Most insured Americans doubt coverage would cover a crisis

Where cost-sharing was the barrier, dental care had the highest avoidance rate among financially strained respondents at 52%. Vision care and doctor visits followed at 37%, prescription medications at 31%, and mental health services at 23%. The gap between what a plan excludes and what an enrolled member can afford reflects two distinct underinsurance mechanisms, both present in the data.

A policy shift added pressure. The Affordable Care Act (ACA) enhanced premium tax credits, which had reduced marketplace premiums for millions of enrollees, expired at the start of 2026. The Congressional Budget Office (CBO) projected that around 4 million people would lose coverage as a result, and those who kept their plans faced higher premiums that left less capacity to absorb cost-sharing when care was needed.

Plan design gaps the data expose

The GoodRx survey carries a specific limitation. Respondents were restricted to adults who had taken a prescription in the prior month and held insurance with drug coverage. That population likely over-represents people actively engaged with the healthcare system. The direction of the findings, however, aligns with published data from the Commonwealth Fund and Mercer on the gap between nominal coverage and practical access.

Dental, vision, and prescription gaps are the three categories where employer plan design has the most direct bearing on the care-avoidance rates GoodRx documented. Dental and vision are stand-alone elections employers can offer, expand, or leave off entirely, and among financially strained respondents, those two categories recorded the highest rates of avoided care. Reducing deductible exposure or adding dental and vision benefits can narrow the access gap without requiring any change to the underlying medical structure.

With 2027 renewals approaching, more than half of insured Americans already doubt their plan would protect them from a catastrophic medical event. That share has grown as premiums have risen and deductibles have widened.