Key takeaways:
Being underinsured means having health insurance and still being unable to afford healthcare. You might also have coverage that doesn’t provide the benefits you need.
Underinsurance is different from being uninsured, which means lacking health coverage.
Underinsurance can lead an individual or family with coverage to skip or delay medical care.
If you are underinsured, there are ways to get free or low-cost healthcare, including prescription medications. These alternative options include patient assistance programs, hospital financial aid, and discounted self-pay programs such as GoodRx Companion.
Having health insurance doesn’t always mean you can afford healthcare. Health plans can vary greatly in their quality of coverage, with some offering fewer benefits at higher out-of-pocket costs. Some people who don’t need regular medical care might prefer this kind of coverage because they spend less in the long run. But others might end up with plans that don’t serve their needs because they lack other coverage options.
If you’ve ever had a health plan and skipped medical care because you simply could not afford your share of costs, you’re likely underinsured. This can be a difficult and stressful reality, but know that you have options. We’ll explain more about what it means to be underinsured and what you can do to find care you can afford.
What does ‘underinsured’ mean?
Being underinsured means having inadequate coverage, unaffordable out-of-pocket costs, or both. Unlike being uninsured or without coverage, being underinsured means you have an active health plan for all 12 months of the year — it’s just one you can’t afford or doesn’t meet your needs. Among adults ages 19 to 64 with health insurance, 23% were considered underinsured, according to the 2026 biennial survey by the Commonwealth Fund, a foundation that promotes equitable healthcare.
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It’s important to understand that underinsurance is not an isolated financial or healthcare status. Underinsurance can have a ripple effect on both your health and your finances. Unaffordable coverage can lead to medical debt and financial toxicity. Financial toxicity occurs when economic hardship caused by medical bills makes you sicker or hinders your recovery from illness. This can create a cycle of debt and illness that can be really hard to escape.
What is an HDHP and what does it have to do with underinsurance?
One reason for a rise in underinsurance in recent years has been the growth of high-deductible health plans (HDHPs). While HDHPs come with low monthly premiums, you pay the full price of covered healthcare (excluding certain preventive services) without plan cost-sharing until you reach a large amount of spending.
The federal government defines the deductible amounts for plans to qualify as HDHPs. For 2026, the minimum deductible for an HDHP is $1,700 for individuals and $3,400 for families. In 2027, the minimum deductible is $1,750 for singles and $3,500 for families.
These plans can seem attractive at first glance, but if you or a family member experience an unexpected medical event, an HDHP can lead to hefty out-of-pocket costs and potentially large medical debt.
How can you tell if you’re underinsured?
While there is not a universal definition for underinsurance, the Commonwealth Fund offers three tests tied to income. You can have health coverage for all 12 months of a year and cross 1 of 3 thresholds to be considered underinsured:
Your out-of-pocket healthcare costs (not including premiums) account for 10% or more of your household income.
If you are low income, your out-of-pocket healthcare costs (not including premiums) account for 5% or more of your household income. In this case, a low income is defined as less than 200% of the federal poverty level. (The numbers are higher in Alaska and Hawaii.)
You have an annual individual or family deductible that's 5% or more of your household income. The deductible is how much you have to pay before your health insurance starts cost-sharing for covered services.
What’s the difference between uninsured and underinsured?
When you are uninsured, you don’t have health insurance. Underinsurance, on the other hand, is coverage that is still unaffordable and/or doesn’t meet your needs. ll. While technically different statuses, both make access to care and affordability challenging.
And in some cases, being underinsured can lead to becoming uninsured. People who aren’t satisfied with their coverage, and find it too expensive for what they’re getting in return, might decide to drop their plans. People might decide to end coverage if:
Their plans don’t offer the benefits they need
They can’t afford the monthly premium
The out-of-pocket spending is too costly
What should you do if you’re underinsured to afford healthcare?
If you’re underinsured or uninsured, finding care you can afford can be a burden. But know you have options that can help.
