woman with brown skin black hair red shirt red pants orange shoes balances the weight of money in her right hand and medicine in her left hand against a background of a large stethoscope and pills

Thumy Phan

28% of Americans with health insurance can’t afford their deductibles

For many Americans, health insurance still fails to protect their finances in the event of a medical emergency.

Headshot of Myles Ma, CPFC

By

Myles Ma, CPFCSenior ReporterMyles Ma, CPFC, is a certified personal finance counselor and former senior reporter at Policygenius, where he covered insurance and personal finance. His expertise has been featured in The Washington Post, PBS, CNBC, CBS News, USA Today, HuffPost, Salon, Inc. Magazine, MarketWatch, and elsewhere.

Published|4 min read

Policygenius content follows strict guidelines for editorial accuracy and integrity. Learn about our editorial standards and how we make money.

A decade ago, the Affordable Care Act introduced the federal health insurance marketplace at HealthCare.gov, added new consumer protections, and made many preventive services available for free. [1]  

But for many Americans, health care is still unaffordable — even with health insurance. In fact, 28% of Americans with health insurance said they wouldn’t be able to pay their deductible immediately, while 16% said they would have to borrow money or use mostly credit, according to the Policygenius 2023 Health Insurance Survey.

Key findings

  • Even among higher earners (Americans with incomes of $80,000 or more), 18% would have to use mostly credit or borrow to pay their deductible, and 16% wouldn’t be able to pay it at all.

  • 45% of insured Americans have avoided medical care because they knew or feared their health insurance wouldn’t cover the cost.

  • 9% of insured Americans said they would go without insurance coverage if they lost their current health insurance, while 25% aren’t sure what they would do.

  • 63% of insured Americans would need at least some help signing up for a plan on the individual health insurance marketplace, with 15% saying they’d be “not at all confident.”

  • Among insured Americans who have seen a mental health provider, 42% have had their health insurance declined.

  • Almost a third of people currently on Medicaid (32%) said they expect to be able to re-enroll in the program if they lost coverage, but 17% said they would have to go without health insurance. Millions of Americans are at risk of losing Medicaid coverage this year because of the end of a “continuous coverage” provision enacted during the COVID-19 public health emergency and people are split on how they’ll maintain health coverage.

A choice between debt and avoiding medical care

Over the last decade, insured families have incurred an increase of 67% in health care costs, including premiums and out-of-pocket spending like deductibles — the amount of money you pay for health care out-of-pocket before health insurance starts covering the bill. [2]  

During that time, the average deductible amount for people covered by employer-sponsored health insurance with single coverage has increased by a staggering 61%. [3] For high-deductible health plans, a type of coverage with a higher-than-usual annual deductible, deductibles can be as high as $7,500 a year for single coverage and $15,000 a year for family coverage in 2023. [4]

According to our survey, 28% of insured Americans wouldn’t be able to pay their entire deductible in the event of a medical emergency. Even 16% of those earning $80,000 a year or more are now “underinsured” because they wouldn’t be able to pay their deductibles out-of-pocket.

health insurance survey 2023 q1

It’s not surprising that 45% of insured Americans say they’ve avoided medical care because they knew or feared health insurance wouldn’t cover the cost. With a high enough deductible, those fears are well founded.

health insurance survey 2023 q2

Millions of Americans are losing Medicaid coverage this year. What will they do?

As part of the COVID-19 public health emergency, Medicaid enrollment grew by more than 20 million people from February 2020 through March 2023 thanks to a temporary “continuous coverage” measure enacted by Congress. [5] But after the end of continuous coverage in March 2023, millions of people are in the process of losing their Medicaid health insurance coverage.

