Cost is the single most common reason people skip or delay health care, but it’s far from the only one. Where you live, whether you have insurance, how far you are from a hospital, whether you speak English, and even how long you’d have to wait for an appointment all play a role. About one in four U.S. adults report skipping or postponing needed care in the past year due to cost alone, and the full picture of access barriers is broader still.
Cost and Insurance Gaps
Money is the barrier that shows up most consistently in national surveys. KFF polling from 2025 found that 36% of adults had skipped or postponed needed health care in the past 12 months because of cost. The problem is sharpest among younger adults (45% of those aged 18 to 29), Hispanic adults (43%), and households earning under $40,000 a year (40%). Even among people who earn $90,000 or more, nearly three in ten reported the same.
Having insurance helps, but not as much as you might expect. More than one in three insured adults (37%) still reported going without needed care because of cost. High deductibles, copays, and out-of-network charges can make coverage feel more like a discount card than a safety net. For the uninsured, the picture is far worse: 75% say they’ve skipped or postponed care due to cost.
The number of people without insurance is also climbing again. Census data from 2024 showed uninsured rates rising in 18 states and Washington, D.C. Medicaid coverage dropped in 33 states for working-age adults and 22 states for children, with kids experiencing the steepest declines. Much of this stems from the end of pandemic-era rules that had kept people continuously enrolled in Medicaid, and many who lost coverage simply fell through the cracks of the re-enrollment process rather than becoming ineligible.
Where You Live Matters
Geography creates a quiet but powerful barrier. The typical rural resident travels about 18 miles to reach medical care, roughly twice the distance of someone living in an urban area. That gap has been growing: more than 100 rural hospitals have closed over the last decade, with at least 18 closing or dropping inpatient services in 2025 alone. Another 700 rural hospitals are considered at risk, and 300 of those are at immediate risk of shutting down.
When a rural hospital closes, the community doesn’t just lose a building. It loses emergency care, labor and delivery services, and routine visits. Residents who previously drove 10 minutes to an ER may now face a 45-minute or longer trip. For time-sensitive emergencies like strokes or heart attacks, that added distance can be the difference between recovery and permanent damage.
Not Enough Doctors to Go Around
Even in areas with open hospitals and clinics, there may not be enough physicians to see patients in a reasonable timeframe. The Association of American Medical Colleges projects a national shortfall of 13,500 to 86,000 physicians by 2036. Primary care alone could be short 20,200 to 40,400 doctors, and surgical specialties could face a gap of 10,100 to 19,900.
The practical result is longer waits. A 2025 survey of the 15 largest U.S. metro areas found the average wait for a new physician appointment had reached 31 days. Cardiology appointments averaged 33 days, up 74% since 2004. Family medicine, often treated as the front door of the health care system, averaged 23.5 days. These are averages in major cities. In smaller or rural communities, waits can stretch considerably longer, and some specialties may not be available locally at all.
Transportation and Logistics
About 6% of U.S. adults report that a lack of reliable transportation has kept them from medical appointments, work, or daily errands. That percentage sounds modest until you consider it represents millions of people. The burden falls hardest on older adults who no longer drive, people with disabilities, and low-income households without a car. Public transit in many parts of the country is either unreliable or nonexistent, and ride-share services add costs that compound the financial barriers already in play.
Logistics extend beyond getting to the appointment itself. Taking time off work, arranging child care, and coordinating follow-up visits all create friction. For hourly workers without paid sick leave, a single doctor’s visit can mean a lost day of income on top of the medical bill.
Language and Health Literacy
Nearly 30 million people in the United States have limited English proficiency. These individuals are more likely to be uninsured, less likely to use preventive care, and more likely to experience poor health outcomes. Federal standards exist to ensure hospitals provide language services, but only 13% of hospitals fully meet them, largely due to interpreter shortages, a lack of multilingual materials, and inadequate reimbursement for translation services. Administrative processes like insurance enrollment and Medicaid re-enrollment are particularly difficult to navigate when forms and instructions aren’t available in your language.
Language is only part of the literacy picture. Just 12% of U.S. adults have what researchers consider proficient health literacy, meaning the ability to do things like interpret prescription labels, understand insurance documents, or follow a recommended screening schedule. Over 77 million adults would have difficulty with these common health tasks. When someone can’t parse a discharge summary or understand pre-procedure instructions, they’re more likely to miss follow-ups, take medications incorrectly, or avoid the system altogether.
The Digital Divide and Telehealth
Telehealth expanded rapidly during the pandemic and remains a major part of how care is delivered, particularly for mental health and chronic disease management. But access to virtual visits requires a reliable internet connection and a device capable of video calls. Data from the American Community Survey found that 26% of Medicare beneficiaries lacked adequate digital access at home, whether that meant no computer, no internet, or no smartphone with a data plan.
The gap is widest among older adults, Black and Hispanic adults, people with disabilities, those with a high school education or less, and adults living below 200% of the federal poverty level. For these groups, the shift toward telehealth hasn’t expanded access. It has created a new barrier layered on top of existing ones.
Bias in the System
Even when people do reach a provider, the care they receive isn’t always equal. Implicit bias, the unconscious assumptions clinicians carry about patients based on race, ethnicity, age, weight, gender, or economic status, affects medical decision-making, communication, and the treatments offered. Both the Institute of Medicine and The Joint Commission have identified implicit bias as a contributor to persistent health care disparities in the U.S.
These biases can show up in subtle ways: pain being undertreated in Black patients, symptoms being dismissed in women, or less time spent explaining options to patients perceived as lower income. The result is that some groups receive lower-quality care even when they’ve overcome every other barrier on this list to walk through the clinic door. Addressing these disparities requires systemic changes in medical training and clinical culture, not just individual awareness.