10 Health Procedures Middle Class Americans Will Start Skipping within the Next Five Years Because They Won’t be Able to Afford Them
Health care costs in the U.S. have kept climbing, with CMS projecting national health spending to rise 5.6% a year through 2032. For middle-income households facing deductibles that often run into the thousands, several common procedures are becoming harder to fit into a family budget.
MRIs for back and joint pain
MRI scans are already expensive for insured patients, especially when deductibles have not been met. FAIR Health said in recent cost estimates that billed charges for an MRI can range from hundreds to several thousand dollars depending on the body part and facility.
For a middle-class family with a high-deductible plan, that can turn a non-emergency back MRI into a delayable expense. KFF has reported that deductibles for employer coverage remain a major out-of-pocket burden, which makes imaging one of the first services patients may postpone.
Colonoscopies with anesthesia or polyp removal
Screening colonoscopies are often covered, but follow-up costs can still surprise patients. The Biden administration moved in 2022 to tighten rules on coverage for follow-up colonoscopy after a positive stool test, yet out-of-pocket bills still arise in some plans and settings.
A procedure that starts as preventive can become more expensive if anesthesia, pathology, or polyp removal is billed separately. Gastroenterology cost reviews and insurer disclosures show patients can face hundreds or more in charges, which may push some adults ages 45 to 49 to delay scheduling.
Hearing aids and related fittings
Hearing care often falls into a gray area because traditional Medicare does not broadly cover hearing aids. The National Council on Aging has said prescription hearing aids commonly cost from about $2,000 to $7,000 per pair, putting them out of reach for many retirees and working families.
Over-the-counter hearing aids became available in the U.S. in October 2022, but that did not eliminate the cost problem for people who need higher-end devices or multiple fittings. For middle-income households, hearing treatment may increasingly mean waiting, using one device, or going without.
Dental crowns and root canals
Dental benefits are frequently separate from medical insurance, and annual caps are often low. The American Dental Association has repeatedly noted that many private dental plans still carry annual maximums near $1,000 to $2,000, a figure that can be exhausted by one major procedure.
A root canal and crown on a molar can easily cost more than that combined, depending on the state and provider. Once a plan maximum is hit, many families choose extraction, delay treatment, or finance the bill, all of which reflect affordability pressure rather than lack of need.
Physical therapy after injury or surgery
Physical therapy is medically routine after orthopedic injuries, but repeated copays add up fast. A patient attending two sessions a week for eight weeks could face 16 copays, and employer plans tracked by KFF often require cost-sharing even for in-network rehabilitation.
The problem gets bigger when plans limit the number of covered visits each year. If a knee surgery patient in Ohio or Texas needs more sessions than a policy allows, the remaining visits may become self-pay, making full rehab harder for middle-income families to complete.
Sleep studies for suspected sleep apnea
Sleep apnea testing has become more common, but lab-based studies remain costly. Cost comparisons from major hospital systems and insurers show overnight in-lab sleep studies can run into the thousands, while home sleep tests are cheaper but not always appropriate for every patient.
That price gap matters because follow-up also costs money, including specialist visits and CPAP equipment. For a household trying to manage rent, groceries, and a deductible at the same time, a sleep study often becomes a condition people live with longer than recommended.
Fertility testing and IVF-related procedures
Fertility care remains one of the least affordable areas of medicine for many insured Americans. RESOLVE and other national advocacy groups have long noted that IVF commonly costs $12,000 to $25,000 per cycle in the U.S., and medication can add several thousand more.
Only a limited number of states require broader fertility coverage, and those mandates vary widely. For middle-class couples in states without strong coverage rules, even initial testing, egg retrieval, or embryo storage can be delayed because the total price rivals a down payment.
Cataract surgery with upgraded lenses
Standard cataract surgery is usually covered by Medicare when medically necessary, but upgraded lens choices often are not. The American Academy of Ophthalmology has said premium intraocular lenses and related refractive corrections can leave patients paying significant out-of-pocket costs.
That creates a two-tier affordability issue for older middle-income adults. They may still get the surgery itself, but skip lens options that reduce dependence on glasses because those upgrades can cost thousands per eye, a major expense for retirees on fixed monthly income.
Skin cancer checks and mole removal
A dermatology visit can be routine until a biopsy or removal changes the bill. Insurance rules often distinguish between preventive screening and diagnostic treatment, and patient cost-sharing can rise quickly once a suspicious mole is removed and sent to pathology.
The American Academy of Dermatology has continued to warn about access issues, especially in areas with specialist shortages. For families balancing copays and deductibles, full-body skin exams may become less frequent, particularly when there is no immediate symptom pushing the visit.
Elective orthopedic procedures like knee arthroscopy
Not every orthopedic procedure is urgent, which makes affordability a major factor in timing. Cost estimators from large health systems show outpatient knee and shoulder procedures can still leave insured patients owing thousands, particularly before deductibles are met.
That means some middle-income patients may shift from surgery to pain management, injections, or home exercise for longer than they otherwise would. The trend fits a broader KFF finding that medical debt and out-of-pocket costs continue to shape when Americans actually use care.
