38% of Insured Americans Are Skipping Medical Care — Here's Why Insurance Isn't Enough

Having a health insurance card in your wallet doesn't mean you're actually protected.

That's the uncomfortable truth behind a mounting body of research — and behind the real stories Tahor Health hears every day. In our community survey of 42 adults, more than two-thirds said they had delayed or avoided care due to uncertainty about what their insurance would cover. Many of them had active, employer-sponsored health plans. They weren't uninsured. They were confused. And that confusion cost them.

The Scale of the Problem: Millions of People, Not Covered Enough

The U.S. Census Bureau confirmed that 92% of Americans had health insurance for some or all of 2024. On paper, that's a historic high. But coverage and actual access to care are very different things.

The Commonwealth Fund's 2024 Biennial Health Insurance Survey found that 23% of adults were insured all year but still considered underinsured — meaning their coverage didn't protect them from unaffordable costs. More than a third of Americans exist in a gray zone: technically covered, practically vulnerable.

A 2025 survey of 2,500 insured adults found that 38% had delayed or skipped care due to cost in the past year — a 41% jump over 2023. Of those who delayed care, 42% said their health condition got worse as a result.

The Working-Age Crisis Nobody Talks About

The people most likely to skip care aren't the elderly or the very poor — they're working-age adults between 25 and 54, many of whom are insured through their jobs.

The West Health-Gallup 2024 Healthcare Affordability Index found that only 47% of adults under 50 could readily afford healthcare — the lowest of any age group. And there's a racial dimension that cannot be ignored: Black (11%) and Hispanic (14%) adults were considerably more likely to be cost-desperate — unable to pay for both care and medicine — than White adults (7%). Women were nearly twice as likely as men to fall in this category.

Coverage Confusion Is a Form of Health Inequity

Not understanding your health insurance is not your fault. Insurance policies are written in language designed for administrators, not patients. The average person cannot parse the difference between their deductible, their out-of-pocket maximum, their coinsurance, and their co-pay — not because they aren't smart, but because these systems were never designed with the patient in mind.

What Happens When You Delay Care

KFF data shows that 1 in 6 adults (17%) reported delaying or going without medical care, prescription drugs, or mental health care in 2024 due to cost. Among those with chronic health conditions — people who need ongoing care the most — the rates are even higher.

Adults with chronic conditions who are underinsured are three to four times more likely to delay or forgo needed care. The gap between needing care and understanding how to access it is exactly where preventable harm happens.

What Real Access Looks Like

Tahor Health exists because insurance literacy is health equity. Knowing what your plan covers — before you need it, not after — is what separates a bill you can manage from a medical debt crisis. Our community survey respondents told us what they actually need:

• A clear view of their remaining deductible and out-of-pocket costs
• The ability to forecast what a visit or procedure will cost before going
• Side-by-side comparisons of in-network vs. out-of-network providers
• One place — mobile, simple, plain-language — to see it all

The card in your wallet is just the beginning. Understanding what's behind it is where real health security starts.