The most common way for people in the U.S. to get health care coverage is through their jobs. Many assume that work-based insurance is a stable and reliable option, but a new analysis from the Commonwealth Fund shows that even employer-sponsored coverage can place a heavy financial burden on workers and their families.
Researchers looked at health insurance costs for workers – what people actually spend to have and use their coverage. This includes not just monthly premiums, but also the costs that come later, such as deductibles, copays, and coinsurance. Across the country, these combined costs are taking up a growing share of household income. For many families, that means coverage in name only.
What Health Insurance Costs for Workers Look Like
For most workers, the key cost of health care coverage is the money taken out of their paychecks for their share of the monthly premium. This amount is often the primary factor people focus on when choosing a health plan.
The data show that nationally, workers with single coverage spend about 4% of their income toward premiums. For families, that share is approximately 6.5%.
The situation in Kentucky is similar to the national figures. Based on 2024 Kentucky median income data for family households under age 65, this translates to premium expenses of $1,750 a year for individuals and $6,400 a year for family coverage.
At first, these numbers may seem manageable. But they do not show what people actually spend on health care over a full year.
Once deductibles are added, the cost as a share of income in Kentucky rises to about 11% for both individual and family coverage. That comes out to costs of nearly $4,000 a year for individuals and about $11,000 for families before insurance begins to pay for most services.
This shows up clearly in the experiences people share with The Asclepius Initiative. According to our 2024 survey of 1,001 adult Kentuckians, more than half of those with health coverage said they delayed or went without care or medications, and 40% were unable to purchase food or clothing, as a result of medical costs. In 2025 interviews, Kentuckians across the state described having coverage, but still struggled to pay for doctor visits, treatment, or follow-up care.
The issue is not simply whether someone has coverage. It is whether that coverage is adequate.
Why Employer Coverage Can Fall Short
Employer-sponsored coverage is frequently described as a benefit of employment, although the vast majority of workers must contribute something towards the monthly premium costs. According to the 2025 KFF Employer Health Benefits Survey, 88% of employees pay a portion of the premium for individual coverage, and 97% pay a portion of the premium cost for family coverage.
But premiums are only one part of the cost.
As overall health care costs have gone up, more of the expense has been shifted to employees in the form of higher deductibles, copays, coinsurance, and out-of-pocket maximums. As a result, a plan that seemed affordable during enrollment can become unaffordable very quickly if care is needed for chronic conditions, unexpected illness develops, or an accident occurs.
It’s All in the Details
Even small increases in premiums, deductibles, and cost-sharing responsibilities can add up, potentially increasing what someone pays by hundreds or even thousands of dollars over the course of a year. But those costs are not always easy to compare or project in advance.
That is where easy-to-understand, practical information becomes important.
The Asclepius Initiative offers resources that explain what health care coverage is, how to use it, and how to compare plans to find one that best meets an individual or family’s medical and financial needs.
TAI wants to help people effectively navigate their options. Meanwhile, long-term solutions are needed to address the cost of care itself and ensure that coverage is synonymous with continuous, high-quality, affordable, equitable, and accessible care.