Out-of-pocket pain means skimping on care

David Garza sometimes feels as if he doesn't have health insurance now that he pays so much to treat his Type 2 diabetes.

His monthly premium payment of $435 for family coverage is about the same as the insurance at his previous job. But the policy at his current job carries an annual deductible of $4,000, which he must pay out-of-pocket for his family's care until he reaches that amount each year.

"Now everything is full price," said the 53-year-old, who works at a warehouse just south of Dallas-Fort Worth. "That's been a little bit of a struggle."

To reduce his costs, Garza switched to a lower-cost diabetes medication, and he no longer wears a continuous glucose monitor to check his blood sugar. Since he started his job nearly two years ago, he said, his blood sugar levels inched upward from an A1c of 7% or less, the target goal, to as high as 14% at his most recent doctor visit in November.

"My A1c is through the roof because I'm not on, technically, the right medication like before," Garza said. "I'm having to take something that I can afford."

In 2024, half of private-industry employees participating in medical care plans were offered high-deductible insurance, up from 38% in 2015, according to federal data. Such plans also are offered through the Affordable Care Act marketplace.

ACA marketplace premiums for next year are increasing, and many of the subsidies to help people pay for them are poised to expire at year's end. People may opt for a plan with low premium payments but a high deductible, gambling that they won't have any medical crises.

High-deductible plans pose a particular challenge for those with chronic conditions, such as the 38 million Americans who live with Type 1 or Type 2 diabetes. Adults with diabetes who are involuntarily switched to a high-deductible plan, compared with adults on other types of insurance, face an 11% higher risk of being hospitalized with a heart attack, a 15% higher risk of hospitalization for a stroke, and more than double the likelihood that they'll go blind or develop end-stage kidney disease, according to a study published in 2024.

The initial rationale behind such high-deductible plans was to encourage people to become wiser health care shoppers, said Rozalina McCoy, an associate professor of medicine at the University of Maryland School of Medicine in Baltimore and the study's lead author. They can be a good fit, proponents say, for people who don't use a lot of medical care or who have cash on hand for a health crisis.

But McCoy said those with unhealthy blood sugar levels might not feel an urgent need to seek treatment — despite the potential long-term damage — given the acute financial pain. "You have no symptoms until it's too late," she said. "At that point, the damage is irreversible."

Overall, medical care for people with diabetes costs insurers and patients an average of $12,022 annually to treat the disease, according to an analysis. Type 2 diabetes, the more common form, is diagnosed when the body can no longer process or produce enough insulin to adequately regulate blood sugars. With Type 1, the body can't produce insulin.

Mallory Rogers, whose 6-year-old daughter, Adeline, has Type 1, calculates it costs about $1,200 a month for insulin, a pump and a continuous glucose monitor. That doesn't include the cost of emergency supplies needed in case Adeline's technology malfunctions. Those include another type of insulin, blood-testing strips and a nasal spray that's nearly $600 for a two-pack of vials — supplies that must be replaced once a year or more frequently.

Rogers, a technology consultant in Sanford, Fla., saved for the coming year when her daughter will move to the health plan offered by Rogers' employer, which has a $3,300 deductible for family coverage.

Many insurance plans carry increasingly high deductibles. To be defined as a high-deductible health plan — and thus be eligible to offer a health savings account — a plan's deductible for 2026 must be at least $1,700 for an individual and $3,400 for a family, according to IRS rules.

Health savings accounts enable people to save money that can be rolled over from year to year for eligible medical expenses, including prior to meeting a deductible. Such accounts, available through a plan or employer, can provide tax benefits. Contributions are limited to $4,400 individually and $8,750 for a family in 2026, and employers may contribute toward that total. Rogers' employer pays $2,000 spread out over the year, and Garza's contributes $1,200.

Rogers recognizes that she's fortunate to have accumulated $7,000 so far in her health savings account.

The median deductible for employer health insurance plans was $2,750 in 2024, but deductibles can run $5,000 or higher, said George Huntley, CEO of both the Diabetes Leadership Council and Diabetes Patient Advocacy Coalition.

When deductibles are too high, Huntley said, routine maintenance is what patients skimp on: "You don't take the drug that you're supposed to take to maintain your blood glucose. You ration your insulin, if that's your scenario. You take pills every other day."

Garza's previous health plan covered a newer class of diabetes medication, called a GLP-1 agonist, for $25 a month. He wasn't charged for his remaining medications, which included blood pressure and cholesterol drugs, or his continuous glucose monitor.

With his new insurance, he pays $125 monthly for insulin and several other medications. He doesn't see his endocrinologist for checkups more than twice a year.

"He wants to see me every three months," Garza said. "But I told him it's not possible at $150 a pop."

Plus, he typically needs lab testing before each visit, an additional $111.

In 2026, the deductible for a "silver"-level plan on the marketplace will average $5,304 without cost-sharing reductions, according to an analysis from KFF, a health think tank that includes KFF Health News. For a "bronze"-level plan, it will be $7,476.

People comparing plan options should figure out their annual outof-pocket maximum, which still applies after the deductible is met, Huntley said.

Garza's family policy requires him to pay 20% until he reaches $10,000, for example.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.