As health care costs climb, patients aren't just paying more — they're increasingly expected to navigate a complex system largely on their own.
Americans are being squeezed on multiple fronts. In 2025, Republican-controlled Congress passed a sweeping tax overhaul that rolled back premium subsidies for Americans enrolled in Affordable Care Act plans, effective 2026. The result: millions of ACA enrollees now face sharply higher premiums, pushing many to drop coverage entirely and risk going uninsured as costs spiral upward. By March 2026, roughly 1 in 10 ACA enrollees had already dropped out — a figure expected to grow.
Meanwhile, high-deductible health plans have proliferated, requiring patients to absorb thousands of dollars in costs before their coverage meaningfully kicks in. Combined with surging drug prices and a growing population of under- or uninsured Americans, medical debt has become one of the country's most pervasive financial burdens.
Nearly half of U.S. adults report struggling to afford care. These compounding pressures are accelerating what analysts call the "consumerization" of health care — a shift in which patients are expected to comparison-shop, weigh options, and manage their own costs, often without reliable pricing information to guide them. In this landscape, knowing which questions to ask may be among the most valuable tools a patient has.
We are professors who study how patients' perceptions of health care costs influence their medical decisions. Our research explores how policies such as price-transparency regulations shape patient behavior. Consistently across our work, patients tell us the same thing: costs are rising, and conversations about price with their providers too often never happen at all.
Why speaking up about cost matters
When one of us brought a child to the pediatrician for pink eye, the doctor quickly sent a prescription for antibiotic eye drops to the pharmacy. The sticker price at pickup: more than US$300. A follow-up call to the doctor's office, however, surfaced a straightforward alternative — a generic version of the same medication, equally effective, at a fraction of the cost.
That single phone call saved hundreds of dollars. It also raised a troubling question: why don't more patients have these conversations? Research suggests they're surprisingly rare — one study found that cost discussions occur in only about 30% of medical visits.
These conversations matter well beyond prescriptions. They're particularly valuable when a recommended procedure has lower-cost alternatives, when out-of-pocket expenses might deter follow-through on care, or when an unexpected bill could tip a family into financial hardship. Raising the question of price can help patients avoid the all-too-common trade-off between getting care and paying other household bills.
The same study found that when cost conversations did happen, doctors and patients identified ways to reduce out-of-pocket expenses — such as switching to a generic or adjusting the timing of care — in nearly half of cases. Critically, these discussions were typically brief and did not affect the quality of care provided.
Patients actually prefer physicians who raise cost proactively, other research has found. Yet most patients stay quiet, saying they want to discuss cost while rarely initiating the conversation — often waiting until a bill arrives, by which point alternatives are no longer on the table. That's why it's so important for patients to feel empowered to ask the right questions. Here are three that can make a real difference.
Is there a generic or lower-cost alternative?
Asking whether a less expensive option exists is one of the most straightforward ways to cut drug costs. Brand-name medications can cost dramatically more than generics, even when they are clinically equivalent. One industry survey estimated that 90% of all prescriptions filled in 2024 were generic or biosimilar — yet those drugs accounted for only 12% of total drug spending.
In many cases, a physician can substitute a generic or recommend a therapeutically similar treatment that achieves the same outcome at a lower price. Even when no direct generic exists, alternatives within the same drug class often do. A brand-name eye drop or inhaler without a generic equivalent, for instance, may have a counterpart that works just as well for far less. Research on physician-patient cost conversations shows that switching to lower-cost, clinically comparable alternatives within the same drug class is one of the most common strategies for reducing out-of-pocket spending without sacrificing care quality.
Is there any financial assistance available?
Many hospitals and large health systems operate programs specifically designed to make care more affordable for lower-income patients — and most states have government programs pursuing the same goal. These assistance programs can offer meaningful discounts, though they can be complex to access and often require paperwork. Many provider offices have staff versed in navigating these options, who can help patients assess eligibility and assist with applications, though the Trump administration has cut funding for some of these resources.
Patients can often locate these programs through hospital or health system websites, which typically include financial assistance or "charity care" sections explaining eligibility and the application process. State Medicaid offices and insurance marketplaces are also key entry points for coverage subsidies. Nonprofit organizations and patient advocacy groups may offer or catalog additional assistance tailored to specific conditions or medications.
For prescription drugs, it's also worth remembering that the price you're first quoted is rarely the only option. Manufacturer coupons, copay assistance programs, and patient assistance programs can all reduce costs. Doctors and pharmacists may know additional ways to save — such as using a different pharmacy, switching to mail order, or changing how a prescription is written. Asking the question can surface savings that aren't always volunteered upfront.
What will this cost me, and are there other options?
Health care pricing is notoriously opaque, and what patients actually pay can vary widely depending on where and how care is delivered. Asking about expected out-of-pocket costs before receiving care is the most reliable way to avoid unwelcome surprises later.
The 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 a nonurgent procedure until their insurance coverage is in a better position to offset the cost.
Speaking up is part of taking care of your health
Health care decisions shouldn't force a choice between your well-being and your finances. A brief, honest conversation about cost can lead to care that is both more affordable and more sustainable over the long term.
Physicians can't address financial concerns they aren't aware of — and most genuinely want to help patients access care they can realistically follow through on. As more of the financial burden shifts to patients, asking these questions isn't just useful. It's essential.
The next time you're handed a prescription or a 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.
