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 had surpassed 433 billion U.S. dollars in 2021.

Health coverage: uninsured or underinsured?

The percentage of uninsured adults in the United States decreased from 20 to nine percent between 2010 and 2021. 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 2022 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 2022, the percentage of covered workers with a deductible for single coverage was more than 85 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 2022.

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: 1,233 USD

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

Annual percentage change in out-of-pocket health care payments in the U.S. in 2021: 10.4%

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 2023 (in U.S. dollars)

Private Health Insurance

Average U.S. worker's annual deductible for single coverage, 2006-2023

Per capita out-of-pocket health care payments in the United States from 1970 to 2022 (in U.S. dollars)

Health Economics

U.S. per capita out-of-pocket health care payments 1970-2022

Out-of-pocket share of total personal health care expenditures in the U.S. from 2010 to 2022

Health Economics

Out-of-pocket share of total U.S. personal health care expenditures 2010-2022

Recommended statistics

Health Insurance in the U.S.

Premium Statistic Percentage of people in the U.S. without health insurance 1997-2022
Percentage of people in the U.S. without health insurance 1997-2022
Percentage of people without health insurance in the United States from 1997 to 2022
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
Premium Statistic Percentage of U.S. Americans with any health insurance 1990-2022
Percentage of U.S. Americans with any health insurance 1990-2022
Percentage of people with any health insurance in the United States from 1990 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)
Premium Statistic Share of total personal health care expenditure in the U.S. in 2020, by fund source
Share of total personal health care expenditure in the U.S. in 2020, by fund source
Distribution of total personal health care expenditure in the United States in 2020, by source of funds

Cost of insurance

Basic Statistic Worker and employer premium contributions for single coverage in the U.S. 1999-2023
Worker and employer premium contributions for single coverage in the U.S. 1999-2023
Average annual worker and employer health insurance premium contributions for single coverage in the United States from 1999 to 2023 (in U.S. dollars)
Premium Statistic Worker and employer premium contribution for family coverage in the U.S., 1999-2023
Worker and employer premium contribution for family coverage in the U.S., 1999-2023
Average annual worker and employer health insurance premium contributions for family coverage in the United States from 1999 to 2023 (in U.S. dollars)
Basic Statistic Distribution of worker premium contribution in the U.S. 2023, by coverage
Distribution of worker premium contribution in the U.S. 2023, by coverage
Distribution of percentage of insurance premium paid by covered workers for single and family coverage in the United States in 2023
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, 2006-2023
Average U.S. worker's annual deductible for single coverage, 2006-2023
Average general annual deductible for single coverage among covered workers in the United States from 2006 to 2023 (in U.S. dollars)
Basic Statistic Distribution of U.S. workers' annual deductible for single coverage, 2007-2023
Distribution of U.S. workers' annual deductible for single coverage, 2007-2023
Distribution of general annual deductible for single coverage among covered workers in the United States from 2007 to 2023*
Basic Statistic Distribution of U.S. workers' copayment for a PCP visit, 2006-2023
Distribution of U.S. workers' copayment for a PCP visit, 2006-2023
Distribution of copayments among covered workers with a copayment for a primary care physician (PCP) visit in the United States from 2006 to 2023*
Premium Statistic Distribution of U.S. workers' copayment to see a specialist, 2006-2023
Distribution of U.S. workers' copayment to see a specialist, 2006-2023
Distribution of copayments among covered workers with a copayment for a specialist physician office visit in the United States from 2006 to 2023*
Basic Statistic U.S. workers' OOP maximum for single coverage, 2009-2023
U.S. workers' OOP maximum for single coverage, 2009-2023
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 2023
Premium Statistic Average MA out-of-pocket maximum in the U.S. 2022, by plan type
Average MA out-of-pocket maximum in the U.S. 2022, by plan type
Average Medicare Advantage (MA) maximum out-of-pocket (MOOP) amount in the U.S. for 2022, by type of plan (in U.S. dollars)