Underinsured and uninsured people may have access to free, discounted, or low-cost healthcare options. Here are some ways to get affordable services and medications:
Find out if you qualify for help from nonprofit organizations such as HealthWell Foundation, Patient Advocate Foundation (which has merged with the PAN Foundation), and CancerCare Co-Copayment Assistance Foundation.
Hospital financial assistance programs may be known as financial aid, charity care, or indigent care. Programs and eligibility requirements vary, but it’s important to ask about whether you are eligible for help.
Pharmaceutical companies often run patient assistance programs, which can help you cover all or part of your medications costs if you qualify. Other nonprofits may also be able to help you save on prescriptions.
Find out if there are community health centers near you, which offer lower-cost health services.
Consider GoodRx Companion, a subscription service with a low monthly price that can help you afford self-pay healthcare. The program offers discounted prices on prescriptions, telehealth, and other everyday healthcare services such as dental, vision, lab work, and imaging and diagnostics. In addition, Companion gives you free access to more than 250 generic medications and hundreds more for less than $10 per fill.
It’s also important to note that if your current health plan is unaffordable, you may be eligible for free or low-cost health insurance or other coverage that fits your budget. You can find a plan during the next open enrollment period or sooner if you qualify for a special enrollment period.
Do some nonprofits specifically help people who are underinsured?
Yes, many patient assistance programs help people who have insurance. Typically, eligible individuals will include people who have coverage but can’t afford medications or care. Many pharmaceutical company medication programs work this way, as do nonprofit funds such as those offered by the CancerCare Co-Copayment Assistance Foundation.
Is it ever better to go without health insurance?
Health insurance is not the only way to pay for healthcare. Opting out of health insurance certainly comes with risks, such as medical debt and even medical bankruptcy. But you could also go into medical debt or bankruptcy even with coverage if you’re underinsured. Individuals who are younger, healthy, and don’t have chronic conditions, for instance, may decide to go without a health plan. If that’s your choice, it’s important to make a plan to meet your healthcare needs as a cash-pay consumer.
If you decide to go without insurance, you can self-pay for healthcare. You might choose alternatives individually or in combination, such as direct primary care, concierge care, and GoodRx Companion subscription discounts. You can also use good faith estimates to have locked-in, ballpark figures of certain healthcare costs in advance.
A key part of self-pay healthcare includes building a personal or family healthcare fund. If you drop your health insurance, you can redirect all or part of what you were spending on premiums to this account. If you have this money in a high-yield savings account, for instance, you can earn a more generous interest rate and have easy access to the money to pay for healthcare.
The bottom line
Even if you have health insurance, you can still be underinsured if you’re unable to afford care or if the treatment you need isn’t covered. Being underinsured can result in people skipping or delaying medical care, which can lead to more serious conditions. Underinsurance can also leave you with medical debt or financial toxicity.
There are ways to access affordable healthcare if you’re underinsured, such as through nonprofit organizations, manufacturer patient assistance programs, and as a cash-pay consumer. You can also get discounted care with a GoodRx Companion subscription.
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References
Collins, S. R., et al. (2026). The state of health insurance coverage in 2026. The Commonwealth Fund.
Healthcare.gov. (n.d.). Federal poverty level (FPL). Centers for Medicare & Medicaid Services.
Healthcare.gov. (n.d.). Special enrollment period (SEP). Centers for Medicare & Medicaid Services.
Internal Revenue Service. (2026). 26 CFR 601.602: Tax forms and instructions, Rev. Proc. 2026-24.
Internal Revenue Service. (2025). 26 CFR 601.602: Tax forms and instructions, Rev. Proc. 2025-19.
Tolbert, J., et al. (2025). The uninsured population and health coverage. KFF.
U.S. Department of Health and Human Services. (n.d.). 2026 poverty guidelines: 48 contiguous states (all states except Alaska and Hawaii).
