US Medical care is sometimes avoided due to cost, distance, not help, etc

Which Americans Avoid Medical Care — and How Many

Which Americans Avoid Medical Care Because of Cost, Distance, or Time — and How Many

About 17% of US adults delayed or went without some form of health care in the past year because of cost. Adding non-cost barriers — distance, no transportation, no paid time off — brings the total who actually forwent needed care to roughly 20–25%. Including dental care and prescription rationing, self-reported rates run 36–43%. The population structurally exposed to these barriers — low income, uninsured, rural, in a provider shortage area, or without a vehicle — is closer to 30–35%, about 100–120 million people.

The single most important finding for anyone designing a low-cost intervention: the barrier is concentrated, not evenly spread. Low income is the master variable. Rural residence, being uninsured, having no car, having no sick leave, and American Indian/Alaska Native status all correlate strongly with it — and with each other.

1. The headline number: cost barriers to medical care

From the 2024 National Health Interview Survey (NHIS), the federal government's primary health-access survey:

Source: Peterson-KFF Health System Tracker, NHIS 2024.
Measure	% of adults
Delayed or went without any health care due to cost	17%
Delayed or went without medical care specifically	10%

The gap between the two is dental care and prescriptions — covered in sections 2 and 3.

Who, specifically

Source: Peterson-KFF Health System Tracker, NHIS 2024.
Group	Delayed / went without care, cost
Uninsured	31%
Insured	8%
Below 200% of Federal Poverty Level	23%
200–400% FPL	19%
Above 400% FPL	12%
Adults under 65	20%
Adults 65 and older	8%
In worse self-reported health	28%
In better self-reported health	15%
Black adults	19%
Asian adults	9%

A separate, stricter measure. Gallup classifies 11% of US adults — about 29 million people — as "Cost Desperate," meaning unable to afford or access needed care and medicine at all. That rises to 25% for households under $24,000 and 19% for $24,000–$48,000. A further 35% say they cannot access affordable quality care when they need it — a record high. (Gallup, Nov–Dec 2024, n=6,296.)

2. Dental care — the largest single cost barrier

Dental care is where cost bites hardest, because dental coverage is separate from medical coverage and far weaker.

Source: Peterson-KFF Health System Tracker, NHIS 2023.
Group	Delayed / went without dental care due to cost
All adults	21%
Uninsured	47%
Insured	19%
Under 65	23%
65 and older	16%
Hispanic adults	31%
In worse health	34%
In better health	19%

Why dental is worse than medical: the coverage gap is structural

Source: American Dental Association, Health Policy Institute. Seniors figure excludes Medicare Advantage dental riders.
Group	Lacks dental benefits
Children (0–18)	7%
Working-age adults (19–64)	21%
Adults 65+	55%

Traditional Medicare does not cover routine dental care. Nearly 65% of Medicare beneficiaries — about 37 million people — have no dental coverage, and 49% had no dental visit in the past year. Among those who did use dental services, 19% spent more than $1,000 out of pocket. Non-coverage rates are higher among Black and Hispanic beneficiaries and those with low incomes.

This is the one place where the low-wealth elderly clearly do face a cost barrier — see the caution in section 6.

3. Prescription drugs — cost-driven rationing

Two measures exist, and they differ by an order of magnitude because they ask different questions.

Strict federal measure (NHIS / NCHS)

Among adults 18–64 who take prescription medication, 8.2% did not take it as prescribed in order to reduce costs — about 9.2 million adults. The behaviors counted are skipping doses, taking less than prescribed, and delaying filling a prescription.

Source: NCHS Data Brief No. 470, NHIS 2021. Base: adults 18–64 currently taking prescription medication.
Group	Did not take medication as prescribed, to save money
All adults 18–64 on medication	8.2%
Uninsured	22.9%
No prescription drug coverage	18.1%
Medicaid	8.0%
Private insurance	6.5%
Adults with disabilities	20.0%
Adults without disabilities	7.1%
Fair or poor health	18.0%
Good or better health	6.3%
Below 100% FPL	14.5%
100–199% FPL	13.8%
200–399% FPL	9.9%
Above 400% FPL	3.9%
Women	9.1%
Men	7.0%
Black adults	10.4%
Hispanic adults	10.4%
White adults	7.4%
Asian adults	6.8%

The 2024 NHIS finds a similar magnitude: about 8% rationing medications and 6% not getting a needed medication to save money.

