David Garza sometimes feels like he doesn't have health insurance now that he's paying so much for treatment for Type 2 diabetes.
His monthly premium of $435 for family insurance is about the same as the insurance at his previous job. But the policy at his current job has an annual deductible of $4,000, which he must pay out of pocket for his family's care until he reaches that amount each year.
“Everything is full price now,” said the 53-year-old, who works in a warehouse south of Dallas-Fort Worth. “It was a little difficult.”
To cut his costs, Garza switched to a cheaper diabetes medication and no longer wears a continuous glucose meter to check his blood sugar levels. Since he started his job nearly two years ago, he said, his blood sugar has gradually risen from a target A1c of 7% or less to 14% at the time of his last doctor's visit in November.
“My A1c is through the roof because I’m technically not on the same medications that I was,” Garza said. “I have to take what I can afford.”
Plans with high deductibles—the amount patients must pay for most health care before insurance kicks in—are becoming more common. In 2024 half of private sector workers Health plan members were offered this type of insurance, up from 38% in 2015, according to federal data. Such plans are also offered through the Affordable Care Act marketplace.
WITH ACA Marketplace Premiums Will Increase Next Year and many subsidies designed to help people pay for them expire at the end of the year, more people face difficult choices as they weigh monthly insurance premiums against deductibles. To afford insurance at all, people may choose a plan with low premiums but a high deductible, betting that they won't have any medical crises.
But high-deductible plans pose a particular problem for people with chronic conditions, such as 38 million Americans who live with type 1 or type 2 diabetes. Adults with diabetes who are involuntarily switched to a high-deductible plan, compared with adults with other types of insurance, face an 11% increased risk of hospitalization for a heart attack, a 15% higher risk of hospitalization for a stroke, and more than twice as likely they will go blind or develop end-stage kidney disease, according to a study published in 2024.
“All of these complications are preventable,” he said. Rosalina McCoylead author of the study.
Care vs Cost
The original reason for such high-deductible plans was to encourage people to become smarter health care shoppers, said McCoy, an assistant professor of medicine at the University of Maryland School of Medicine in Baltimore. And they could be a good fit for people who don't use health care often or who have cash to spare in case of a health crisis, proponents say.
But while people with excruciating ear pain will seek help, McCoy says, people with unhealthy blood sugar levels may not feel a pressing need to seek treatment—despite the potential long-term damage—given the acute financial pain.
“You don’t have symptoms until it’s too late,” she said. “At this point the damage is irreversible.”
Overall, medical care for people with diabetes costs insurers and patients an average of $12,022 per year for treatment disease, according to tests. Type 2 diabetes, the more common form, is diagnosed when the body can no longer process or produce enough insulin to adequately regulate blood sugar levels. In type 1, the body cannot produce insulin. Those with the condition may find themselves on the hook for funding not only for insulin and other types of medications, but also for related equipment.
Mallory Rogers, whose six-year-old daughter Adeline has type 1, estimates that insulin, a pump and a continuous glucose monitor cost about $1,200 a month. This amount does not include the cost of emergency supplies needed in case Adeline's technology fails. These include another type of insulin, blood test strips and a nasal spray that costs nearly $600 in a two-pack—consumables that must be replaced once a year or more often.
“If she doesn't have insulin, the situation will become an emergency within two hours,” said Rogers, a technology consultant who lives in Sanford, Florida. Rogers was saving money for next year, when her daughter switches to a high-deductible health plan offered by Rogers' employer, which includes a $3,300 deductible for family coverage.
Tax decisions
Many insurance plans have increasingly higher deductibles. But to qualify as a high-deductible health plan—and therefore be eligible to offer a health savings account—the plan's 2026 deductible must be at least 1700 US dollars per person and 3400 US dollars per familyaccording to IRS rules.
Health savings accounts allow people to set aside money that can be carried over from year to year to be used for eligible medical expenses, including before meeting the deductible. These accounts, available through a plan or employer, may provide tax benefits. Contributions are capped at $4,400 individually and $8,750 for a family in 2026, and employers can match that amount. Rogers' employer pays $2,000 for the year, while Garza's employer pays $1,200.
Rogers admits she's fortunate to have $7,000 saved up in her savings account to prepare for her daughter's insurance switching to Rogers' plan.
“Adding a financial burden to an already very difficult health situation hurts my heart,” she said, thinking about those who cannot similarly stockpile. “Nobody asks who has type 1 or type 2 diabetes.”
The average deductible for employer health plans in 2024 was $2,750, but deductibles can be as high as $5,000 or higher, said George Huntley, CEO of both companies. Diabetes Leadership Council And Diabetes Rights Coalition.
When deductibles are too high, Huntley says, patients skimp on regular care: “You're not taking the drug you're supposed to be taking to maintain your blood glucose levels. You're rationing your insulin, if that's your scenario. You're taking pills every other day.”
Garza knows he should be doing more to control his blood sugar, but financial realities complicate the equation. His previous health insurance plan included a new class of diabetes drugs called a GLP-1 agonist for $25 a month. He was not charged for his remaining medications, including blood pressure and cholesterol medications and a permanent blood glucose monitor.
Thanks to his new insurance, he pays $125 a month for insulin and several other medications. He does not visit the endocrinologist for examinations more than twice a year.
“He wants to see me every three months,” Garza said. “But I told him it wasn’t possible at $150 a piece.”
In addition, he usually needs to undergo a laboratory test before each visit, which costs an additional $111.
In 2026, the deductible for a silver plan in the market will average $5,304 without cost-sharing reductions, according to an analysis by KFF, a health care think tank that includes KFF Health News. For Bronze level plan, it will be $7,476. The annual visit and some preventive screenings, such as mammograms, will be covered at no cost to the patient.
Moreover, people comparison of plan optionswhether through their employer or the marketplace, must determine their annual out-of-pocket maximum, which still applies after the deductible is met, Huntley said.
For example, Garza's family policy requires him to pay 20% until he reaches $10,000.
Given Garza's high blood sugar, his doctor prescribed a fast-acting form of insulin to be taken as needed with meals, which costs an additional $79 per month. He planned to top it up in December, when he would only be responsible for 20% of the cost after he reached his deductible, but had not yet reached his out-of-pocket maximum.
Garza loves his job, despite its health insurance plan, and says he has never missed a day of work, even recently when he had a stomach ailment. At the end of 2025, he was still undecided about whether to sign up for health insurance when his company's enrollment period begins in mid-2026.
He's concerned that not having insurance would put his family at too much risk if a major medical crisis were to occur. However, he noted, he could then use the money he now spends on monthly insurance premiums to directly pay for treatment to better manage his diabetes.
“To be honest, I’m just stuck,” he said.
