Having a health insurance plan with a high deductible could not only cost you—it could also kill you.
A new study in JAMA Network Open found that people who faced those high out-of-pocket costs as well as a cancer diagnosis had worse overall survival and cancer-specific survival than those with more standard health plans.
The findings, while perhaps not surprising, are a stark reminder of the fraught decisions Americans face as the price of health care only continues to rise and more people try to offset costs by accepting insurance plans with higher deductibles—that is, higher out-of-pocket costs they have to pay before their health insurance provider starts paying its share.
The issue is particularly critical right now for people who have insurance plans through the Affordable Care Act marketplace. Prices for those plans have skyrocketed 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 data on ACA enrollments for 2026 not only suggests that fewer people are signing up for the plans, but also that those who are enrolling are often choosing bronze plans, which are high-deductible plans.
In the study, researchers considered plans to be "high-deductible health plans" (HDHPs) if their deductibles were at least $1,200 to $1,350 for individuals or $2,400 to $2,700 for families between 2011 and 2018 (with the cutoffs increasing within the ranges during that time). For context, the average individual deductible for an ACA bronze plan in 2026 is about $7,500, according to KFF.
Risky plans
Based on previous data, such high out-of-pocket costs are known to lead people to delay or decrease health care—they may skip doctor visits, put off diagnostics, and avoid treatments. But for the new study, researchers led by Justin Barnes at Mayo Clinic in Rochester, Minnesota, wanted to know, more directly, if the plans were linked to lower survival—specifically for cancer patients, who obviously need more care than others.
The study used health survey data from a nationally representative group of over 147,000 people. In all, nearly 9,800 had been diagnosed with cancer, and of those, around 2,300 had HDHPs. Another group of over 37,000 who had not been diagnosed with cancer also had HDHPs. Adjusting for demographic factors and health status, cancer patients on an HDHP had a lower overall survival rate (46 percent higher risk of death) and lower cancer-specific survival rate (34 percent higher risk of death) than people on standard-deductible plans. In further analyses, the researchers found that, for cancer patients, whether their HDHP had a health savings account (HSA) did not make a difference. In survey responses, cancer patients on HDHPs reported more financial worry than people on standard plans.
By contrast, people on an HDHP who did not have a cancer diagnosis did not have lower survival rates than people on other plans, suggesting that the plans might not affect your survival as long as you don't have any serious health conditions, such as cancer.
Barnes and his colleagues conclude, "In the current political environment, in which there may be proliferation of HDHPs, these results suggest that HDHP proliferation could exacerbate adverse cancer outcomes. These data underscore the importance of educating patients with cancer about potential (increased) need for health care utilization, educating the public about potential risks of HDHPs, identifying policy solutions to decrease costs of care, and optimizing health policies to avoid disincentives for seeking what may turn out to be necessary and lifesaving or life-prolonging care."

