Rising health care costs aren't just inflating medical bills—they're shifting more responsibility onto patients to navigate an increasingly complex system and advocate for themselves.
The affordability crisis has intensified on multiple fronts. In 2025, Congress passed sweeping tax legislation that reduced premium subsidies for Affordable Care Act plans beginning in 2026. Millions of Americans now confront sharply higher premiums, with many dropping coverage or planning to go uninsured as costs climb. By March 2026, roughly 1 in 10 ACA enrollees had already dropped their plans, a figure expected to grow.
At the same time, high-deductible health plans have proliferated, forcing patients to pay thousands out of pocket before insurance coverage begins. Combined with soaring prescription drug prices and a growing population of under- or uninsured Americans, medical debt remains a persistent financial burden.
Nearly half of U.S. adults now struggle to afford health care. These pressures are driving the "consumerization" of health care, where patients must comparison shop and manage costs like any other purchase—except pricing remains frustratingly opaque. In this landscape, knowing which questions to ask may be a patient's most valuable tool.
We are professors who study how cost perceptions influence patient decision-making. Our research explores how price-transparency regulations affect patient choices. Throughout our work, we consistently hear from patients about escalating costs and the frustrating absence of price conversations with their providers.
Why speaking up about cost matters
When one of us took a child to the pediatrician for pink eye, the doctor quickly sent a prescription for antibiotic drops to the pharmacy. At pickup, the pharmacist delivered unwelcome news: the drops would cost over $300. A quick call back to the doctor's office, however, revealed that a generic version offered identical treatment and results at a fraction of the price.
That brief phone call saved hundreds of dollars. It also raised a troubling question: Why don't more patients have these conversations? Research shows cost discussions occur in only about 30% of medical visits.
These conversations matter beyond medications. They're crucial when a recommended procedure has multiple alternatives, when out-of-pocket costs might determine whether you follow through on care, or when an unexpected bill could create financial hardship. Discussing price can help patients maintain their health while avoiding the common trade-off between medical care and household finances.
The study cited above found that doctors and patients identified ways to reduce out-of-pocket costs—such as switching to generics or adjusting care timing—in nearly half of cost conversations. Importantly, these discussions were typically brief and didn't compromise care quality.
Patients actually prefer doctors who raise cost concerns, other research confirms. Yet most patients remain reluctant. While a majority want to discuss cost, only a minority actually do, often waiting until a bill arrives—when it's too late to explore alternatives. That's why patients need to feel empowered to ask the right questions. Here are three that can make care more affordable.
Is there a generic or lower-cost alternative?
One of the simplest ways to cut drug costs is asking whether a less expensive option exists. Brand-name medications often cost significantly more than generics, even when equally effective. Industry data shows that 90% of prescriptions filled in 2024 were generic or biosimilar, yet these accounted for only 12% of drug spending.
Physicians can often substitute a generic drug or recommend a similar treatment that achieves the same outcome at lower cost. When no direct generic exists, therapeutic alternatives may be worth considering. If a brand-name eye drop or inhaler lacks a generic equivalent, doctors can often prescribe a different medication in the same class that works equally well but costs far less. Research on physician-patient cost conversations shows that switching to lower-cost, clinically similar alternatives within the same drug class is a common strategy for reducing out-of-pocket spending without compromising care.
Is there any financial assistance available?
Many hospitals and large health systems offer programs to make care more affordable for lower-income patients. State government programs serve similar purposes. These programs often provide care discounts but can be complex to navigate and require substantial paperwork. Many health care offices employ staff knowledgeable about these programs who can help determine eligibility and sometimes assist with applications, though the Trump administration has reduced funding.
Patients can typically find these programs through hospital or health system websites, which usually include financial assistance or "charity care" pages outlining eligibility and application processes. State Medicaid offices and insurance marketplaces also serve as key entry points for coverage and subsidy programs. Nonprofit organizations and patient advocacy groups may offer or list assistance tailored to specific conditions or medications.
For prescription medications, the quoted price isn't always final. Many medications come with cost-reduction options, including manufacturer coupons, copay assistance programs and patient assistance programs. Doctors' offices and pharmacists may know practical money-saving strategies, such as using a different pharmacy, switching to mail order or adjusting how a prescription is written. Asking about these options can uncover savings that aren't immediately apparent.
What will this cost me, and are there other options?
Health care pricing is notoriously opaque, and costs can vary dramatically depending on where and how care is delivered. Asking upfront about expected out-of-pocket costs can help avoid surprises later.
This question also opens the door to alternatives. Patients may be able to choose a lower-cost imaging center, opt for outpatient rather than hospital-based care, or delay nonurgent services until insurance coverage improves.
Speaking up is part of taking care of your health
Health care decisions shouldn't force a choice between well-being and financial stability. A brief, honest conversation about cost can lead to more affordable and sustainable care.
Physicians can't address financial concerns they don't hear about, and most want to help patients access care they can realistically afford and follow through on. As costs continue shifting toward patients, asking these questions isn't just helpful—it's essential.
The next time you receive a prescription or referral, remember: one simple question about price could make all the difference.
Deidre Popovich has received grant funding from BlueCross BlueShield of Texas and Providence Health.
Helen Colby does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.