Nearly Half of U.S. Adults Lack Adequate Health Coverage, and Many Avoid Care Because of Cost

Cost is still keeping many working-age Americans from seeing a doctor, filling a prescription, or getting a test they need. That is the central takeaway from the Commonwealth Fund’s latest Biennial Health Insurance Survey, which shows a broader problem with coverage and affordability.

The survey found that 46% of adults ages 19 to 64 had poor health insurance. In this group, 11% were uninsured, 12% had coverage for only part of the year, and 23% had insurance that still left them unable to afford care. The survey included 9,360 adults, with most of the analysis focused on 7,362 working-age respondents.

Coverage Does Not Always Mean Protection

Having a health plan does not necessarily mean being financially protected. Even among people who had coverage throughout the year, 30% were underinsured. That includes 29% of those with employer-sponsored coverage, the type most Americans rely on. Employer family plans now average $28,303 a year, yet nearly three in ten workers with employer plans still face bills they cannot comfortably pay.

The strain is also showing up in household finances: 30% of respondents said they were paying off medical debt.

The share of uninsured working-age adults has also climbed, rising from 8.9% in 2024 to 11.2% in the latest survey. More people are going without coverage entirely, while many others remain enrolled in plans with deductibles that function like a second premium.

Middle-Income Households Have Little Room to Absorb Shock Costs

Federal Reserve figures help explain why an unexpected medical bill so often becomes debt. In the second quarter of 2026, the bottom 20% of households by income held 2.8% of household net worth but carried 7.1% of consumer credit. The middle 20% held 7.5% of net worth and 18.8% of consumer credit. For many families in that range, even a single emergency room bill can end up on a credit card.

Some of those balances show up in collections. Consumer Financial Protection Bureau research found that 4.2% of consumers with a credit record had medical collections on their file.

Retirees are under pressure as well. The standard Medicare Part B premium rose to $202.90 a month from $185, and the deductible increased to $283 from $257. The Medicare Trustees also now project that the hospital insurance trust fund will be depleted in 2033, one year earlier than previously expected, at which point only 89% of scheduled benefits would be payable.

Delayed Care Often Leads to Larger Costs Later

When people postpone treatment, the bill rarely disappears. A skipped checkup can turn into an emergency hospitalization months later. Hospitals absorb more bad debt, insurers end up paying for sicker patients, employers lose productivity, and money that could have gone toward savings or retirement contributions instead goes to medical bills. Consumer lenders, meanwhile, are left holding medical costs that appear as credit card balances.

Two coming developments will help show whether the pressure is getting worse. Federal officials are expected to announce the next Medicare premium, while open enrollment will reveal whether employers are shifting more costs to workers through higher deductibles and out-of-pocket maximums. If deductibles continue rising faster than wages, the share of underinsured Americans is likely to increase, and medical debt may appear more often in credit data.