Why 44% of Insured Adults Still Struggle with Medical Costs—and How to Bridge the Gap

44% of insured adults under age 65 say it's difficult to afford their health care costs, according to KFF data. That's well below the 82% of uninsured adults who report the same struggle, but it still means more than 4 in 10 insured people are feeling real financial strain.

Even with great health insurance, you're not immune to an unexpected medical bill. The good news is that with the right plan in place, you can bridge the gap between coverage and costs. This guide walks you through how to pay medical bills you weren't expecting, and how to avoid getting caught off guard again.

Expert Insights

• Insurance has limits: Having medical insurance can protect you from most high costs, but not all.
• Some procedures aren't covered: Elective and experimental procedures and treatments are not usually covered by insurance, so you'll have to pay out of pocket.
• You have options to bridge the gap: An HSA, emergency savings, medical credit cards, or a personal loan can all help cover costs your insurance doesn't.
• Know your policy: Understanding your deductibles and co-pays can help you prepare for medical costs before they come.

Medical care in the U.S. is expensive for many reasons, including (but not limited to) a largely privatized insurance system and a fragmented provider network. In fact, simply having medical insurance doesn't guarantee affordable care: 44% of insured adults under age 65 say it's difficult to afford their health care costs.

Rising Premiums Are Part of the Problem

The medical insurance itself is a big part of the expense. Whether your plan comes through your employer or the ACA marketplace, you owe a monthly premium that can be expensive and continues to rise.

KFF's 2025 benchmark survey puts the average family premium for employer-sponsored coverage at $26,993, with workers paying about $6,850 from their paychecks. That's roughly $570 a month just for the insurance, not for any actual medical care.

Higher Deductibles Mean Less Real Coverage

If you buy insurance using the ACA healthcare exchange, your premium may have also jumped after enhanced subsidies expired at the end of 2025.

To keep premiums manageable, many families reportedly traded down to plans with higher deductibles, which were often bronze-tier plans with lower-value coverage. When that happens, you're effectively underinsured, meaning you're technically covered, but exposed to higher medical costs.

Most Families Have No Buffer for Surprise Costs

When your health insurance is expensive, you may need a safety net for surprise costs, and many Americans don't have one. About half of U.S. adults say they couldn't cover an unexpected $500 medical bill out of pocket.

That's why an unexpected dental emergency or hospital stay can create debt for an insured family, and one reason health care now ranks as a top financial worry for many U.S. households.

Having health insurance can still leave you with a gap in medical costs in two ways: the money you owe on care that it does cover, and the care it won't cover at all.

What You Owe Even When Insurance Covers the Care

The biggest of the first kind is your deductible, the amount you pay out of pocket before your plan starts sharing costs. In 2025, the average deductible for single coverage reached $1,886, running steeper at small firms ($2,631) than at large ones ($1,670). The average deductible on an ACA healthcare plan is $4,000, based on data from KFF.

If you're already stretched thin with your premiums, that's a four-figure amount you have to pay before your coverage even kicks in. After the deductible, copays and your out-of-pocket maximum can each add to what you owe.

What Insurance Doesn't Cover at All

Even the best health insurance plans don't cover everything. You'll typically need additional coverage for dental and vision care, and cosmetic, elective, or experimental procedures usually aren't covered either.

If a bill arrives that you can't cover at once, don't panic. There are a few ways to tackle the debt:

• Provider payment plans: Many hospitals and clinics will split a bill into monthly installments, often at 0% interest. Ask the billing department directly, these aren't always advertised.
• Health savings account: If you have a health savings account, you can use the tax-advantaged dollars you've already set aside.
• Check your bills: Itemized medical bills can contain errors, so make sure to compare charges and ask about anything you feel may be overpriced. It is not always possible, but if you can negotiate your costs, you may save.
• Medical credit cards: These cards may offer a promotional 0% period, but watch for deferred interest that kicks in when the period ends, which can make payments much higher.
• Personal loans: A fixed-rate option that can be funded quickly can be a good choice, but you need good credit to qualify for the most affordable rates.

And don't forget to go straight to the source. "Hospitals and providers have every incentive to negotiate lower balances and interest-free payment plans with patients who still owe them directly," said Dr. Virgie Bright Ellington, an internal medicine physician with 20 years of clinical practice and a decade as a health insurance executive. "Once a patient puts the bill on a credit card, the provider has been paid in full and therefore has zero incentive to negotiate."

You can use a personal loan to bridge a gap or pay for uncovered healthcare expenses, but it isn't right for everyone.

If you can easily pay off the loan and your credit score qualifies you for the best rates, a personal loan may be worth considering. If not, signing up for a provider payment plan or paying the debt directly with the provider could help protect your credit.

That's because medical debt that stays with your provider keeps protections in place that ordinary debt doesn't. While the Consumer Financial Protection Bureau (CFPB) tried to keep medical debt off credit reports, a federal judge blocked its rule in 2025. To date, medical debt under $500 isn't reported to the major credit bureaus, and if you pay your medical debts, they're removed from your credit report.

That same 44% of insured adults who struggle to afford medical costs could find that a surprise bill sets them back financially. If you're concerned about becoming part of this demographic, there are ways to protect yourself:

• Build an emergency fund: Even a small cushion covers the most common out-of-pocket expenses.
• Contribute to a Health Savings Account (HSA): This tax-advantaged account can provide the funds to cover care that isn't protected by your insurance.
• Understand your insurance plan: Always read the fine print, and if you have questions, call the number on the back of your insurance card. You and any family members covered by your plan should know your deductible, coinsurance, copays, out-of-pocket maximum, and anything your insurance won't pay for.
• Price-check non-urgent procedures: Ask if a provider takes your insurance, and if not, ask about costs upfront.

It's worth checking the insurance side too, not just the provider's bill. If your plan denied a claim, you can push back. "If your insurance declined to cover something, consider filing an appeal," says Ellen Falbo, CCO at Possible Finance. If you win, that appeal can wipe out the debt before you have to take on more to pay it off.

If you're among the 44% of insured adults struggling with medical costs, you may not be able to change your plan's deductible, but there are other actions you can take: check your medical bills against your explanation of benefits, ask your provider about discounts and payment plans before a procedure and consider building an emergency fund or contributing to an HSA.

If you’re interested in using a personal loan to help pay for uncovered medical care, it's always recommended to shop around for the best rates and terms. Having health insurance can help shield you from some medical debt, but not all of it, so being prepared for surprise costs can keep your finances healthy, even when you don’t feel well.