Out-of-pocket health care spending in the U.S. - Statistics & Facts

Out-of-pocket expenses are generally defined as medical expenses that are not reimbursed by insurance, which includes deductibles, coinsurance, and copayments. Usually, the insurance premium, referred to as the employee’s contribution to the premium, is not included. Therefore, even if someone has health insurance, there may still be a large amount to be paid out-of-pocket for health care services. Total out-of-pocket health care payments in the U.S. continue to increase and were projected to surpass 400 billion U.S. dollars for the first time in 2020.

Health coverage: uninsured or underinsured?

The percentage of uninsured adults in the United States decreased from 20 to 13 percent between 2010 and 2020. Understandably, there was a slight rise in the share of people with health insurance, but more noticeable was the increase in adults who were underinsured. The Commonwealth Fund considers a person to be underinsured if their deductible is equal to five percent or more of income. Alternatively, for people living under 200 percent of the federal poverty line (the low-income bracket), underinsured refers to an individual whose out-of-pocket expenses, excluding premiums, are equal to five percent or more of their income. A 2020 survey found that around half of U.S. adults had medical bill or debt problems if they were uninsured or underinsured in the past year.

What is not covered by health insurance?

A deductible is what needs to be paid by an insured person for the year before their insurance starts covering them. In 2020, the percentage of covered workers with a deductible for single coverage was more than 80 percent, compared with just over half in 2006. Even after a deductible is reached, most insurance plans have further cost-sharing components in the form of coinsurance (a percentage of the health service cost the enrollee must pay) or copayments (a set amount an enrollee must pay for each service). Among covered workers with a copayment for a physician office visit, the most common cost is between 20 and 30 U.S. dollars. An out-of-pocket maximum is the upper amount the worker must pay in a year for all health care costs. Once the limit is reached, the insurance company would then pay for all other health care costs that the plan covers. A survey looking at the percentage of U.S. workers in individual plans with an out-of-pocket maximum found that nearly two-thirds of employees were enrolled in plans with a limit of 3,000 U.S. dollars or more in 2020.

Rising health care costs and the threat of medical debt

Out-of-pocket costs are rising at much faster rates than workers’ wages in the United States, and this is one reason why so many people who have health insurance find themselves in medical debt. According to a 2021 survey, nearly 40 percent of U.S. adults have a medical-related debt. Due to all of the financial challenges, decisions regarding a visit to a doctor or receiving specialist care can come down to cost, leaving many people without the care they need. Since 2014, the percentage of U.S. adults who go without health care due to cost has been around 35 percent.

This text provides general information. Statista assumes no liability for the information given being complete or correct. Due to varying update cycles, statistics can display more up-to-date data than referenced in the text.

U.S. annual out-of-pocket health care payments per capita: 1,223USD

Percentage of median income U.S. employees spent on health plan costs: 11.6%

Percentage of employees who had difficulty understanding their out-of-pocket cost: 44%

Editor’s Picks Current statistics on this topic

Average general annual deductible for single coverage among covered workers in the United States from 2006 to 2022 (in U.S. dollars)

Private Health Insurance

Average U.S. worker's annual deductible for single coverage, 2006-2022

Per capita out-of-pocket health care payments in the United States from 2014 to 2021 (in U.S. dollars)

Health Economics

U.S. per capita out-of-pocket health care payments 2014-2021

Out-of-pocket share of total personal health care expenditures in the U.S. from 2010 to 2021

Health Economics

Out-of-pocket share of total U.S. personal health care expenditures 2010-2021

Recommended statistics

Health Insurance in the U.S.

Premium Statistic Percentage of people in the U.S. without health insurance 1997-2021
Percentage of people in the U.S. without health insurance 1997-2021
Percentage of people without health insurance in the United States from 1997 to 2021
Premium Statistic Percentage of U.S. Americans with any health insurance 1990-2021
Percentage of U.S. Americans with any health insurance 1990-2021
Percentage of people with any health insurance in the United States from 1990 to 2021
Premium Statistic Percentage adults with health insurance in the U.S. 2003-2022
Percentage adults with health insurance in the U.S. 2003-2022
Percentage of health insured vs. uninsured adults in the United States from 2003 to 2022
Basic Statistic Number of health uninsured vs insured adults in the U.S. 2003-2020
Number of health uninsured vs insured adults in the U.S. 2003-2020
Number of health insured vs. uninsured adults in the United States from 2003 to 2020 (in millions)

Cost of insurance

Basic Statistic Worker and employer premium contributions for single coverage in the U.S. 1999-2022
Worker and employer premium contributions for single coverage in the U.S. 1999-2022
Average annual worker and employer health insurance premium contributions for single coverage in the United States from 1999 to 2022 (in U.S. dollars)
Premium Statistic Worker and employer premium contribution for family coverage in the U.S., 1999-2022
Worker and employer premium contribution for family coverage in the U.S., 1999-2022
Average annual worker and employer health insurance premium contributions for family coverage in the United States from 1999 to 2022 (in U.S. dollars)
Basic Statistic Distribution of worker premium contribution in the U.S. 2022, by coverage
Distribution of worker premium contribution in the U.S. 2022, by coverage
Distribution of percentage of insurance premium paid by covered workers for single and family coverage in the United States in 2022
Basic Statistic Share of income spent on health plan costs by U.S. employees 2008-2020
Share of income spent on health plan costs by U.S. employees 2008-2020
Percentage of median income spent on premium contribution and deductible by U.S. employees from 2008-2020

