Alfac Survey: Many Americans Forced to Choose: Pay Medical Bills or Maintain Holiday Cheer

Wednesday, December 8th, 2021

Many American households struggle to pay for medical expenses, forcing some to make difficult decisions. According to the 2021 Aflac Health Care Issues Survey released today, these choices include working more, forgoing medical care, cutting back on holiday spending and more. Even with health insurance, families that experienced COVID-19 and those with children are especially hard hit. With the latest Centers for Disease Control and Prevention data indicating more than 45 million Americans tested positive for COVID-19 since the pandemic began, millions of households may be facing similar financial challenges, especially as the holiday season approaches.

"The study paints a picture of resourcefulness and sacrifice with certain households reporting that they had to take extra shifts at work, dip into their 401(k) accounts and even delay medical treatment for themselves," said Jeramy Tipton, senior vice president, Distribution Expansion and Consumer Markets at Aflac. "We also found that households with health insurance are not immune from having to cope with significant out-of-pocket health care expenses."

COVID-19 contributing to increased financial stress
According to the Aflac study, households that have experienced a COVID-19 diagnosis since the start of the pandemic are far more likely to have experienced high out-of-pocket costs. Most notably:

  • Nearly two-thirds (64%) had out-of-pocket health care expenses in the last 12 months, compared to 45% of other American households.

  • Nearly a quarter (23%) reported more than $1,500 in out-of-pocket expenses versus 16% of non-COVID-19 households.

  • These families were three times more likely to have taken money out of their 401(k) or other retirement funds, twice as likely to have borrowed money from a friend or family, and three times as likely to have filed for bankruptcy compared to families that did not experience COVID-19.

Financial challenges are also putting a damper on holiday cheer. More than half (60%) of American households that experienced a COVID-19 diagnosis expect to be affected this holiday season out of concern about health care expenses. The most common cost-saving actions Americans expect or have taken leading up to this holiday season include:

  • Reducing overall holiday spending on gifts and/or décorations (41%).

  • Canceling holiday travel plans to see friends and/or family (40%).

  • Canceling holiday events (37%).

Even the insured feel the pinch
Roughly half (51%) of households with health insurance still reported out-of-pocket medical costs. And in roughly one-fifth (19%) of these cases, insured households faced medical costs exceeding $1,500.

"Unfortunately, health care costs are rising, but that doesn't mean Americans should have to decide between paying medical bills or celebrating the holidays," said Tipton. "Households can help prevent future holiday blues by educating themselves on supplemental benefits, which help close the gap for costs that health insurance doesn't cover. Plans like critical illness, cancer or hospital indemnity are great because they pay policyholders cash to cover anything from copays to monthly bills such as mortgage or rent, enabling them to focus on the things that matter most, like holiday cheer."

Households with children make more sacrifices to maintain holiday cheer
Naturally, households with children are less likely to reduce their holiday spending (33% compared to 44% of other households) or cancel holiday events (23% versus 35%), but they are especially feeling the weight of financial concerns. This year, 43% of households with children plan to take some actions in and around the upcoming holiday season out of concern over health care expenses, including taking up more hours at work.

Holidays aside, households with children experience more financial hardships year-round than other households:

  • About half, 51%, of households with children say they acted out of concern over medical expenses last year compared to only 34% of households without children.

  • Within the past 12 months, households with children are:

    • More than twice as likely to have picked up hours/shifts (45% vs. 17%).

    • Nearly twice as likely to have tapped into their 401(k)/retirement savings (21% vs. 11%).

    • Much more likely to have filed for/declared bankruptcy (7% vs. 1%).

"Throughout the pandemic, parents have been confronted with hard decisions on how to best care for their children," continued Tipton. "The survey shows high health care costs are forcing parents to make even more sacrifices this holiday season – which should be a joyous time of year – on top of everything they already do for their families year-round."

To see additional survey findings and learn more about the financial effects of health care issues – and how Aflac can help with the expenses health insurance doesn't cover – visit