With ACA marketplace premiums for next year increasing<\/a> and many of the subsidies to help people pay for them poised to expire at year\u2019s end, more people face tough choices as they weigh monthly premium costs against deductibles. To afford insurance at all, people may opt for a plan with low premium payments but with a high deductible, gambling that they won\u2019t have any medical crises.<\/p>\n But high-deductible plans pose a particular challenge for those with chronic conditions, such as the 38 million Americans<\/a> who live with Type 1 or Type 2 diabetes. Adults with diabetes who are involuntarily switched to a high-deductible plan, compared with adults on other types of insurance, face an 11% higher risk of being hospitalized with a heart attack, a 15% higher risk of hospitalization for a stroke, and more than double the likelihood<\/a> that they\u2019ll go blind or develop end-stage kidney disease, according to a study published in 2024.<\/p>\n \u201cAll of these complications are preventable,\u201d said Rozalina McCoy<\/a>, the study\u2019s lead author.<\/p>\n Care vs. Cost<\/strong><\/p>\n The initial rationale behind such high-deductible plans was to encourage people to become wiser health care shoppers, said McCoy, an associate professor of medicine at the University of Maryland School of Medicine in Baltimore. And they can be a good fit, proponents say, for people who don\u2019t use a lot of medical care or who have cash on hand for a health crisis.<\/p>\n But while people with an excruciating earache will seek care, McCoy said, those with unhealthy blood sugar levels might not feel as urgent a need to seek treatment \u2014 despite the potential long-term damage \u2014 given the acute financial pain.<\/p>\n \u201cYou have no symptoms until it\u2019s too late,\u201d she said. \u201cAt that point, the damage is irreversible.\u201d<\/p>\n Overall, medical care for people with diabetes costs insurers and patients an average of $12,022 annually to treat<\/a> the disease, according to an analysis. Type 2 diabetes, the more common form, is diagnosed when the body can no longer process or produce enough insulin to adequately regulate blood sugars. With Type 1, the body can\u2019t produce insulin. Those with the disease may end up on the financial hook not just for insulin and other types of medication but for related equipment.<\/p>\n Mallory Rogers, whose 6-year-old daughter, Adeline, has Type 1, calculates that it costs roughly $1,200 a month for insulin, a pump, and a continuous glucose monitor. That figure doesn\u2019t include the cost of emergency supplies needed in case Adeline\u2019s technology malfunctions. Those include another type of insulin, blood-testing strips, and a nasal spray that\u2019s nearly $600 for a two-pack of vials \u2014 supplies that must be replaced once a year or more frequently.<\/p>\n \u201cIf she doesn\u2019t have insulin, it would become an emergency situation within two hours,\u201d said Rogers, a technology consultant who lives in Sanford, Florida. Rogers has been saving for the coming year when her daughter moves to the high-deductible health plan offered by Rogers\u2019 employer, which has a $3,300 deductible for family coverage.<\/p>\n Taxing Decisions<\/strong><\/p>\n Many insurance plans carry increasingly high deductibles. But to be defined as a high-deductible health plan \u2014 and thus be eligible to offer a health savings account \u2014 a plan\u2019s deductible for 2026 must be at least $1,700 for an individual and $3,400 for a family<\/a>, according to IRS rules.<\/p>\n Health savings accounts enable people to squirrel away money that can be rolled over from year to year to be used for eligible medical expenses, including prior to meeting a deductible. Such accounts, available through a plan or employer, can provide tax benefits. The contributions are limited to $4,400 individually and $8,750 for a family in 2026, and employers may contribute toward that total. Rogers\u2019 employer pays $2,000 spread out over the year, and Garza\u2019s contributes $1,200.<\/p>\n Rogers recognizes that she\u2019s fortunate to have accumulated $7,000 so far in her health savings account to prepare for her daughter\u2019s insurance shifting to Rogers\u2019 plan.<\/p>\n \u201cAdding a financial burden to an already very stressful medical condition, it hurts my heart,\u201d she said, reflecting on those who can\u2019t similarly stockpile. \u201cNobody asks to have diabetes, Type 1 or Type 2.\u201d<\/p>\n The median deductible for employer health insurance plans was $2,750 in 2024, but deductibles can run $5,000 or higher, said George Huntley, CEO of both the Diabetes Leadership Council<\/a> and Diabetes Patient Advocacy Coalition<\/a>.<\/p>\n When deductibles are too high, Huntley said, routine maintenance is what patients skimp on: \u201cYou don\u2019t take the drug that you\u2019re supposed to take to maintain your blood glucose. You ration your insulin, if that\u2019s your scenario. You take pills every other day.\u201d<\/p>\n Garza knows he should do more to control his blood sugar, but financial realities complicate the equation. His previous health plan covered a newer class of diabetes medication, called a GLP-1 agonist, for $25 a month. He wasn\u2019t charged for his remaining medications, which included blood pressure and cholesterol drugs, or his continuous glucose monitor.<\/p>\n With his new insurance, he pays $125 monthly for insulin and several other medications. He doesn\u2019t see his endocrinologist for checkups more than twice a year.<\/p>\n \u201cHe wants to see me every three months,\u201d Garza said. \u201cBut I told him it\u2019s not possible at $150 a pop.\u201d<\/p>\n Plus, he typically needs lab testing before each visit, an additional $111.<\/p>\n In 2026, the deductible for a \u201csilver\u201d-level plan on the marketplace will average $5,304 without cost-sharing reductions, according to an analysis from KFF, a health information nonprofit that includes KFF Health News. For a \u201cbronze\u201d-level plan, it will be $7,476<\/a>. An annual visit and some preventive screenings, such as a mammogram, would be covered free of cost to the patient.<\/p>\n Moreover, people comparing plan options<\/a>, whether through their employer or the marketplace, should figure out their annual out-of-pocket maximum, which still applies after the deductible is met, Huntley said.<\/p>\n Garza\u2019s family policy requires him to pay 20% until he reaches $10,000, for example.<\/p>\n Given Garza\u2019s high blood sugar levels, his doctor prescribed a fast-acting form of insulin to take as needed with meals, which costs an additional $79 monthly. He planned to fill it in December, when he\u2019s responsible for only 20% of the cost after he has hit his deductible but not yet reached his out-of-pocket maximum.<\/p>\n Garza likes his job despite its health plan, saying he\u2019s never missed a day of work, even recently when he had a stomach bug. As of late 2025, he remained conflicted about whether to sign up for health insurance when his company\u2019s enrollment period rolls around in mid-2026.<\/p>\n He worries that dropping insurance would place his family too much at risk if a major medical crisis struck. Still, he pointed out, he could then use the money he now spends on monthly premiums to directly pay for care to better manage his diabetes.<\/p>\n \u201cI\u2019m just stuck, to be honest with you,\u201d he said.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/www.dangeladvertising.com\/wp-content\/uploads\/2025\/12\/DiabetesDeductible_01.jpg\")
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