If you’re opting for a health insurance plan with lower premiums, keep in mind that paying less for your health insurance usually means getting less coverage and paying more out of pocket for your care. In short, the lower the health insurance premium and the higher the deductible, the more likely it is that you will be paying a very large portion of your health care bills or going without care because your costs are too high. That’s why good health insurance, like Medicare, reins in provider rates and prescription drug costs, covers all the care you need and has low out-of-pocket costs. And, the best health insurance is not offered by corporation in business to maximize profits.
Increasingly, Americans cannot afford good health insurance. In fact, insurers rarely make it available to anyone in the individual health insurance marketplace. Tens of millions of Americans are left underinsured. Proposals that simply lower the cost of insurance but increase the amount you pay before your coverage kicks, do not make the cost of care affordable. They are not fixes. Yes, they still could save you hundreds of thousands of dollars if you need complex care, but only if you are able to pay the deductible or are willing to face substantial medical debt.
A new KFF poll regarding people’s financial worries finds that Americans are most concerned about the cost of health care. Two out of three say that, more than other basic necessities, they are concerned that they won’t be able to afford health care for their family, and a majority assume costs will keep rising. Of those, 32 percent are very worried about health care costs and 34 percent are somewhat worried about these costs. By comparison, 24 percent are very worried about the cost of food and groceries and 33 percent are somewhat worried about the cost of food and groceries.
Not only are insurers requiring people to pay high health care costs, but they are imposing obstacles to care–denying coverage for care from out-of-network specialists people need to see and inappropriately using prior authorization to delay and deny needed care from network specialists. (In 2021, one insurer was found to have denied half of all claims!) Medicare Advantage plans made 53 million prior authorization determinations in 2024. And, of the denials that were appealed, 80 percent were inappropriate and reversed! The insurers have the power to keep you from getting care, but they claim not to have the power to bring down health care costs.
So, before you enroll in a health plan, ask yourself two questions. Will you be able to pay the deductible and coinsurance required to get the care you need? And, will your insurer cover the care you need from the doctors and hospitals you want to use? Mark Cuban is not wrong when he says: “The real health insurance scam is that [insurers] know as their deductibles go up, fewer people can afford to use their insurance. Which means they don’t have insurance. Despite having to pay premiums.”
Whether health care costs will affect the outcome of the 2026 elections is unclear. But, a majority of Democratic voters and roughly half of Republican voters say it will affect their votes. A majority of Americans trust Democrats more than Republicans to address health care affordability overall. Notably, when it comes to the cost of prescription drugs, neither party has an edge.
Here’s more from Just Care:
- Medicare for all would save $600 billion a year in administrative costs
- Costs in Medicare Advantage present barrier to care
- High-deductible health plans mean high risk
- 2025: Planning for health care costs in retirement
- What are the major differences between Medicare for all and a public option?
