Health insurance costs for middle-income families in the United States are rising steadily, placing a growing financial burden on households. Recent research indicates that many families now spend at least one-tenth of their annual income on insurance premiums and deductibles, with some southern states experiencing particularly acute pressure.
According to the 2024 analysis by the Commonwealth Fund, in 19 states the average household expenditure on premiums and deductibles exceeds 10% of income. These figures do not include co-payments, which can further increase out-of-pocket spending.
The state-wise breakdown of family health insurance expenses is as follows:
| State | Median Household Income (USD) | Premium & Deductible (% of Income) | Expense Amount (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 Colby, a researcher at the Commonwealth Fund, noted: “Workers in the South generally earn lower wages, meaning that health insurance costs can create significant strain on household budgets. As a result, families may limit spending on other essential items or delay necessary medical care.”
In the United States, approximately 16.7 million working-age adults under 65 obtain health coverage through their employers, typically receiving about 70% of family-based premium costs from their employer, while employees must cover the remainder, including deductibles and co-payments.
In 2024, the average total family health insurance cost was $24,540, of which employees contributed $7,216. For individual coverage, 26 states reported deductibles that equaled 5% or more of median income, with the highest burdens in the South-East and Midwest regions.
Costs continued to rise in 2025, increasing by approximately 6% compared to 2024, with expectations of further growth. Senior Commonwealth Fund researcher Sara Collins emphasised: “Congress, employers, insurers, and healthcare providers must work together to control costs and ensure that all family members can access necessary medical care.”
Meanwhile, individuals purchasing coverage through the Affordable Care Act marketplace are not receiving additional tax credits in 2025, further increasing out-of-pocket expenses and intensifying financial pressures on families.
The analysis underscores the ongoing challenge for middle-income Americans: even with employer support, healthcare affordability remains a pressing concern, particularly in lower-income regions.