How Delayed Care Driving Up Health Plan Costs

 

Something significant is happening in healthcare right now — and it’s not being talked about in the right way.

Yes, care is getting more expensive. Yes, premiums are rising. But there’s a deeper issue quietly driving costs higher:

Patients are entering the healthcare system sicker than they have in years… a crazy statement to conceptualize… considering advancements in modern medicine.

But this new reality is reshaping everything for healthcare systems, carriers, and employers.

WATCH: How Delayed Care Is Quietly Driving 2026 Health Plan Costs

Hospital Systems Under Pressure Due to Sicker Patients

Across the country, physicians and hospitals are reporting the same trend:

  • More late-stage cancer diagnoses

  • More unmanaged diabetes

  • More advanced heart disease

  • More patients entering care through the emergency room instead of a primary care office

People aren’t just consuming more healthcare. They’re arriving in worse condition when they finally do seek treatment.

Long story short: patients are aware there’s a problem, but are waiting until the very last minute to treat it – often under the belief that this will offset costs, especially if the problem ends up “being nothing.”

But late-stage care is dramatically more expensive than early intervention.

Early Care vs. Late Care: The Cost Gap

Here are some examples of medical treatments. The financial difference between early intervention vs. late care is staggering in both scenarios:

  • A routine cancer screening? Relatively inexpensive. Stage IV cancer treatment? It can cost hundreds of thousands of dollars.

  • Early diabetes management with medication and monitoring? Manageable. Kidney failure, stroke, or heart attack from uncontrolled diabetes? Astronomical.

As we stated before, the reason patients choose to wait is they don’t want to pay for what could be a waste of money trip to the doctor.

Those costs don’t actually completely disappear… They’re absorbed into the system — and ultimately reflected in premiums for employers and families.

When patients show up sicker, the system requires:

  • More specialists

  • More imaging

  • More hospital days

  • More emergency care

  • More high-cost medications

In the end, everyone, including the really sick patient, suffers.

What’s Causing This Shift?

There are many reasons why this is happening, but the main ones are:

1. Pandemic Fallout

During the height of COVID-19, routine care slowed dramatically. Screenings were postponed. Office visits were canceled. Preventive services were delayed.

Many conditions progressed quietly during that time, going undetected and unmanaged.

Now that patients are re-entering the system, they’re coming in at a more advanced stage of illness.

2. An Aging Population

Every day, roughly 10,000 Americans turn 65.

As more people age into Medicare eligibility, the healthcare system sees higher rates of chronic disease. Older adults are more likely to manage multiple complex conditions, which increases both utilization and cost intensity.

3. Financial Pressure on Households

We’ve mentioned this a few times. If you’re reading this, you’ve probably though about skipping getting that pesky knee injury checked out for this exact reason.

Higher deductibles. Higher out-of-pocket costs. More cost-sharing.

When care feels expensive, people delay it. They ration medications. They wait until symptoms become severe enough that they can’t ignore them.

And by the time they finally seek care, it’s often urgent and far more costly.

Why This Matters for Employers in 2026

Delaying care isn’t just a healthcare issue.

It’s:

  • A financial issue for families

  • A budget issue for employers

  • A sustainability issue for the entire healthcare system

When employees enter care later and sicker, claims become more severe, and that severity drives overall plan costs. Those escalating costs are one of the major contributors to the premium increases we’re seeing on a macro level in 2026.

This trend isn’t about overutilization… it’s about delayed utilization – and that distinction matters.

What Can Be Done?

Employers and plan sponsors have more influence here than they may realize. To mitigate costs from delayed care, you can:

  • Strengthening preventive care incentives

  • Reducing financial barriers to early intervention

  • Educating employees on available benefits

  • Supporting chronic condition management programs

  • Leveraging data to identify gaps in care

However, the goal isn’t simply to reduce spending… but to shift the mindset of your employees to get care earlier when it’s actually more affordable, more effective, and better for their long term health.

 
Alyssa Johnson