Broad self-report measure (KFF)

Asked more expansively, 43% of adults say they did not take a medication as prescribed because of cost in the past 12 months:

Source: KFF Health Tracking Polls, 2025–2026. Base: all adults.
Behavior	% of adults
Used an over-the-counter drug instead of a prescription	31%
Did not fill a prescription	27%
Cut pills in half or skipped doses	19%
Any of the above	43%

Source: KFF Health Tracking Polls, 2025–2026. Prescription cost compromise, by subgroup.
Breakdown	Groups
By income	52% under $40,000 · 47% at $40–90,000 · 30% above $90,000
By insurance	58% uninsured · 43% insured
By race	55% Black · 47% Hispanic · 40% White
By sex	49% women · 36% men

The same KFF polling finds 36% of adults skipped or postponed needed health care due to cost — rising to 75% among uninsured adults under 65.

Why the two prescription measures differ so much: the NHIS asks a narrow question of people currently on medication, in a clinical-survey context; KFF asks a broad question of all adults in a telephone poll and counts OTC substitution. Both are correct for what they measure. Cite the 8% when you need a defensible federal floor; cite the 43% when describing the full spectrum of cost-driven compromise.

4. Non-cost barriers: distance, transportation, and time

Provider supply and distance. 92 million people — about 27% of the US population — live in a designated primary care Health Professional Shortage Area (HPSA). Of the 8,466 designated primary care HPSAs, 63.1% are rural.

Rural population. 19.3% (64.5 million people) by the federal Office of Rural Health Policy definition; 20% (66.3 million) by the Census definition, covering 97% of US land area.

Source: Urban Institute / RWJF, 2023. Base: non-elderly adults. "Did not get needed care in the past 12 months because of difficulty finding transportation."
Group	Missed needed care due to transportation
All non-elderly adults	5%
Below 138% FPL	14%
Adults with disabilities	17%
On public insurance	12%
No household vehicle	13%
No vehicle + fair/poor transit	21%
No vehicle + good transit	9%

Time off work. No clean national figure exists for "avoided care because I didn't want to take time off." The closest proxy: roughly two-thirds of low-wage workers have no paid sick days. This barrier is real but overlaps almost entirely with the low-income group already counted — treat it as a mechanism, not an additional population.

5. American Indian and Alaska Native populations

Source: KFF, Key Data on Health and Health Care for AIAN People.
Measure	Value
AIAN alone or in combination	7.2 million (~2% of US)
AIAN alone	1.7 million
Uninsured, AIAN alone, under 65	21% (3× the White rate of 7%)
Living on reservations or land trusts	13%

The Indian Health Service is chronically underfunded relative to need.

Interpretation: this is a high-severity, small-population group. It matters enormously for equity and for targeted programs, but at ~2% of the population it cannot move a national percentage. Report it as a severity finding, not a volume finding.

6. Two cautions before combining these numbers

Caution 1 — the elderly are the least cost-blocked group for medical care. At 8%, adults 65+ report the lowest cost barriers of any age group, and only 4% are "cost desperate" in Gallup's measure. Medicare works for medical care. The intuition that low-wealth seniors skip care because of cost is not supported for medical care — but it is supported for dental (55% have no coverage, 49% no visit last year) and for transportation and mobility. Place seniors under the right heading.

Caution 2 — these groups overlap almost completely; do not add them. Low income, rural residence, being uninsured, lacking a vehicle, lacking sick leave, and AIAN status are strongly correlated with one another. Adding 23% + 20% + 5% + 2% would count the same households three or four times. Any combined estimate must be de-duplicated.

