By NextBestFitUnderinsurance: covered, but can't afford to use it
High deductibles and coinsurance mean many insured people avoid care. Average single deductibles in employer plans are about $1,800, and out-of-pocket maximums reach $9,200 single and $18,400 family (2025).
Evidence
- ACA out-of-pocket maximum $9,200 single / $18,400 family (2025).
- 36% of adults skipped or postponed care because of cost in the past year.Sources: KFF (2025)
Who's affected
Who is hurt
- People with ongoing or specialist care needs: High deductibles and coinsurance lead them to avoid care.
- Low- and middle-income households: High deductibles and coinsurance lead them to avoid care.
Who gains while it lasts
- Health insurers, brokers, and their shareholders: They benefit from lower premiums.
- Employers: They benefit from lower premiums.
- Health financing intermediaries and lenders: They administer health savings accounts associated with high-deductible plans.
Under your mix of paths
Paths that fix or soften it
Using your saved plan. 0 paths picked.Edit all picks
Root causes
- Cost sharing used to hold down premiums
- Employers shifting costs to workers
Related costs
Open questions
- Should patients pay anything at the point of care? If so, how much and with what cap?
Solution paths (3)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Covered services are free when used: no deductibles, copays, or coinsurance.
- +Underinsurance: covered, but can't afford to use it
- +Medical debt affects about 100 million people
- +About $1 trillion a year in administrative cost
- −Longer waits if demand grows faster than capacity
- −Raises spending or loosens control over it
- −Replacing premiums with taxes
Keep small charges to discourage low-value use, but cap total out-of-pocket at a share of income and exempt the poor.
- +Underinsurance: covered, but can't afford to use it
- +Low-value care and overtreatment
- +Replacing premiums with taxes
- −Copays keep billing systems alive and still deter poorer patients
Value-based cost sharingRejected
Free for high-value care (primary care, chronic-disease drugs, prevention); copays only for low-value services.
- +Underinsurance: covered, but can't afford to use it
- +Low-value care and overtreatment
- −Adds paperwork, coordination, or complexity
- −Copays keep billing systems alive and still deter poorer patients