The cost of health insurance for middle-income families in the United States is rising steadily, with many households now spending at least one-tenth of their annual income on premiums and deductibles. A recent analysis by the Commonwealth Fund highlights the growing financial strain on working families.
According to the 2024 report, in 19 states, the combined cost of family health insurance premiums and deductibles averages 10% or more of median household income. These figures do not include additional out-of-pocket expenses such as co-payments.
The state-by-state breakdown for family health insurance spending is as follows:
| State | Median Household Income (USD) | Premium & Deductible Cost (%) | Annual Cost (USD) |
|---|---|---|---|
| Louisiana | 63,000 | 15.6% | 9,836 |
| Florida | 72,500 | 13.7% | 9,942 |
| Mississippi | 55,980 | 13.7% | 7,677 |
| North Carolina | 70,200 | 13.7% | 9,627 |
| District of Columbia | 92,000 | 5.7% | 5,244 |
Kristen Colb, a researcher at the Commonwealth Fund, explained, “Workers in the South, who generally earn lower wages, are particularly affected. Health insurance costs occupy a significant portion of family budgets, leaving less income for other essentials and increasing the risk of delaying or foregoing necessary medical care.”
In the United States, approximately 16.7 million working-age individuals under 65 rely on employer-sponsored health insurance for themselves and their families. Employers typically cover around 70% of family premiums, leaving employees responsible for the remainder, including deductibles and co-payments.
In 2024, the average total cost of family health insurance reached USD 24,540, with employees contributing USD 7,216. For individual coverage, deductibles in 26 states exceeded 5% of median personal income, particularly in the Southeast and Midwest regions.
Health insurance costs rose by 6% in 2025 compared with the previous year, a trend that analysts expect to continue. Senior Commonwealth Fund researcher Sara Collins emphasised, “Congress, employers, insurers, and healthcare providers must take active measures to curb costs and ensure that all families can access essential care.”
Some Americans face additional challenges. Those purchasing insurance through the Affordable Care Act marketplace are no longer receiving certain tax credits in 2025, further increasing out-of-pocket costs and placing additional pressure on household budgets.