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With premiums poised to climb and enhanced ACA subsidies set to lapse without congressional action, some Americans are weighing cash payment over insurance. Experts say select services—like X-rays, scans, allergy tests, or some generics—can cost less at posted cash prices or via charity care, especially for high-deductible enrollees. But skipping coverage sacrifices negotiated rates, preventive benefits, and progress toward deductibles, and can explode costs if emergencies strike outside enrollment windows. Advocates urge careful price checks, billing-office questions, and federally qualified health centers; hospitals must still provide emergency care under federal law.

Prepared by Olivia Bennett and reviewed by editorial team.