Many middle-income families spend at least a tenth of their income on health insurance
More than half of working-age adults get their health insurance through an employer, but in many states premium contributions and deductibles take a significant bite out of household incomes.
A new analysis from the Commonwealth Fund, a research nonprofit focused on health care, found that in 2024, premium contributions and deductibles for family plans totaled 10 percent or more of the median household income in 19 states. The calculation did not include copayments.
The share of the median household income spent on premium contributions and deductibles for family coverage ranged from a low of 5.7 percent in the District of Columbia to a high of 15.6 percent in Louisiana. The states with the highest percentages were concentrated in the South — Florida, Mississippi and North Carolina, all at 13.7 percent, were the only other states that topped 13 percent.
“Southern workers face some of the highest cost burdens because wages in the region are lower, so families spend a bigger share of their pay on employer coverage,” said Kristen Kolb, lead author of the report and a research associate at Commonwealth Fund, in a statement to Stateline.
“This leaves workers and their families with less room in their budgets for other necessities and can increase the risk that people delay or skip needed care.”
About 167 million working-age adults under 65 in the United States get their health insurance through an employer or a family member’s employer. Employers typically pay about 70 percent of the cost of insurance premiums for family coverage. Employees kick in the rest, and shoulder other costs including deductibles and copays.
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The median household income in the United States in 2024 was $83,730. The lowest median income was in Mississippi ($55,980) while the highest was in Massachusetts ($113,900).
Employees contributed an average of $7,216 a year for family coverage in 2024, out of an average total cost of $24,540, according to the report. Health care insurance costs vary regionally, though, as well as by industry and size of the employer.
“Premiums and deductibles for many American workers can drain household budgets and increase the risk that people will delay care or take on medical debt,” said Sara Collins, a senior scholar for health care coverage and access at the Commonwealth Fund, in a statement.
For single coverage, deductibles took 5 percent or more of median individual income in 26 states in 2024, mostly in the Southeast and Midwest.
Health care costs in the United States continue to skyrocket. In 2025 they were 6 percent higher than in 2024 and are expected to continue growing.
“Congress, employers, insurers and health care providers all can play a role in lowering costs and making care more affordable, so families across the income spectrum can get the care they need,” Collins said.
Meanwhile, some folks are getting less help paying for insurance. People who enroll in health insurance through the Affordable Care Act marketplaces can no longer access enhanced tax credits after those expired at the end of last year.
