1 in 4 Americans Skip Medical Care Over Cost (2026)

You have a symptom. You also have a deductible that resets in January, a checking account that clears $600 after rent, and a memory of the last bill. So you wait. Skipping medical care because of cost is not a fringe behavior in the United States. It is the default setting for roughly a quarter of adults, and it operates on people with insurance cards in their wallets.

The numbers below come from the Federal Reserve, Gallup, KFF, and the Commonwealth Fund. They describe a health system that prices the first visit high enough that millions of people decline to have it, then bills them more when the condition they ignored comes back.

How many people are skipping medical care because of cost?

The Federal Reserve asks the question every year in its Survey of Household Economics and Decisionmaking (SHED). In 2023, 27% of adults reported going without some form of medical care because they could not afford it. The 2022 figure was 28%, up from 24% in 2021, when pandemic relief payments were still in bank accounts.

Gallup asks a broader question: did you or a family member put off any medical treatment in the past year because of cost? In late 2022 the answer hit 38%, the highest reading in more than two decades of tracking, and it has stayed near that level since. About 27% of respondents said the treatment they postponed was for a very or somewhat serious condition.

Prescriptions are a category of their own. KFF polling in 2023 found close to three in ten adults reported not taking a medicine as prescribed at some point in the prior year because of cost: skipping doses, cutting pills in half, or leaving the pharmacy without the bag. Insulin rationing is the version that makes headlines. Blood pressure pills and inhalers are the version that does not.

What kind of care gets skipped first?

Dental. Every year the Federal Reserve's survey puts dental visits at the top of the skipped list, ahead of doctor visits, prescriptions, follow-up care, and mental health treatment. Dental coverage is separate from medical coverage, annual maximums often sit around $1,500, and a single crown can eat that cap in one appointment.

The order matters because it reveals the logic. People skip the care with the most predictable, out-of-pocket price first. A dental visit is a known $200. A specialist visit under a high-deductible plan is an unknown number that arrives six weeks later. Both lose to groceries.

Why do insured people skip care?

Because the insurance card does not cover the first several thousand dollars of anything.

The average deductible for single coverage in employer plans passed $1,700 in 2024 (KFF Employer Health Benefits Survey). Family deductibles run $3,000 to $5,000 in many plans. The worker's share of a family premium averages more than $6,000 a year before a single claim. A household at the median income of about $80,000 (U.S. Census Bureau, 2023) that pays $6,000 in premiums and then faces a $4,000 family deductible has committed one-eighth of its pretax pay to healthcare before the plan pays for anything beyond preventive visits.

The Commonwealth Fund has a word for this: underinsured. Its 2024 survey counted 23% of insured working-age adults as underinsured, meaning out-of-pocket costs or deductibles were high relative to income. Underinsured adults skipped care at rates close to the uninsured. FFLW's piece on what underinsured means walks through the definition.

Then add the roughly 26 million people with no coverage at all. The Census Bureau put the uninsured rate near 8% in 2023, concentrated in states that did not expand Medicaid and among adults working jobs that offer no plan. For them the number to fear is the full chargemaster price of an emergency room visit, with no negotiated discount behind it.

Insurance in America is a discount card with a large activation fee. For a third of the workforce, the activation fee is more than they have in the bank. The Federal Reserve's same survey found that 37% of adults could not cover a $400 emergency expense with cash. A $1,700 deductible is four of those emergencies stacked.

Who skips care the most?

The people with the least room. In the Federal Reserve data, adults with household income under $25,000 skipped care at more than double the rate of adults above $100,000. Black and Hispanic adults skipped care at higher rates than white adults. Adults with a disability skipped care more than adults without one, which is a cruel arrangement, because they need more of it.

Age cuts the other way from what you would expect. Adults 65 and older skip care the least, because Medicare covers them. Working-age adults in their 30s and 40s, the ones raising children and paying the full cost of health insurance through an employer, skip it the most. The system protects retirees and exposes parents.

Parents also make the decision for two generations at once, and the adult's care loses. A mother postpones her own mammogram to pay for her son's orthodontia. The mammogram is the one that should not wait.

What does skipping care cost later?

More than the visit would have. The math runs one direction.

A blood pressure prescription costs $10 to $30 a month with a generic. A stroke costs tens of thousands of dollars in acute care, and the American Heart Association puts the lifetime cost in six figures once rehabilitation and lost work are counted. A dental cleaning costs about $100 to $200. A dental abscess treated in an emergency room costs several times that, and the ER cannot fix the tooth. Screening colonoscopy is covered at no cost under the Affordable Care Act. Stage 3 colon cancer treatment runs into the hundreds of thousands.

Then the debt. KFF estimates about 100 million Americans carry some medical debt, totaling roughly $220 billion. A large share of that debt started with a condition that went unmanaged until it required a hospital. Medical bankruptcy statistics show illness and medical bills contributing to most personal bankruptcies, and a good number of those filers had insurance when they got sick.

The pattern connects to a related article on the cost of chronic illness: a condition managed for $2,000 a year becomes one managed for $20,000 a year once it advances. Skipped care does not save money. It transfers the cost to a later date, adds interest in the form of lost health, and hands the larger bill to the same household that could not afford the smaller one.

How does the United States compare to other countries?

Badly. The Commonwealth Fund's international surveys of high-income countries have placed the United States last or near last on cost-related access barriers in every recent round. In the 2023 edition, U.S. adults reported skipping care, skipping a prescription, or skipping a recommended test because of cost at rates two to four times those of Germany, the Netherlands, or the United Kingdom.

Those countries spend roughly half as much per person on healthcare (Peterson-KFF Health System Tracker) and their residents see doctors more often. FFLW's comparison of healthcare costs versus other countries lays out the per-capita numbers. Americans pay the most and use the least, because the price at the point of care is set to make them hesitate.

Why does the system work this way?

Because hesitation is the design. American health policy adopted a theory in the 2000s that patients with "skin in the game" would shop for care, and high-deductible plans grew from a niche product to more than a quarter of employer coverage (KFF, 2024). Economists who studied what happened found that patients cut care across the board. They skipped the valuable visits and the wasteful ones in equal measure, because a person with $600 in checking does not price-compare a chest pain.

The deductible functions as a cost-control tool that controls cost by keeping sick people out of the building. It works. Hospitals bill less to the insurer, insurers price the plan a little lower, and the patient absorbs the difference in the form of a condition that gets worse in silence. The medical debt pillar traces where that silence ends: a collections call, a garnished paycheck, a GoFundMe page.

One in four adults skipping care is the rational response of households whose wages never caught up with the price of a doctor's visit, inside a system that treats the first several thousand dollars of sickness as the patient's problem. The federal minimum wage has sat at $7.25 since 2009. A single-coverage deductible now takes more than 230 hours at that wage to pay off. The data on our affordability stats page show that gap widening every year the system leaves both numbers where they are.