Insurance Coverage and Health Care Affordability Among Adults in New York City: A Cross-Sectional Analysis, January 2022.

Objectives. To examine whether insurance coverage (private, Medicaid, Medicare, uninsured) is associated with health care affordability among New York City adults and how this varies by household poverty. Methods. A January 2022 probability-based survey assessed difficulty in affording premiums, provider visits, prescriptions, and medical devices, weighted to New York City's adult population. Poverty was categorized by federal poverty level (FPL; < 100%, 100%-199%, 200%-399%, 400%-599%, and ≥ 600%). Ordered logistic regression estimated associations between coverage type and affordability outcomes overall and within 2 income groups (< 100% and 100%-199% of FPL), and how poverty affects outcomes among privately insured and Medicare enrollees. Results. Overall, 32% reported difficulty affording provider visits, 23% premiums, 30% prescriptions, and 19% medical devices. Uninsured adults faced the greatest barriers. Among those with incomes 100% to 199% of FPL, private insurance was associated with higher odds of difficulty affording visits, prescriptions, and devices, whereas Medicare enrollees had higher odds for prescriptions than Medicaid enrollees. Within private insurance and Medicare, lower income was associated with progressively higher odds of affordability difficulties. Conclusions. Private insurance and Medicare do not fully shield low-income adults from high out-of-pocket costs. Medicaid provides the most protection. (Am J Public Health. Published online ahead of print July 23, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308573).