Average amount of deductibles and copayments

Premium Statistic Average U.S. worker's annual deductible for single coverage, 2006-2022
Average U.S. worker's annual deductible for single coverage, 2006-2022
Average general annual deductible for single coverage among covered workers in the United States from 2006 to 2022 (in U.S. dollars)
Basic Statistic Distribution of U.S. workers' annual deductible for single coverage, 2007-2022
Distribution of U.S. workers' annual deductible for single coverage, 2007-2022
Distribution of general annual deductible for single coverage among covered workers in the United States from 2007 to 2022*
Basic Statistic Distribution of U.S. workers' copayment for a PCP visit, 2006-2022
Distribution of U.S. workers' copayment for a PCP visit, 2006-2022
Distribution of copayments among covered workers with a copayment for a primary care physician (PCP) visit in the United States from 2006 to 2022*
Premium Statistic Distribution of U.S. workers' copayment to see a specialist, 2006-2022
Distribution of U.S. workers' copayment to see a specialist, 2006-2022
Distribution of copayments among covered workers with a copayment for a specialist physician office visit in the United States from 2006 to 2022*
Basic Statistic U.S. workers' OOP maximum for single coverage, 2009-2022
U.S. workers' OOP maximum for single coverage, 2009-2022
Percentage of workers in a single coverage insurance plan with an out-of-pocket (OOP) maximum above select thresholds in the United States from 2009 to 2022

Total out-of-pocket spending in the U.S.

Basic Statistic U.S. total out-of-pocket health care payments 1960-2021
U.S. total out-of-pocket health care payments 1960-2021
Total out-of-pocket health care payments in the United States from 1960 to 2021 (in billion U.S. dollars)
Premium Statistic U.S. per capita out-of-pocket health care payments 2014-2021
U.S. per capita out-of-pocket health care payments 2014-2021
Per capita out-of-pocket health care payments in the United States from 2014 to 2021 (in U.S. dollars)
Basic Statistic U.S. out-of-pocket health care payments annual change 2010-2021
U.S. out-of-pocket health care payments annual change 2010-2021
Annual change of out-of-pocket health care payments in the U.S. from 2010 to 2021
Premium Statistic Out-of-pocket share of total U.S. personal health care expenditures 2010-2021
Out-of-pocket share of total U.S. personal health care expenditures 2010-2021
Out-of-pocket share of total personal health care expenditures in the U.S. from 2010 to 2021
Basic Statistic U.S. residents with high out-of-pocket medical costs 2019-2020, by state
U.S. residents with high out-of-pocket medical costs 2019-2020, by state
Percentage of U.S. residents with high out-of-pocket medical costs in 2019-2020, by state*
Basic Statistic Health spending of families with large employer coverage in the U.S., 2003-2018
Health spending of families with large employer coverage in the U.S., 2003-2018
Average health spending of a family of four with large employer health coverage in the United States from 2003 to 2018
Basic Statistic Health spending growth for U.S. families with large employer coverage, 2008-2018
Health spending growth for U.S. families with large employer coverage, 2008-2018
Percentage change in premiums and out-of-pocket spending for a family of four with large employer coverage compared to wages in the United States from 2008 to 2018

Out-of-pocket spending on specific drugs or health care services

Basic Statistic Atorvastatin out of pocket cost U.S. 2004-2020
Atorvastatin out of pocket cost U.S. 2004-2020
Atorvastatin out of pocket cost in the U.S. from 2004 to 2020* (in U.S. dollars)
Premium Statistic Insulin human out of pocket price in the U.S. 2004-2020
Insulin human out of pocket price in the U.S. 2004-2020
Insulin human out-of-pocket cost in the U.S. from 2004 to 2020* (in U.S. dollars)
Basic Statistic Health costs distribution of private insurance and out-of-pocket payments U.S. 2020
Health costs distribution of private insurance and out-of-pocket payments U.S. 2020
Health spending distribution of private insurance and out-of-pocket payments in the United States in 2020
Basic Statistic Hospital care spending in the United States by payer 2013-2019
Hospital care spending in the United States by payer 2013-2019
Hospital care services spending in the United States from 2013 to 2019, by payer (in billion U.S. dollars)
Basic Statistic Prescription drugs spending in the U.S. by payer 2013-2020
Prescription drugs spending in the U.S. by payer 2013-2020
Prescription drugs spending in the United States from 2013 to 2020, by payer (in billion U.S. dollars)
Basic Statistic Dental service spending in the U.S. by payer 2014-2020
Dental service spending in the U.S. by payer 2014-2020
Spending for dental services in the United States from 2014 to 2020, by payer (in billion U.S. dollars)

Miscellaneous

Basic Statistic Medication abandonment among U.S. patients in 2017, by out-of-pocket cost
Medication abandonment among U.S. patients in 2017, by out-of-pocket cost
Percentage of U.S. patients that abandon their medications as of 2017, by out-of-pocket cost*
Basic Statistic Difficulty affording select health care costs among U.S. workers with ESI in 2018
Difficulty affording select health care costs among U.S. workers with ESI in 2018
Percentage of workers with employer-sponsored health insurance in the U.S. who reported difficulty affording select health care or insurance costs as of 2018
Basic Statistic U.S. workers with employer-sponsored insurance, problems understanding plans, 2018
U.S. workers with employer-sponsored insurance, problems understanding plans, 2018
Percentage of workers with employer-sponsored health insurance in the U.S. who reported select problems in understanding their current health insurance plan as of 2018

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