Key points
- Underinsured means insured all year yet facing out-of-pocket costs or a deductible high relative to income — the Commonwealth Fund's standard definition, from its 2014 survey (brief, May 2015): 23% of insured US adults aged 19–64, about 31 million people, in 2014.
- In 2026 the average employer-sponsored family premium was $28,303 a year, up 5%; covered workers paid $7,471 of it on average, up 9% — $621 more than in 2025 (KFF Employer Health Benefits Survey, released 22 October 2026).
- Marketplace insurers proposed a median premium increase of 15% for 2027 (276 insurers, all 50 states and DC), after a median proposed 18% and a median finalised 20% for 2026 (KFF, 3 August 2026).
- Every figure on this page is a population average. None of it says what any one person pays — premiums, deductibles and subsidies vary by plan, employer, state and income.
Direct answer: At population level, US health insurance got more expensive in 2026 and is set to rise again in 2027. The average employer-sponsored family premium reached $28,303 a year in 2026, with covered workers paying $7,471 of it on average (KFF, 22 October 2026). Marketplace insurers proposed a median premium increase of 15% for 2027 (KFF, 3 August 2026). And being insured does not always mean being protected: under the Commonwealth Fund's standard definition, 23% of insured US adults aged 19–64 were underinsured in its 2014 survey. Every figure on this page is a population average — none of it says what any one person pays.
What “underinsured” means
Having insurance and being protected from medical costs are not the same thing. The Commonwealth Fund’s standard definition of underinsured, from its Biennial Health Insurance Survey, is an adult who was insured all year yet still faced out-of-pocket costs or a deductible that was high relative to household income. Specifically, someone insured all year is underinsured if out-of-pocket costs, excluding premiums, over the prior 12 months were 10% or more of household income — or 5% or more if income was under 200% of the federal poverty level — or if the deductible was 5% or more of household income (Commonwealth Fund, brief, May 2015).
In the survey behind that definition — fielded July to December 2014 — 23% of US adults aged 19–64 who were insured all year, about 31 million people, were underinsured. That share was nearly double the figure when the measure was first introduced in 2003, and statistically unchanged from 2010 and 2012. The definition is the standard one still used to describe the problem; the 23% and 31 million figures are from 2014 and are not a current prevalence estimate. Do not read them as today’s rate.
The consequences in that survey were concrete: half (51%) of underinsured adults reported problems with medical bills or debt, and more than two of five (44%) reported not getting needed care because of cost — not going to the doctor when sick, not filling a prescription, skipping a test or treatment a doctor recommended, or not seeing a specialist. Deductibles were a growing cause: by 2014, 11% of adults insured all year had a deductible that was high relative to their income, up from 3% in 2003, and an estimated 7 million people were underinsured because of their deductible alone.
For how insurance is supposed to protect people from exactly this — the raising, pooling and purchasing of health money, and what financial protection means — see how healthcare is funded. For how countries organise that protection, including the US mix, see how countries pay for UHC.
What US workers pay on average
Most Americans get health insurance through an employer: employer-sponsored insurance covers almost 157 million people under age 65 (KFF, 2026 Employer Health Benefits Survey). The survey, released on 22 October 2026 and based on 1,937 interviews with non-federal public and private firms, is the 28th annual edition. Its 2026 averages, for covered workers:
| Coverage | Average annual premium | Average worker contribution |
|---|---|---|
| Single | $9,804 (up 5% on 2025) | $1,672 |
| Family | $28,303 (up 5% on 2025) | $7,471 (up 9%, +$621) |
On average, covered workers contribute 18% of the premium for single coverage and 27% for family coverage — similar shares to 2025. The change in 2026 was in the worker’s share, not the total: the family premium rose 5%, but the worker’s contribution rose 9%, while wages rose 3.7% and inflation was 2.7%. The average single-coverage deductible was $1,955, similar to $1,886 in 2025. Among large firms (200 or more workers), the most common response to projected cost increases was raising the share of the premium workers contribute — 44% did so.
Averages hide wide variation: the average worker contribution for family coverage was $9,687 at smaller firms (10–199 workers) against $6,840 at larger firms, and 13% of covered workers are in a plan with a worker contribution of $12,000 or more for family coverage. A national average is a description of the population, not a prediction for any one worker.
Why marketplace premiums are rising for 2027
Separate from employer coverage, people who buy their own coverage usually do so through the Affordable Care Act Marketplaces. KFF’s analysis of 2027 marketplace rate filings, updated on 3 August 2026, found insurers proposing a median premium increase of 15% for 2027 across 276 insurers with publicly available filings in all 50 states and the District of Columbia. That is the second consecutive year of double-digit proposed increases: last year’s median proposed change was 18%, and the median finalised change was 20%. The 15% proposal is the second-highest requested rate change since 2018.
Insurers cite several drivers, in KFF’s reading of the detailed filings from 16 states and DC:
- Rising costs for health services. Hospitalisations, physician visits and prescription drugs — including GLP-1s and other specialty medications — plus labour shortages and general economic inflation pushing up provider wages. The underlying cost of medical care and prescription drugs rose by 10% for 2027, greater than the 8% average growth seen over the last few years (KFF, preliminary analysis, 8 July 2026).
- The expiry of the enhanced premium tax credits at the end of 2025. That led to a 58% average increase in out-of-pocket premiums in 2026 and deductibles of about $1,000 more per person. People with incomes at 400% or more of the federal poverty level lost subsidies entirely and face the full increase.
- A sicker risk pool. As healthier enrollees left the marketplaces in 2026, those remaining were somewhat sicker and more expensive to cover on average. Insurers estimated the sicker risk pool drove 2026 premiums up by roughly four percentage points, and expect another four percentage point increase in 2027.
- Federal regulatory changes, including the Notice of Benefit and Payment Parameters and the Marketplace Integrity and Affordability Rule.
Proposed is not final. KFF’s November 2026 open-enrollment briefing reports the average increase in finalised benchmark silver premiums for 2027 as 13% — after those premiums rose 26% from 2025 to 2026 — with HealthCare.gov states at 11% and state-based marketplaces at 16%. The two measures differ: the 15% is a median across insurers’ proposed rates; the 13% is the average change in the benchmark silver plan after regulators reviewed the filings. Either way, it is a second straight year of double-digit increases, on top of the steep 2026 rise.
The market is also shrinking: marketplace plan selections fell by 1.2 million in the 2026 open enrollment period, effectuated enrollment was down 12% (2.6 million people) to 19.2 million by February 2026, and the Congressional Budget Office projects marketplace enrollment falling from a peak of 22.4 million in 2025 to 13.1 million in 2027 (KFF, November 2026). Fewer, sicker enrollees and higher premiums reinforce each other — which is why insurers expect further upward pressure.
What these figures do not say
Three limits apply to everything on this page. First, averages are not individuals: no figure here says what any one person pays, and this page gives no personal advice — it describes populations. Second, proposed rates are not final rates: the 15% median for 2027 is what insurers asked for, and state regulators approve the rates that actually apply. Third, the underinsurance figures are dated: the 23% and 31 million come from a 2014 survey, and the definition — not the prevalence — is what is current. A figure without its year cannot be trusted, and this page dates every one it uses.