Quick answer
If you can easily pay for routine care yourself, you may not need a plan with low copays, but you still need protection from a huge bill. Most health spending comes from a small number of very expensive illnesses and injuries that no one can predict. A high-deductible, HSA-eligible plan or a catastrophic plan lets you pay your own way for everyday care while capping your costs if something serious happens.
Key takeaways
- In 2023, the top 5% of spenders accounted for about half of U.S. health spending, averaging $72,918 each.
- The top 1% averaged $150,467, a cost few people can pay out of pocket.
- Insurance also gets you negotiated prices and a yearly out-of-pocket cap ($10,600 in 2026).
- You can’t buy ACA coverage whenever you want; you’ll usually have to wait for open enrollment.
- HSA-eligible plans let you save pre-tax money for the care you pay for yourself.
On this page
Why paying your own way is risky
Most years, most people spend little on health care: the bottom half of the population averaged just $433 in 2023, according to Peterson-KFF. But in a bad year, costs can climb fast. A cancer diagnosis, a premature baby or a serious accident can run into the hundreds of thousands of dollars. Insurance is built for those years.
Insurance also saves money on care you’d pay for anyway. Insurers negotiate lower prices, and once you hit your out-of-pocket maximum, the plan pays 100% of covered in-network care for the rest of the year.
Plans that fit people who can pay for routine care
| Option | How it works | Good to know |
|---|---|---|
| High-deductible HSA-eligible plan | Low premium; you pay most routine costs until the deductible | Since 2026, bronze and catastrophic marketplace plans qualify for an HSA |
| Catastrophic plan | Very low premium; covers preventive care and three primary care visits before the deductible | Only for people under 30 or with a hardship exemption |
| Bronze plan | Lower premium, higher deductible | See bronze, silver, gold and platinum plans |
A higher deductible lowers your premium. Your deductible is what you pay before the plan shares costs; see how to meet your deductible. Some plans charge copays for visits even before the deductible.
Paying cash for small things
You can still pay cash for some care while insured. Cash prices for lab work, imaging or generic drugs are sometimes lower than your plan’s rate. The catch: what you pay outside your insurance usually doesn’t count toward your deductible. Since 2026, you can also pair an HSA with a direct primary care membership, a flat monthly fee for unlimited visits with a primary care practice.
Ways to lower your premium without going uninsured
- Compare every insurer in your area; prices for similar plans vary a lot. See why rates differ between insurance companies and the best health insurance companies.
- Check whether a narrower network still includes your doctors; see how to find out if a doctor is covered.
- Switch plans at open enrollment if yours is overpriced; see how to switch health insurance companies.
- If you have two plans, decide whether you need both; see how deductibles work with two plans.
For more ideas, see the cheapest ways to get health insurance and comparing health insurance.
If you’re facing bills you can’t cover
Ask for an itemized bill, a discount for paying promptly, financial assistance or a payment plan. Nonprofit hospitals must have financial assistance policies. If you’re uninsured, you can ask for a good faith estimate before scheduled care and dispute a bill that comes in $400 or more above it.
See what a high-deductible plan would cost you: compare quotes by ZIP code.
Frequently asked questions
Is it smart to go without health insurance if I have savings?
Usually not. Savings cover routine costs, but a serious illness can cost far more than most savings. A high-deductible plan protects you for a lower premium.
Can I pay cash and still use my insurance?
Yes, but cash payments made outside your insurance usually don’t count toward your deductible or out-of-pocket maximum.
Can I buy insurance after I get sick?
Usually only during open enrollment or after a qualifying life event, so you could be stuck paying for months of care.
Sources
This article is general information, not insurance or financial advice. Last reviewed September 2026.