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

Basic Statistic U.S. total out-of-pocket health care payments 1960-2022
U.S. total out-of-pocket health care payments 1960-2022
Total out-of-pocket health care payments in the United States from 1960 to 2022 (in billion U.S. dollars)
Premium Statistic U.S. per capita out-of-pocket health care payments 1970-2022
U.S. per capita out-of-pocket health care payments 1970-2022
Per capita out-of-pocket health care payments in the United States from 1970 to 2022 (in U.S. dollars)
Basic Statistic U.S. out-of-pocket health care payments annual change 2010-2022
U.S. out-of-pocket health care payments annual change 2010-2022
Annual change of out-of-pocket health care payments in the U.S. from 2010 to 2022
Premium Statistic Out-of-pocket share of total U.S. personal health care expenditures 2010-2022
Out-of-pocket share of total U.S. personal health care expenditures 2010-2022
Out-of-pocket share of total personal health care expenditures in the U.S. from 2010 to 2022
Basic Statistic U.S. residents with high out-of-pocket medical costs 2020-2021, by state
U.S. residents with high out-of-pocket medical costs 2020-2021, by state
Percentage of U.S. residents with high out-of-pocket medical costs in 2020-2021, by state*

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

Basic Statistic Out-of-pocket health care spending per person in the U.S. by category 2016-2021
Out-of-pocket health care spending per person in the U.S. by category 2016-2021
Annual out-of-pocket (OOP) health care spending per person in the United States among those with employer-sponsored insurance from 2016 to 2021, by category (in U.S. dollars)
Basic Statistic Health costs distribution of private insurance and out-of-pocket payments U.S. 2021
Health costs distribution of private insurance and out-of-pocket payments U.S. 2021
Health spending distribution of private insurance and out-of-pocket payments in the United States in 2021
Basic Statistic Dental service spending in the U.S. by payer 2013-2021
Dental service spending in the U.S. by payer 2013-2021
Spending for dental services in the United States from 2013 to 2021, by payer (in billion U.S. dollars)
Basic Statistic Hospital care spending in the United States by payer 2013-2021
Hospital care spending in the United States by payer 2013-2021
Hospital care services spending in the United States from 2013 to 2021, by payer (in billion U.S. dollars)
Basic Statistic Prescription drugs spending in the U.S. by payer 2013-2021
Prescription drugs spending in the U.S. by payer 2013-2021
Prescription drugs spending in the United States from 2013 to 2021, by payer (in billion U.S. dollars)
Basic Statistic Atorvastatin out of pocket cost U.S. 2004-2021
Atorvastatin out of pocket cost U.S. 2004-2021
Atorvastatin out of pocket cost in the U.S. from 2004 to 2021 (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)

Miscellaneous

Premium Statistic Ability to afford out-of-pocket costs on health care in the U.S. 2023
Ability to afford out-of-pocket costs on health care in the U.S. 2023
Distribution of employees who would be able to afford unexpected out-of-pocket (OOP) health costs in the U.S. in 2023. by amount
Premium Statistic Average OOP spending for health management activities in the U.S. in 2022, by age
Average OOP spending for health management activities in the U.S. in 2022, by age
How much do you pay out-of-pocket each year for your health management activities in total?
Premium Statistic Amount paid out-of-pocket for surprise medical bills in the U.S. as of 2022
Amount paid out-of-pocket for surprise medical bills in the U.S. as of 2022
Distribution of U.S. American adults who have paid out-of-pocket (OOP) for a surprise medical bill received since January 2022, by amount paid
Basic Statistic Share of older adults with high out-of-pocket health costs worldwide 2021
Share of older adults with high out-of-pocket health costs worldwide 2021
Percentage of adults aged 65 and older who reported out-of-pocket health costs of more than 2,000 USD in the past year in select high-income countries in 2021

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