A family with employer-sponsored coverage paid $26,993 for their health plan in 2025, and $6,850 of that came straight out of worker paychecks. Those figures come from KFF’s 2025 Employer Health Benefits Survey, and they are the honest place to start any conversation about what American families spend on health care. The premium is only the first layer. Deductibles, cash spending at the pharmacy counter, and the debt that follows a bad year all stack on top of it.
The premium is the biggest number, and workers see only part of it
KFF’s 2025 survey puts the average annual premium for employer-sponsored family coverage at $26,993, up 6 percent over 2024. Workers contribute $6,850 of that, roughly 26 percent, with employers covering the rest. Single coverage averaged $9,325, with the worker paying $1,440.
The employer share is not a gift. Economists have long treated it as compensation that would otherwise show up in wages, which is why premium growth and wage stagnation tend to travel together. A worker who sees a 3 percent raise while family premiums climb 6 percent has not gained ground. They have handed the difference to the health plan.
The gap between what a household pays and what the plan costs also explains a persistent confusion in public debate. Ask an insured worker what their coverage costs and most will answer with their payroll deduction. The real figure is close to four times larger.
Deductibles moved the goalposts
Having a card in your wallet is not the same as being able to use it. KFF found the average general annual deductible for single coverage reached $1,886 in 2025, an increase of 17 percent over five years and 43 percent over ten. Thirty-four percent of covered workers now face a single-coverage deductible of $2,000 or more, up from 32 percent the year before.
Firm size drives much of the spread. At companies with 10 to 199 workers, the average single deductible ran $2,631 and 53 percent of covered workers faced a deductible of $2,000 or more. At larger firms the comparable figures were $1,670 and 28 percent. Small-business employees carry meaningfully more exposure for the same nominal benefit.
Set that against household savings and the arithmetic gets uncomfortable. A $2,000 deductible is not a rounding error for a family living close to its income.
What households actually spend
The Bureau of Labor Statistics Consumer Expenditure Survey reported average health care spending of $6,197 per consumer unit in 2024, or 7.9 percent of total annual expenditures of $78,535. That total breaks into health insurance at $4,055, medical services at $1,252, drugs at $658, and medical supplies at $233.
Read that breakdown carefully, because it is routinely misquoted. The $6,197 figure includes insurance premiums. The portion spent at the point of care, on services, drugs, and supplies, is the part that arrives without warning and without a payment plan.
Overall medical inflation has been mild lately. BLS put the 12-month change in the medical care index at 1.7 percent for July 2026, with medical care services up 2.7 percent and medical care commodities down 2.7 percent. Prices are not the current pressure point. The share of the bill that has been shifted onto households is.
Cost is changing what people do
KFF polling conducted in May 2025 found 36 percent of adults said they skipped or postponed needed care because of cost, and 44 percent said they find it difficult to afford their health care costs.
The Federal Reserve’s Report on the Economic Well-Being of U.S. Households in 2025 reached a similar place from a different direction. Twenty-six percent of adults went without some form of medical care because they could not afford it, with dental care skipped most often. Among adults with income under $25,000 the figure was 38 percent, against 13 percent for those at $100,000 or more.
Note the insured numbers in the Federal Reserve survey. This is not only a coverage-gap story. Twenty-four percent of people who have insurance still skipped care they could not afford.
The debt that follows
KFF’s Health Care Debt Survey, fielded in February and March of 2022, found 41 percent of adults carried debt from medical or dental bills. That included 24 percent with bills they were past due on or unable to pay, 21 percent paying a provider over time, and 17 percent who owed a bank, collection agency, or other lender. Nearly one in five with health care debt expected never to pay it off, a figure that rose to 53 percent among those owing $10,000 or more.
On the aggregate, KFF’s October 2025 review of health care costs put total medical debt owed at a minimum of $200 billion as of the end of 2023, drawing on the Census Bureau’s Survey of Income and Program Participation. The Federal Reserve’s 2025 household survey found 18 percent of adults carried debt from their own or a family member’s medical care, within the 15 to 18 percent band it has recorded every year since 2019.
These figures get muddled constantly in public conversation, so the vintages are worth stating plainly. The frequently cited $220 billion total describes debt outstanding at the end of 2021. The widely repeated claim that roughly 100 million Americans carry health care debt traces to a KFF Health News and NPR investigation published in June 2022, not to a single survey question.
Why the headline inflation rate misses this
Medical care rose 1.7 percent over the year to July 2026 while all items rose 3.4 percent. By that measure health care looks like a solved problem. It is not, because the household experience is driven by the level of the bill and the share of it borne directly, not by this year’s percentage change.
A family paying $6,850 in premium contributions and facing a $2,000 deductible has committed close to $9,000 before a single claim is denied. That commitment does not shrink when the medical care index cools.
Anyone tracking this problem across categories rather than one bill at a time will find the affordability data that Fight For A Living Wage keeps in one place a useful reference point, since health care rarely fails a household in isolation. It fails alongside housing, childcare, and food.
What the numbers add up to
Three things are true at once. Coverage is near a historic high, with the Census Bureau reporting 92.0 percent of people, about 310 million, insured for some or all of 2024. Medical price inflation is currently modest. And more than a third of adults still delayed care over cost while 18 percent carried medical debt.
A system can expand coverage and still leave families exposed, because the exposure now sits inside the coverage rather than outside it. That is the shift worth watching, and it is the one least visible in the headline statistics.