In our survey, almost a third of people on Medicaid (32%) said they expect to be able to re-enroll in the program, but 17% said they would have to go without health insurance. When asked what they would do if they lost their current health insurance, a plan on the federal marketplace was the most popular choice for insured Americans, especially among those with employer-provided coverage and those who already have marketplace plans.

health insurance survey 2023 q3

Still, the number of people who selected a state or federal marketplace is relatively low, especially among people covered by Medicaid. Only 14% said they would enroll in a marketplace plan, almost as many as the number of people who said they would go without health insurance coverage altogether. One reason may be a lack of information about these plans. 

Only 30% of insured Americans said they would feel “very confident” signing up for a plan on the health insurance marketplace. Most (63%) said they would need at least some help, including 15% who said they felt “not at all confident — I wouldn’t know where to start.”

health insruance survey 2023 q4

The Biden administration has increased funding for navigator organizations, which help people sign up for health insurance coverage. [6] Healthcare.gov has a search tool that lets users look up certified agents, brokers, and navigators who can provide application help in your area.

Many mental health care providers are still declining insurance

An increasing number of U.S. adults are seeking mental health care in the wake of the COVID-19 pandemic, but health insurance coverage has not always been adequate to meet the mental health crisis. In our survey, 29% of insured Americans said they weren’t sure whether their plans covered mental health care, and among insured Americans who have seen a mental health provider, 42% have had a provider decline their insurance.

The Biden administration proposed a rule that aims to require health insurance companies to report more data on their mental health coverage, but insurance isn’t the only issue with mental health care. Many providers opt out of insurance networks entirely because they can earn more from patients who pay out of pocket.

health insurance survey 2023 q5

Methodology

Policygenius commissioned YouGov to poll 2,051 Americans 18 or older who confirmed having health insurance at the time of the survey. The survey was carried out online from Aug. 24 through Aug. 31, 2023. The results have been weighted to be representative of all U.S. adults. The average margin of error was +/- 2%.

About Policygenius

Policygenius transforms the insurance journey for consumers by providing a one-stop platform where consumers can compare options from top insurance carriers, get unbiased expert advice, buy policies, and manage their insurance portfolio, in one seamless, integrated experience. Our proprietary technology platform integrates with the leading life, disability, and home & auto insurance carriers and delivers an exceptional digital experience for both consumers and insurance carriers. Since 2014, our content, digital tools, and experts have served as a resource for millions of people on their insurance journey, and we have sold more than $200 billion in coverage. In 2023, Policygenius was acquired by Zinnia, an insurance technology and digital services company.

For reporters

To request more information about the data, or to speak with one of our experts, contact press@policygenius.com.

Infographics by Anna Konson

References

dropdown arrow

Policygenius uses external sources, including government data, industry studies, and reputable news organizations to supplement proprietary marketplace data and internal expertise. Learn more about how we use and vet external sources as part of oureditorial standards.

  1. National Library of Medicine

    . "

    Key Features of the Affordable Care Act by Year

    ." Accessed September 27, 2023.

  2. Peterson-KFF Health System Tracker

    . "

    Tracking the rise in premium contributions and cost-sharing for families with large employer coverage

    ." Accessed September 27, 2023.

  3. KFF

    . "

    2022 Employer Health Benefits Survey

    ." Accessed September 27, 2023.

  4. IRS

    . "

    Publication 969 (2022), Health Savings Accounts and Other Tax-Favored Health Plans

    ." Accessed September 27, 2023.

  5. KFF

    . "

    10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision

    ." Accessed September 27, 2023.

  6. U.S. Department of Health and Human Services

    . "

    Biden-Harris Administration Makes Largest Investment Ever in Navigators Ahead of HealthCare.gov Open Enrollment Period

    ." Accessed September 27, 2023.

Corrections

No corrections since publication.

Author

Myles Ma, CPFC, is a certified personal finance counselor and former senior reporter at Policygenius, where he covered insurance and personal finance. His expertise has been featured in The Washington Post, PBS, CNBC, CBS News, USA Today, HuffPost, Salon, Inc. Magazine, MarketWatch, and elsewhere.

Questions about this page? Email us at .