How Much Do Marketplace and Other Nongroup Enrollees Spend on Health Care Relative to Their Incomes?

A patient pays cash for services in a medical office.

Data show that some still face high financial burdens.

The issue

Research examining household spending on health care shows that typical marketplace enrollees with incomes between 200 and 500 percent of the federal poverty level spend more than 10 percent of their income on insurance premiums and out-of-pocket costs.

Key Findings

  • Those with high expenditures can spend more than 20 percent of their income on medical care.

  • Those in “fair” or “poor” health, those over age 45, and those who earn less are more likely to spend a higher percentage of their income on insurance premiums and out-of-pockets.


The researchers say policy-makers should explore ways to protect those most vulnerable to high costs relative to their income. The research follows an earlier Urban Institute analysis showing progress on affordability since the Affordable Care Act’s implementation—with the percentage of nonelderly adults having problems paying medical bills sharply declining. 

About the Urban Institute

The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Visit the Urban Institute’s Health Policy Center for more information specific to its staff and its recent research.