V-BID Update: Healthcare Costs, Coverage Denials, and Consumer Financial Strain

In this Issue:

• Survey Finds Healthcare Costs Top Americans’ Concerns
• Rising Healthcare Costs Lead Consumers to Cut Spending and Delay Care
• EBRI Finds Many Employees Unprepared for Unexpected Medical Costs
• Study Finds Growth in $0 Cost-Sharing for Medicare Advantage Primary Care
• Employer Health Benefit Costs Expected to Rise 8.2% in 2027
• Commonwealth Fund Finds Coverage Denials Delay Care and Increase Medical Debt

Commonwealth Fund Survey Finds Healthcare Costs Top Americans’ Concerns

A new Commonwealth Fund survey found that healthcare costs are the top concern among Americans. Overall, 80% of people with commercial insurance cited premiums or out-of-pocket costs such as copays and coinsurance as their primary concern. Americans differed more sharply on how to address rising costs, with Democrats more likely to favor government action and Republicans more likely to believe insurers should address the problem.

Rising Healthcare Costs Lead Consumers to Cut Spending and Delay Care

A new EBRI analysis found that 4 in 10 privately insured adults reported higher healthcare costs in the past year. Among those experiencing increased costs, 55% reduced discretionary spending, 44% decreased contributions to other savings, 35% increased credit card debt, and 34% had difficulty paying other bills. Cost was also the leading reason people delayed or avoided needed care, including mental health services, physical therapy, and hospital outpatient care. The findings highlight how rising healthcare costs can affect household finances and access to care beyond direct medical spending.

EBRI Finds Many Employees Unprepared for Unexpected Medical Costs

A new Employee Benefit Research Institute (EBRI) survey found that many employees lack both understanding of voluntary benefits and the financial resources to manage unexpected medical expenses. Only 34% of workers said they were very prepared for a $500 unexpected expense, while 47% reported at least moderate financial difficulty from medical events and 37% had a medical bill sent to collections. The study also found that 57% of employees had delayed medical care because of cost, with 26% doing so within the past year. EBRI found that clear, plain-language information about supplemental benefits substantially increased employees’ interest in enrolling, suggesting that better benefits education could help workers make more informed coverage decisions.

Study Finds Growth in $0 Cost-Sharing for Medicare Advantage Primary Care

A new JAMA Health Forum study found that the share of Medicare Advantage beneficiaries enrolled in plans offering $0 cost-sharing for in-network primary care visits increased from 46.4% in 2019 to 78.1% in 2025, representing approximately 15 million additional beneficiaries. However, $0 cost-sharing was less common in zero-premium plans and counties with higher poverty rates. The authors say the uneven distribution raises equity concerns and highlights potential trade-offs between premiums and point-of-service costs.

Employer Health Benefit Costs Expected to Rise 8.2% in 2027

Marsh (formerly Mercer) projects employer-sponsored health benefit costs will increase 8.2% per employee in 2027, the largest annual increase since 2003. Rising costs for GLP-1 medications, provider consolidation, high-cost treatments, AI-enabled claims, and the No Surprises Act’s dispute resolution process are contributing to the increase. Nearly 60% of employers plan to make cost-cutting changes, including higher deductibles and other changes that could increase employees’ out-of-pocket costs.

Commonwealth Fund Finds Coverage Denials Delay Care and Increase Medical Debt

A new Commonwealth Fund survey found that 21% of working-age adults with private insurance reported that their insurer denied coverage for doctor-recommended care for themselves or a family member in the past year. Among those experiencing prior authorization denials, 41% said the denial delayed care, 28% said a health problem worsened, and 63% reported experiencing worry or anxiety. Nearly 70% of people who experienced a claim denial said it increased their household’s costs, while 43% said the denial led to medical debt they are still paying off. Only about half of people who experienced a denial appealed.

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