Nearly 1 in 4 Insured Americans Skipped Medical Care Over Cost as Coverage Leaves Gaps

Nearly one in four American adults with health insurance went without medical care because they could not afford it in 2025, according to a Federal Reserve report showing that coverage did not eliminate financial barriers to treatment.

The Fed’s annual report on household economic well-being found that 24% of insured adults skipped some form of care because of cost. Among uninsured adults, the share was substantially higher, at 45%. Overall, 26% of adults reported going without care, an improvement from 28% in 2024.

Eighteen percent of adults skipped dental care, 15% went without a doctor or specialist visit, and 10% skipped follow-up treatment. Another 10% went without mental health care or counseling, while 9% skipped prescription medicine. Respondents could report multiple categories.

Income was closely associated with access. Among adults with family incomes below $25,000, 38% skipped care because of cost, compared with 13% of those with incomes of $100,000 or more.

Medical debt presented another burden: 18% owed money for their own care or a relative’s treatment. That debt was not necessarily incurred during the previous year. The health findings sit within a broader picture of households managing limited room between income and expenses.

About 4 in 10 adults (41%) said they always or often had money left at the end of the month, essentially unchanged from 2024. Among those with family incomes below $25,000, just 19% regularly had money remaining, compared with 59% of those earning at least $100,000.

Price increases continued to weigh on household finances. Fifty-eight percent said changes in the prices they paid had made their financial situation worse over the previous year, including 14% who described it as much worse.

Many responded by changing their spending or saving habits. Sixty-two percent switched to cheaper products, 60% used less of a product or stopped using it, and 46% delayed a major purchase. Forty-one percent reduced savings in response to higher prices.

Twelve percent of adults said they could not cover a hypothetical $400 emergency expense by any means. A larger 37% would not cover it entirely using cash, savings, or a credit card paid off at the next statement.

That larger group should not be described as universally unable to afford the expense. Some would borrow, sell something, or carry a credit card balance and others might preserve available cash for different needs. A separate savings question found that 18% could handle an emergency expense of less than $100 using savings alone. Another 12% could manage between $100 and $499.

Longer-term protection was also uneven. Fifty-five percent had set aside enough money to cover three months of expenses, unchanged from 2024 but below the 59% recorded in 2021. Thirty percent could not cover three months through savings, borrowing or selling assets.

The findings come from a final sample that included 12,934 adults surveyed last year, and results were weighted to represent the U.S. adult population. Ipsos administered the survey online through its probability-based KnowledgePanel.