David Garza sometimes feels like he doesn't have health insurance because his treatment for Type 2 diabetes is so expensive.
Her monthly premium of $435 for family coverage is almost equal to the coverage from her previous job. But the health insurance plan at your current job has an annual deductible of $4,000 that you must pay out of pocket before the insurance begins covering your family's medical expenses each year.
“Everything is full price now,” said the 53-year-old man who works in a warehouse south of the Dallas-Fort Worth area. “It was a little difficult.”
To cut her expenses, Garza changed her diabetes medication to a cheaper one and stopped using the continuous glucose meter that monitored her blood sugar. Since he started this work nearly two years ago, he said, his hemoglobin A1c level has risen from 7% or less (the recommended goal) to 14% at the time of his last doctor's visit in November.
“My A1c is through the roof because I’m technically not taking the right medications like I used to,” Garza lamented. “I take what I can afford.”
Plans with high deductibles—the amount patients must pay for most health care services before insurance takes over—are becoming more common.
In 2024 half of employers offered this type of coverage, up from 38% in 2015, according to federal data. These plans are also available through the Affordable Care Act (ACA) insurance marketplace.
WITH ACA marketplace premium increases With next year and the possible end of some subsidies at the end of 2025, more people are facing difficult decisions when comparing the monthly cost of their premiums to their deductible. To afford insurance, some people choose plans with low premiums but high deductibles, betting that they won't have a medical crisis.
But these plans pose a particular challenge for people living with chronic conditions, such as 38 million people who have type 1 or type 2 diabetes in the United States.
Adults with diabetes who involuntarily switch to a high-deductible plan face an 11% higher risk of hospitalization for a heart attack than those with other types of insurance, according to a study published in 2024. They also have a 15% increased risk of stroke and more than doubled chance of blindness or developing end-stage kidney disease.
“All of these complications are preventable,” he said. Rosalina McCoylead author of the study.
Attention vs cost
The original purpose of high-deductible plans was to encourage better decision-making when seeking medical care, said McCoy, an assistant professor at the University of Maryland School of Medicine in College Park.
But while someone with excruciating ear pain will seek medical help, he said, people with out-of-control blood sugar levels may not feel the same urgency — despite the potential long-term damage — because of the dire financial consequences.
“There are no symptoms until it’s too late,” he said. “And at that point the damage becomes irreversible.”
Average cost of medical care for people with diabetes $12,022 per yearaccording to an analysis of 2022 data. Type 2 diabetes, the most common form, is diagnosed when the body stops making enough insulin or doesn't use it properly, making it difficult to control blood sugar levels.
In type 1 diabetes, the body does not produce insulin. People with this condition must cover not only the cost of insulin and other medications, but also the equipment needed to care for them.
Mallory Rogers estimates she spends about $1,200 a month on care for her 6-year-old daughter Adeline, who has Type 1 diabetes. This includes insulin, an insulin pump, and a continuous glucose monitor. Not included are the essentials that would be needed if any of these devices failed: another type of insulin, blood glucose test strips and two bottles of nasal spray, which costs nearly $600 and must be refilled at least once a year.
“If I didn't have insulin, I would be in an emergency situation in less than two hours,” explained Rogers, a technology consultant who lives in Sanford, Florida. The woman was saving money in case her daughter had to take advantage of her employer's high-deductible health insurance plan, which tops out at $3,300 for family coverage.
Tax decisions
Many insurance plans have increasingly higher deductibles. But for a plan to officially be considered a “high deductible” and thus offer a health savings account (HSA), the deductible in 2026 must be at least $1,700 for individual coverage and $3,400 for family coverage.according to IRS rules.
In 2026, those who have access to a health savings account (HSA) through their plan or employer will be able to get a tax break by contributing up to $8,750 per household or $4,400 per individual if they can afford it. Rogers' employer contributes $2,000 for the year, and Garza's employer contributes $1,200.
Rogers admits she's lucky she's managed to save $7,000 in her HSA by the time her daughter's insurance rolls over to her plan.
“Adding a financial burden to an already difficult health condition breaks my heart,” she said, thinking about those who cannot save as much. “Nobody asks who has diabetes, whether it’s type 1 or type 2.”
In 2024, the average deductible for employer plans was $2,750, but it could exceed $5,000, according to George Huntley, the fund's executive director. Diabetes Leadership Council And Coalition for the rights of patients with diabetes.
When deductibles are too high, Huntley says, the first thing people start cutting back on is basic care: “They're not taking the medications they should be taking to control their glucose levels. They ration insulin if that's the case. They take pills every other day.”
Garza knows he should do more to fight diabetes, but his financial situation doesn't allow it. Her previous insurance covered a new type of diabetes medication known as GLP-1 agonists for $25 a month. It also covered his other medications, such as blood pressure and cholesterol medications, as well as his continuous glucose monitor, free of charge.
Thanks to his new insurance, he pays $125 a month for insulin and other medications. He sees his endocrinologist only twice a year.
“He wants to see me every three months,” Garza said. “But I told him it wasn’t possible at $150 a consultation.”
Additionally, you typically need lab tests before each visit, which will cost you another $111.
Next year, the average deductible for a Silver plan in the ACA market will be $5,304 without any cost-sharing reductions, according to KFF's analysis. For Bronse Mapthe average would be $7,476.
An annual doctor's visit and some preventive screenings, such as mammograms, will be included at no cost to the patient.
Besides, who compare plans — whether through their employer or the insurance marketplace — keep in mind what their annual out-of-pocket maximum is, which still applies even after the deductible is reached, Huntley explained.
For example, Garza's family plan requires him to pay 20% of expenses up to $10,000.
Because her sugar levels are so high, her doctor prescribed rapid-acting insulin to take with meals, which costs an additional $79 per month. Garza planned to fill the prescription in December, when she would only have to pay 20% of the cost—she had already met her deductible but had not yet reached the out-of-pocket maximum.
Garza loves his job despite his health insurance plan and says he never misses a day, even recently when he had a stomach virus. By the end of 2025, you still haven't decided whether to sign up for health insurance when your company's enrollment period hits in mid-2026.
You are concerned that not having insurance will put your family at risk in the event of a medical emergency. However, he said, he could use the money he now pays in monthly insurance premiums to directly cover his medical care and thus better control his diabetes.
“To be honest, I feel trapped,” he concluded.
