Dive Brief:

Americans continue to worry about paying for healthcare. In a new Bankrate survey of 1,000 adults, 22% said they or a close family member opted not to get necessary medical care because of the cost, while 77% said cost worries had led them to avoid care.

Of those who admitted skipping a doctor's visit in the past year, 29% got their insurance coverage in the individual marketplace, such as the ACA exchanges, and 22% were covered under employee benefit plans. About 17% were Medicare and Medicaid beneficiaries.

Women feel significantly less secure than men when it comes to healthcare. When asked if they had chosen not to get medical care in the past year, 25% of women answered "yes," compared with 18% of men. Nearly half (47%) of women said a bill they paid in the past 12 months was more expensive than they anticipated, versus 35% of men.

Dive Insight:

Overall, 41% of those surveyed said a bill paid in the past year was higher than expected.

There’s also widespread concern about access to affordable health insurance. Among all adults, 54% said they are very or somewhat worried that they might not have affordable coverage in the future. That share grew to 67% among younger baby boomers and to 59% for Gen Xers.

"Health care is a huge issue in the run-up to the midterm elections, especially with the effort to eliminate coverage for pre-existing conditions," Bankrate.com analyst Taylor Tepper said in a statement. "It is incredibly hard to comparison shop, premiums are rising and so are deductibles. The onus has been on the patient to keep prices down."

This is far from the only survey to show Americans are worried about paying their medical bills. In a recent survey by The Commonwealth Fund, just two-thirds of U.S. adults said they are very or somewhat confident they could afford to pay for a serious illness, down from 70% in 2015. And that confidence dropped to about half when people earned less than $30,150, down from 60% three years ago and 20% below that of adults with higher incomes.

These findings come as CMS has recently issued a final rule requiring hospitals to start posting their price information online. Hospitals must make available a list of their standard charges in a machine-readable format and update it at least annually. But even with mandatory price lists, it can be difficult for patients to anticipate out-of-pocket costs and avoid being blindsided by surprise billings. CMS already required hospitals to make their standard charges public, but a supplementary RFI to the final rule acknowledges pricing transparency issues still need to be addressed.

In the meantime, some states have taken steps to increase visibility around healthcare pricing. In October, Maryland launched a statewide initiative, called Wear the Cost, to help consumers compare prices for common nonemergency procedures at hospitals. The website calculates two types of costs — typical and anticipated costs, such as office visits and surgery, and costs associated with potentially avoidable complications. Consumers are encouraged to look for hospitals with low total costs and low rates of avoidable complications to get the best value.

Massachusetts requires insurers to post healthcare price information online, and Arizona requires large medical facilities to post patient costs for the 50 most common medical procedures. Smaller hospitals must provide prices for the top 35 procedures.

But studies have shown most Americans don't price shop for healthcare. In a national poll by the Bucknell Institute for Public Policy, just over one-fourth of respondents said they request cost information from providers. Those numbers may be higher among younger consumers, though. A 2016 PNC Healthcare survey found 41% of millennials would likely seek cost estimates before getting treatment, versus 21% of baby boomers.