Americans with employer-sponsored health insurance paid an average of $120 per month for individual coverage and $571 per month for family coverage in 2025. Those premiums provide protection against potentially catastrophic medical bills, but they do not guarantee payment for every treatment or claim.
The latest federal marketplace data show that insurers denied approximately 1 in 5 claims in 2024. With premiums and deductibles rising, some consumers may wonder whether insurance remains worth its cost—or whether paying cash could sometimes be the better deal.
Family Premiums Exceed $2,200 Per Month
Employer-sponsored insurance covers approximately 154 million Americans younger than 65.
The 2025 KFF Employer Health Benefits Survey, the latest edition available, found that total premiums averaged $9,325 annually for individual coverage and $26,993 for family coverage. That equals approximately $777 and $2,249 per month, respectively.
Employers paid most of that expense. Workers contributed an average of $1,440 annually for individual coverage and $6,850 for family coverage, with employers paying the remainder as part of workers’ compensation.
Premiums do not include deductibles, copayments, or coinsurance that patients may owe when they receive care.
Costs also increased for people purchasing insurance through Affordable Care Act marketplaces. Average monthly premium payments rose 58%, from $113 in 2025 to $178 in 2026, following the expiration of enhanced federal tax credits.
Average marketplace deductibles increased 37%, from $2,759 to a record $3,786 per person. KFF attributed much of that increase to consumers moving from silver plans into lower-premium bronze plans with higher deductibles.
Marketplace Insurers Denied 20% of Claims
The newest comprehensive federal claims-denial figures cover qualified health plans sold through HealthCare.gov during 2024.
A KFF analysis published in March 2026 found that insurers denied 19% of in-network claims and 37% of out-of-network claims. The combined denial rate was approximately 20%.
As previously reported by The Dallas Express, the figures help explain consumer frustration but do not establish that every denial was improper.
Claims may be denied because a service is excluded, deemed medically unnecessary, or provided outside the plan’s network. Billing errors, duplicate submissions, missing information, and failure to obtain prior authorization can also lead to denials.
The federal dataset covers medical and prescription-drug claims submitted after care was provided. It does not include employer-sponsored plans, Medicaid, Medicare Advantage, state-operated marketplaces, or every plan sold by a major insurer.
There is no comprehensive federal database showing a single companywide claims-denial rate for UnitedHealthcare, Elevance Health, CVS Health, Cigna, Humana, Centene, or other large insurers across all lines of business.
Major Insurers Differ on Prior Authorization
Prior-authorization data offer another view of insurer practices, although prior authorization and claims are not the same.
Prior authorization occurs when an insurer reviews a proposed treatment, service, or medication before it is provided. A claim seeks payment after care has been delivered.
An August 2026 KFF analysis of the latest insurer disclosures found average standard prior-authorization denial rates of 12% in Medicare Advantage, 14% in Medicaid managed care, and 18% in ACA marketplace plans during 2025.
UnitedHealth Group denied 17% of standard requests in Medicare Advantage, 11% in Medicaid managed care, and 21% in ACA marketplace plans. The rates cannot be combined into one companywide percentage because the markets contain different numbers of patients and requests.
More detailed Medicare Advantage figures for 2024 showed substantial variation among large companies. UnitedHealth Group denied 12.8% of prior-authorization requests, followed by Centene at 12.3%. Humana denied 5.8%, while Elevance Health recorded the lowest rate among the large insurers examined, at 4.2%, according to a separate KFF analysis of federal Medicare data.
Those figures do not necessarily establish which company offers better coverage. Insurers require prior authorization for different services and process different numbers of requests per enrollee.
Successful Appeals Often Go Unfiled
Fewer than 1% of denied HealthCare.gov claims were appealed internally in 2024. Insurers upheld 66% of the denials consumers challenged.
Medicare Advantage prior-authorization appeals produced a different result. Only 11.5% of denied requests were appealed in 2024, but insurers reversed 80.7% of those challenged decisions in full or in part.
The high reversal rate could mean supporting documentation was missing from the original request. It may also raise questions about whether some initial denials should have been approved, KFF noted.
The Centers for Medicare & Medicaid Services states that many consumers may request an internal appeal and, if the insurer maintains its denial, an independent external review.
Is Paying Cash Better?
Paying cash can cost less for certain predictable services, including some office visits, laboratory work, imaging, and prescription drugs. It can be particularly attractive to patients with high deductibles who would otherwise pay the insurer-negotiated price themselves.
A patient who does not use insurance can generally request a written good-faith estimate for non-emergency care scheduled at least 3 business days in advance. Under CMS rules, the patient may dispute a final bill that is at least $400 higher than the estimate.
Cash payment has disadvantages. The expense generally will not count toward the patient’s insurance deductible or annual out-of-pocket limit if no claim is submitted. Patients may also lose access to an insurer’s negotiated network rate, which can be lower than the provider’s standard charge.
HealthCare.gov states that uninsured patients pay twice as much for care on average, although a provider’s discounted cash price can sometimes be lower than the insured price for a particular service.
The larger risk comes from abandoning comprehensive coverage. A hospitalization, serious accident, cancer diagnosis, or major surgery can generate expenses far beyond the savings most households possess.
For 2026, a marketplace plan’s out-of-pocket limit can reach $10,600 for an individual and $21,200 for a family. Those limits apply to covered, in-network care and do not include monthly premiums.
The data therefore support comparing cash and insurance prices for scheduled, non-emergency services rather than treating cash payment as a financially equivalent replacement for major-medical coverage. Consumers considering cash payment should ask for both prices, determine whether the expense will count toward their deductible, and request a written estimate before receiving care.
Provided by Dallas Express
