As the national debate over affordable health insurance continues, new findings from the Nationwide Retirement Institute show that rising medical costs are forcing even insured Americans to make difficult decisions about their care. Nearly two in five U.S. adults with insurance (37%) report avoiding medical care when sick due to cost concerns, and 41% of insured Americans have skipped healthcare appointments due to rising costs in the past year alone.

To cope with this pressure, insured Americans are increasingly cutting the preventative care that can identify health concerns early and avoid costly interventions later. Over the past year, Americans have postponed or cancelled:

• Dental cleanings (23%)
• Vision tests (20%)
• Seeing a specialist (17%)
• Mental health care (16%)

While these cuts may feel necessary in the moment, skipping care today can create greater health and financial risks in retirement.

At the same time, the price of staying insured is climbing. In 2025, the average cost for single coverage is on track to increase 5%, with family costs rising 6%. With temporary Affordable Care Act (ACA) tax credits set to expire, many households may soon face even steeper premiums.

This creates financial squeeze on two sides: people are paying more to stay insured, yet their insurance covers less of their total health care expenses. Higher premiums combined with rising out-of-pocket costs mean many Americans spend more upfront and still face bills they cannot manage.

Indeed, Nationwide's survey found:

• 18% of Americans have already turned to medical debt or credit cards to cover out-of-pocket expenses.
• Nearly one-third (31%) say they cannot afford to pay an unexpected $500 out-of-pocket medical bill.

The introduction of high-cost medications, including GLP-1 drugs for diabetes and weight management, is adding more pressure. Many adults who could benefit from these treatments face steep out-of-pocket costs or limited coverage, further widening the gap between what insurance pays and what patients must shoulder themselves.

"Today's health care costs are forcing Americans to make difficult decisions about when and how to seek care," said Kristi Rodriguez, senior vice president, Financial Services Marketing and leader of the Nationwide Retirement Institute. "Those tradeoffs may feel short-term, but they can have lasting consequences — leading to poorer health outcomes that, over time, drive higher medical expenses and greater financial stress in retirement."

Rising Retirement Fears

Rising health care costs pose an even greater challenge as increased longevity requires Americans to manage both higher expenses and more years of care. This pressure is reflected in people's concerns:

• 73% of U.S. adults list health care expenses going out of control as one of their top retirement fears.
• 71% say they are terrified of what those costs could do to their retirement savings.
• More than half (51%) say medical/health expenses have drastically reduced how much they have saved or will be able to save for retirement.
• 68% worry that a single, major health event could ruin their finances for years to come.

Despite these fears, most Americans admit they are unprepared:

• Nearly six in 10 (59%) say they are not confident in their ability to budget for health care expenses in retirement.
• Two-thirds (66%) cannot estimate how much those costs will total in all of retirement.
• Only 38% have a plan to save for the amount they expect to need in retirement.

These knowledge gaps also extend to safety net programs like Medicare, which currently covers more than 69 million Americans. On average, respondents answered fewer than half of a 16-question Medicare quiz correctly (~7 correct answers on average). One of the biggest misconceptions: two-thirds (66%) incorrectly think that or are not sure if Medicare covers long-term care costs — leaving a costly gap in many people's plans.

Turning Financial Anxiety into Action with Help

While the financial risks of rising health care costs are clear, the survey also points to an actionable solution: guidance from a trusted financial professional. Americans who work with an advisor are significantly more likely to feel informed and confident about their health care planning. For example, 42% of those not paying to work with an advisor say they do not know how Medicare works to cover medical costs in retirement, compared to just 21% of those who pay to work with a financial professional.

Still, these findings suggest there's room for deeper conversations:

• More than half (56%) of those working with a financial professional say they have not yet received advice on how and when to file for Medicare benefits.
• Seven in 10 (72%) of those working with a financial professional or those who do not work with a financial professional but do plan to ask one about Medicare benefits in the future say they would switch to an advisor who could offer that guidance.

"Now is the time to close the gap between concern and action," said Rodriguez. "Financial professionals have a powerful opportunity to help clients understand the connection between health and wealth—by budgeting for routine care and out-of-pocket expenses, planning realistically for health care costs in retirement, and navigating Medicare with confidence. Proactive guidance can protect savings and give clients greater peace of mind about retirement."

To help financial professionals guide these conversations, Nationwide's Health Care Cost Assessment tool uses proprietary health risk analysis and updated actuarial cost data to help financial professionals and clients estimate future medical and long-term care expenses, and its educational resources ensure advisors have strategies and tools to help their clients prepare.