A healthy body is a luxury good.

Earlier this year, 20-year-old Eric, a senior at The College of New Jersey, tripped and fell down a flight of stairs on his way to meet friends. At first, he thought nothing of it, but when he woke up, his arm “felt like it was on fire” and he called his college’s medical services. “They asked ‘Do you want us to call you an ambulance?” he recalls. “And I was thinking ‘My health insurance doesn’t cover an ambulance.’” The ride was $450, a cost he couldn’t afford. “I was sitting here like, my arm might be broken, but I don’t have $450.”

Eric took painkillers and waited until the morning for his roommate to wake up and drive him to the hospital. The problems didn’t stop there: After his arm was set, E.R. doctors recommended Eric see a specialist to check for long-lasting muscle damage. The appointment carried a price tag of over $1000; his insurance didn’t cover it. Eric had to refuse, even as he worried that his arm would never be the same.

Stories like Eric’s happen daily in America. Over the past year, one-in-four American families have had to turn down medical care that they needed because of the cost, according to a study out Wednesday from Bankrate.com. Older millennials (ages 27-36) have it the worst - they were the most likely to do this, with 32% shunning medical care because they couldn’t afford it in the past year.

Some of this, of course, is because many Americans (11.3%) simply don’t have insurance. But that’s just a small part of this: Even for families with insurance, costs are steep. In 2015, workers paid an average of $1,318 out of pocket before meeting their deductibles, and those in high-deductible plans (24% of workers) often pay even more. Even after surpassing their deductibles, workers paid an average copay of $24 for primary care office visits, $37 for specialty care office visits, and $308 for hospital admission.

And though those numbers may seem negligible, for the least well off in the United States, they can be prohibitive. Nick, 23, who has lived in poverty for most of his life, is regularly forced to put his health at risk in order to afford basic needs.

Nick grew up in Massachusetts, where many of his health expenses were covered by the state. When he moved to Rhode Island to attend Brown University, however, he had to switch to a less comprehensive plan provided by his university’s financial aid program. The plan covered only basic checkups for primary care. Everything else from medications to dental care, glasses, and therapy cost money Nick didn’t have.

“I stopped going to the dentist,” he says. “I stopped having my ears checked. I had to settle for chronic back pain and tooth aches. I had to suck it up as my vision grew worse. I was already dealing with too many costs, and I kept telling myself that I would eventually get a job and fix everything.”

In the meantime, “I had to hope that nothing catastrophic happened to my body.”