Carrying a health insurance plan with a steep deductible can do more than drain your wallet—it can be deadly.
A recent JAMA Network Open study reported that people facing those high out-of-pocket costs who were diagnosed with cancer had worse overall and cancer-specific survival than those with more conventional health plans.
While not entirely surprising, the results highlight the difficult choices Americans confront as health care prices continue to rise and more people try to lower premiums by selecting plans with larger deductibles—that is, bigger out-of-pocket amounts they must pay before their insurer starts covering costs.
This problem is especially acute right now for people covered through the Affordable Care Act marketplace. Costs for those plans have surged this year after Congress failed to extend critical tax credits. Without those credits, monthly premiums for ACA plans have, on average, more than doubled. Early 2026 enrollment data not only suggests fewer people are signing up, but also that many who do are opting for bronze plans, which act as high-deductible plans.
For the study, researchers classified plans as “high-deductible health plans” (HDHPs) when individual deductibles ranged from $1,200 to $1,350 or family deductibles ranged from $2,400 to $2,700 between 2011 and 2018 (with the cutoffs rising within those ranges over time). For context, KFF reports the average individual deductible for an ACA bronze plan in 2026 is about $7,500.
Risky plans
Prior evidence shows these large out-of-pocket obligations prompt people to delay or reduce care—they may skip doctor visits, defer diagnostic tests, and avoid treatments. For the new analysis, a team led by Justin Barnes at the Mayo Clinic in Rochester, Minnesota, aimed to assess more directly whether such plans were associated with lower survival—particularly for cancer patients, who generally require more intensive care.
