Given the necessity of insurance to defray the full cost of health care in the United States, it shouldn’t come as a surprise that the vast majority of people who had spent some time uninsured during the year would report difficulty affording their health care costs. More surprising is the large share of adults who had insurance all year but still report difficulty paying health care expenses. Forty-three percent of people in employer plans, 57 percent enrolled in marketplace or individual-market plans, 45 percent with Medicaid, and 51 percent with Medicare said it was difficult to afford their health care.

Among people enrolled in employer plans, those with low income especially struggled with health care costs: 56 percent with income under 200 percent of the federal poverty level ($29,160 for an individual and $60,000 for a family of four) reported difficulty paying these costs.

Being in poor health exacerbates problems affording care, even for people covered by Medicare. Those under age 65 who are Medicare-eligible have serious disabilities or health conditions that prevent them from working full time, making them among the poorest and sickest people we surveyed. Because of their low income, many are also eligible for Medicaid.

The cost of health services is an insurmountable barrier to getting timely care for most uninsured people. As our survey shows, costs are also a barrier for many people who have insurance. Nearly three in 10 people in employer plans, more than one-third in marketplace or individual-market plans, and about two of five people with Medicaid or Medicare said they or a family member had delayed or skipped needed health care or prescription drugs in the past 12 months because they couldn’t afford it.

Among people in employer plans, those with incomes under 400 percent of poverty ($58,320 for an individual and $120,000 for a family of four) reported much higher rates of care delayed or forgone because of cost compared to those with higher incomes.