher prices do not automatically mean higher quality, Ullmann said. He pointed to prenatal ultrasound prices in Orlando, which vary widely despite no clear difference in quality. “Same city, same procedure,” he said. “That is a reflection of a broken system.”
Medical debt can delay treatment
The financial consequences can continue long after an appointment. Carmilla Collins, 52, of Omaha, Nebraska, had her wages garnished in 2025 after she fell behind on medical bills from periods when she was insured and uninsured. The bills followed care for thyroid disease and routine preventive services, including a colonoscopy. A hospital sent the debt to a collection agency, which sued her; a court then allowed money to be taken from her paycheck.
Collins, a single mother working two jobs, said the deductions left her close to missing rent. She eventually received financial assistance from the hospital. But before qualifying, she delayed thyroid surgery for four months as a goiter grew and made it difficult to eat. She had employer coverage at the time, yet worried about the deductible and other charges.
“I equated taking care of my health with debt that I couldn’t afford,” Collins said.
Lynn Ludaway, 40, of Evanston, Illinois, said she faced tens of thousands of dollars in medical bills after being diagnosed with multiple sclerosis in 2023. She initially had coverage through her husband’s job, but still faced large out-of-pocket costs. As her mobility declined, she also paid for transportation and a cane.
Ludaway gave up her consulting business and used savings and retirement funds to pay for testing and treatment. She now pays $500 a month for coverage through Illinois’ marketplace. Her household income makes the couple ineligible for state or federal financial assistance, she said.
“I thought I was well prepared for an emergency,” Ludaway said. “Nobody can prepare for this.”
She uses private assistance from foundations and the hospital system where she receives care. She has also gone without dental and mental health care because she cannot afford it. “I need to rest to heal, but I need to work to live,” she said. “Broke undergrad has nothing on chronic illness.”
Shayna Sanders, a 45-year-old marriage and family therapist in New Haven, Connecticut, has bought marketplace coverage for more than a decade. Her monthly premium has climbed to close to $1,000. Insurance plans pay for her patients’ appointments, helping her run her practice, but she says the same coverage is increasingly unaffordable for her personally.
Premium increases force difficult trade-offs
For small-business owner Damien Waikoloa, 35, keeping coverage means cutting other expenses. His marketplace premium in Honolulu rose to more than $400 a month from about $240 the year before. He wants the insurance to help manage several chronic conditions, so he is looking for savings in his business, including considering a reduction in his own pay. He has also cut back on restaurants and trips to see friends and family in Seattle and California.
“Things like saving for a down payment for a house or even starting a family have completely gone out the window,” he said.
Other families have had to drop coverage altogether. Melody Stephens, 55, a geriatric nurse in Berryville, Arkansas, ended her marketplace plan after the monthly premium for her and her younger daughter rose from just over $200 to more than $2,000. She said she could not afford her employer plan either, which would have cost $1,000 a month.
Stephens first enrolled in a marketplace plan about a decade ago, after an anal cancer diagnosis. Insurance covered much of her cancer care, but she still faced large bills for treatment of radiation side effects. She filed for bankruptcy two years ago.
Now Stephens and her daughter rely on financial assistance and limit care where they can. Hospitals covered some of her daughter’s surgery bills, but the family still owes money for tests and treatment. Stephens stopped taking a GLP-1 medicine prescribed for diabetes and a medicine for nerve pain because of the cost. She also says she cannot afford a colostomy and lives with incontinence.
Prescription costs offer some relief: drug prices had their largest decline in decades this year, after actions by both the Biden and Trump administrations and sustained consumer pressure. But that drop has not erased other medical costs, and patients’ experiences depend on the medicines they need and what their coverage pays.
Coverage changes and who pays
Marketplace premiums have been affected by the end of enhanced subsidies introduced during the pandemic. Those subsidies helped lower what many enrollees paid each month. Their expiration has left many shoppers facing higher bills. At the same time, access has expanded to plans with lower premiums and higher deductibles, shifting more of the cost to patients when they use care.
Employers are also passing rising health costs to workers, while some clinicians require patients to pay upfront toward deductibles. These arrangements can make the monthly premium look more manageable while leaving households exposed to sizable charges when they need treatment.
Nationally, about 27 million people, nearly 10% of those under 65, lacked health insurance in 2024, according to KFF. The Congressional Budget Office projects that the number could grow by 10 million or more by 2034 because of coverage and funding changes. For people who lose coverage, the cost of a diagnosis or hospital visit can become a direct bill. For people who stay insured, higher premiums and deductibles can still lead them to delay care.
Debates over health coverage often focus on who pays: patients, employers or taxpayers. Proposals to expand public coverage could reduce some out-of-pocket charges for patients, but they would not necessarily lower the prices providers and drugmakers receive. Those prices would still need to be paid, in that case largely through public funds.
Likewise, requiring hospitals and doctors to post prices has had limited effect on what care costs. Greater visibility can help people compare charges when they have time and options, but it does not by itself change the prices that providers set or the underlying cost of delivering care.
Michael Chernew, a professor of health care policy at Harvard Medical School, said discussions about access and care quality should also account for total spending. “We don’t have some rich uncle that’s coming and just paying for all of our care,” he said. “One way or another, collectively we are paying. It’s just we’re shifting who is paying, how much we’re paying, and through which mechanisms we pay.”
Reducing the total bill is difficult because spending for patients is revenue for someone else in the health system. Zack Cooper, a health economist at Yale University, described the central tension simply: “For the most part, health spending for us is income to someone else.” Changes to prices or administrative costs therefore meet resistance from the groups whose income would fall.
Pressure is building, but relief is uncertain
Insurers expect marketplace premiums to rise 15% next year, the second consecutive year of increases in the double digits. Employer health costs are projected to climb 9.5% in 2027, a trend likely to put more pressure on workers’ pay and household budgets.
Health economists and policy researchers are skeptical that national efforts will soon bring down total spending. But costs are pressing on employers and state budgets as well as families, prompting proposals that depart from familiar political positions. Indiana has placed limits on what some nonprofit hospitals can charge patients with employer coverage. Beginning in 2029, five of the state’s largest nonprofit hospitals risk losing tax-exempt status if their charges exceed those limits. Texas Gov. Greg Abbott has proposed limits on certain drug prices, and President Trump has also pursued lower prescription prices.
These efforts target particular charges or products. Their effect on a family’s total expenses remains uncertain, especially when premiums, deductibles, hospital bills, medicines and other costs rise together.
McAdams’ experience shows how billing fears can affect the decision to seek care. After his first stroke in September 2025, he bought insurance, but it did not cover preexisting conditions. In March, when he noticed problems with his vision and balance, he went to urgent care instead of the emergency room because he feared another large bill.
Later that month, he spoke with the hospital about the earlier stroke bill. He said he became upset during the conversation, experienced symptoms again and ended up in the emergency room with a second stroke. McAdams believes the stress of the bill contributed to that stroke; his account is his own, and the source does not establish a medical finding about the cause.
The hospital eventually reduced his total bill to $50,436, still more than he can afford without a steady salary. McAdams can no longer work as a nurse and is applying for Social Security Disability Insurance. He and his wife are expecting a baby this fall.
“Due to all the stress, it delayed me in seeking care,” he said. “I didn’t want to deal with the stress of more hospital bills.”
He once felt proud to work in a health system that saved lives, including his own. Now the financial pressure has damaged his trust in it. His case, alongside those of families cutting medicine, selling homes or postponing procedures, points to the central problem: having coverage does not guarantee that care feels affordable. For households facing higher premiums, the practical choices are increasingly about which bills to pay now, what care to delay and how much financial risk they can carry.