7. The combined estimate

US adult population ≈ 262 million; total US population ≈ 342 million (2025). People-counts are approximate and rounded.
Definition	Share of US	Approx. people
Forwent needed medical care last year, cost only	~10%	~26 million
Forwent any health care last year, cost only	17%	~44 million
"Cost desperate" — cannot afford care or medicine at all	11%	~29 million
Forwent dental care, cost	21%	~55 million
Forwent needed care — any barrier (cost, distance, transport, time)	~20–25%	~70–85 million
Rationed prescriptions, strict federal measure	8%	~9 million
Structurally exposed (low income, uninsured, rural, shortage area, no vehicle)	~30–35%	~100–120 million
Broad self-report incl. dental and Rx compromise	36–43%	~120–145 million

Recommended figures to cite

20% — "avoided needed medical care in the past year." Defensible, conservative, close to the NHIS 17% once non-cost barriers are added.
30% — "population at structural risk of avoiding care." The more useful number for estimating who could benefit from something low-cost and self-administered, because it includes people who have not yet skipped care but would if they needed it.
40% — "experienced any cost-driven compromise in care, including dental and prescriptions." Accurate, but requires the broader definition to be stated explicitly.

What this does NOT show

These percentages come from different surveys with different question wording, reference periods, and populations. They cannot be added together. NHIS asks about the past 12 months of a household sample; Gallup and KFF are telephone polls with broader questions; the dental figures are 2023 while the medical figures are 2024 and the strict prescription figures are 2021.
None of these are measures of health outcomes. "Delayed care" does not establish that harm resulted. Some deferred care is low-value care that would not have changed anything.
"Avoiding care" is self-reported and subject to recall and social-desirability effects in both directions — people under-report skipping care they feel embarrassed about, and over-report cost as a reason when the real reason was inconvenience or fear.
The prescription figures do not distinguish essential from non-essential medication, nor do they establish clinical consequence.
No causal claim is made that removing a cost or distance barrier would produce a proportional increase in care received, or in health.
The 30–35% "structurally exposed" figure is an estimate, de-duplicated by judgment rather than by individual-level record linkage. It should be presented as an approximation, not a survey result.
The HPSA count (92 million) measures provider supply in an area, not whether any individual actually failed to get care. Many people in shortage areas receive adequate care.

Source table

All sources are publicly accessible as of August 2026.
#	Source	Publisher	Survey / year	Used for
1	How does cost affect access to healthcare?	Peterson-KFF Health System Tracker	NHIS 2023 & 2024	Medical and dental cost barriers; all demographic breakdowns
2	Inability to Pay for Care, Medicine Hits New High	Gallup	Nov–Dec 2024, n=6,296	"Cost desperate" 11%; income and race breakdowns
3	Americans' Challenges with Health Care Costs	KFF	Health Tracking Polls 2025–2026	Broad self-report: 36% skipped care, 43% Rx compromise
4	NCHS Data Brief No. 470	CDC / NCHS	NHIS 2021	Strict Rx non-adherence 8.2%; full demographic table
5	Coverage, Access & Outcomes	American Dental Association HPI	Ongoing	Dental benefit gaps by age (7% / 21% / 55%)
6	Most Medicare Beneficiaries Lack Dental Coverage	KFF	Medicare Current Beneficiary Survey	65% / 37M without dental; 49% no visit; out-of-pocket costs
7	State of the Primary Care Workforce 2025	HRSA Bureau of Health Workforce	2025	92M in primary care HPSAs; 63.1% rural
8	What Is Rural?	HRSA Federal Office of Rural Health Policy	2020 Census	Rural population 19.3% / 64.5M
9	Transportation Barriers to Health Care	Urban Institute / RWJF	2022 survey, published 2023	Transportation barriers, 5% overall to 21% concentrated
10	Key Data on Health Care for AIAN People	KFF	Multiple federal sources	AIAN population, uninsured rate, IHS funding
11	Access to paid sick leave remains highly unequal	Economic Policy Institute	BLS National Compensation Survey	Paid sick leave gap for low-wage workers

Vitamin D as a low-cost intervention reachable without a clinic visit
Populations with low vitamin D levels and low health care access
Cost of vitamin D supplementation vs. cost of a physician visit

Page compiled August 2026. Figures reflect the most recent survey year available for each measure: NHIS medical data 2024, dental data 2023, strict prescription data 2021. Where a people-count is shown it was derived from the cited percentage applied to current population estimates, and is approximate.