Rising High-Deductible Health Plans Challenge Diabetes Patients’ Care

High-deductible health plans (HDHPs) are increasingly common in the U.S. insurance market, offering lower premiums but requiring insured individuals to pay substantial out-of-pocket costs before coverage begins. In 2024, half of private-sector employees with employer-sponsored health plans were offered HDHPs, up from 38% in 2015. These plans are prominently available on the Affordable Care Act (ACA) marketplace, where rising premiums and the expiration of some subsidies put additional financial pressure on consumers. For patients with chronic illnesses like diabetes, HDHPs create significant challenges. With 38 million Americans living with Type 1 or Type 2 diabetes, the financial burden of high deductibles can lead to delayed or reduced care. A 2024 study shows those involuntarily moved to high-deductible plans face increased risks of severe complications including heart attacks, strokes, blindness, and kidney disease, conditions that are largely preventable with regular treatment. The design rationale for HDHPs was to encourage consumers to make cost-conscious health care decisions. While this may work for healthy individuals with infrequent care needs, chronic illness management, such as diabetes, requires consistent care which becomes financially burdensome under these plans. Average annual costs for diabetes care reach over $12,000, including medication, monitoring equipment, and related supplies. For example, families managing Type 1 diabetes face monthly insulin, pump, and glucose monitor expenses exceeding $1,000, with additional costs for emergency supplies. IRS regulations define HDHPs as plans with deductibles of at least $1,700 for individuals and $3,400 for families in 2026, enabling eligibility for Health Savings Accounts (HSAs). HSAs offer tax benefits and allow funds to roll over year to year, potentially mitigating some out-of-pocket expenses. Contributions are capped at $4,400 for individuals and $8,750 for families annually. Despite the availability of HSAs, many patients still face substantial deductible amounts, with median employer plan deductibles around $2,750 in 2024 and some reaching $5,000 or higher. High deductibles often lead patients to reduce adherence to prescribed treatment regimens, increasing health risks. Patients on HDHPs may switch to less effective medications or reduce frequency of monitoring and specialist visits to manage costs, potentially leading to deteriorated health outcomes and greater long-term expenses. For instance, patients may skip recommended quarterly endocrinologist visits due to high copayments. Marketplace insurance options for 2026 indicate average deductibles of $5,304 for silver-level plans and $7,476 for bronze-level plans without cost-sharing reductions. Out-of-pocket maximums also remain an important consideration for consumers comparing plans. Given the escalating cost pressures, insured individuals with chronic conditions face complex decisions balancing monthly premiums, deductibles, and out-of-pocket costs. These market dynamics underscore the need for strategic plan selection and potential policy consideration to address gaps affecting chronic disease management under HDHPs.