Out-of-network confusion, rising costs pushing more patients to delay care

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Nearly half of insured Americans are delaying health care due to cost or network confusion, according to new research from Madaket Health. These findings underscore persistent affordability and access issues plaguing the U.S. health care system, even affecting those with coverage.

The national survey of 1,000 U.S. adults found that 47% of Americans have put off care because of cost, and 74% said they would delay care if their preferred provider was out-of-network.

Millennials, in particular, are feeling the pinch. Seventy-eight percent said they delayed care due to cost, compared to 56% of Gen X respondents and just 30% of Baby Boomers.

The survey, conducted by Censuswide in May 2025, also found that more than two-thirds (68%) of Americans cited cost as the most important factor when selecting a health plan, followed by access to in-network providers (59%).

“The fact that so many people are delaying care if their preferred provider is out-of-network highlights the importance of data accuracy,” said Eric Demers, CEO of Madaket Health. “When provider information is outdated or incorrect, patients can’t reliably identify affordable, in-network options, leading to unnecessary delays and higher costs.”

DIY health spending on the rise

Not only are Americans delaying care due to coverage barriers, but many are choosing to pay out of pocket to bypass those hurdles.

Thirty-eight percent of respondents said they had paid out of pocket for services that were either out-of-network or not covered by their insurance. Among Millennials, that figure jumps to 68%, compared to 44% of Gen X and just 21% of Boomers.

The data reflects a growing “do-it-yourself” mindset among younger patients. Nearly half (43%) of Millennials reported using concierge medicine — often paying a flat monthly or annual fee for enhanced access to primary care or other services — compared to just 20% of Gen X and 8% of Boomers.

Digital care gaining ground

Even as cost remains a top concern, Americans are showing growing interest in digital models of care. Sixty percent of respondents said they had used online or app-based health care services. Online prescriptions (28%) and virtual primary care (24%) were among the most common.

That trend is no longer confined to younger patients. While Millennials lead in digital care adoption, 65% of Gen X and 49% of Baby Boomers said they had accessed online health services.

That said, there are still limits. Only 35% of respondents said they would be open to receiving primary care virtually, and even fewer (33%) expressed willingness to receive mental health care online. Nearly half (47%) said they were not open to digital testing.

Taken together, the findings paint a portrait of a health system struggling to meet the needs of even its insured population. High costs, difficulty navigating in-network care and a lack of transparency are driving patients — particularly younger ones — to seek alternatives, whether by going digital, paying out of pocket or avoiding care altogether.