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An insured American adult with an employer-sponsored health insurance plan can expect to spend more than $320,000 (including insurance premiums and out-of-pocket costs) during their lifetime, and that figure is more than double for those who buy their own insurance or suffer from chronic illnesses.

New consumer research from Synchrony, a consumer financial services company found that Americans underestimate their healthcare expenses by as much as 145%, leading many to delay recommended medical procedures, often to the detriment of their health.

The “Lifetime of Healthcare Costs” study released Monday found that while respondents estimated their annual out-of-pocket healthcare expenditures as approximately $850 (not including paid premiums) on average, the actual spending was around $2,100 annually.

“Today’s consumers set aside money for college or a mortgage, but not for healthcare,” said Alberto Casellas, CEO, Health and Wellness, at Synchrony. “The study shows there is a meaningful gap between people’s perceptions and the reality of the costs of healthcare. As consumers assume more and more responsibility for their healthcare expenses, it is important to understand the cost of care and how to find responsible financial solutions that can help them save for and manage those costs.”

For the subset with employer-sponsored health insurance plans, the $320,000 lifetime cost broke down as follows: $5,266 annual healthcare costs, including premiums, out-of-pocket expenses, and co-insurance over deductibles. Extrapolated over an adult lifetime that would mean an estimated $320,000 in healthcare costs between the ages of 18 and 79.

The estimate doubles for people who obtain health insurance without government or employer subsidies or those who have chronic illnesses such as diabetes, heart diseases or cancer.

The impact of these real-world costs is substantial. More than one in four respondents said they have delayed a recommended procedure due to cost — and almost 20% of respondents ignored the recommended care completely. For those who delayed or ignored the recommended care, nearly 50% said it caused additional medical issues.

According to the study, four out of five respondents said they do not have a dedicated savings account for unexpected health costs. Among those who do, almost half say it is not enough. Fewer than half are actively saving for future healthcare expenses; and of those who are, only 55% believe it will be enough to meet their expenses.

While the affordability of healthcare was a crucial concern among all respondents, the study illustrated stark differences when data was broken out by age among Gen Z (those born between 1997-2012), Millennials (those born between 1981-1996), Gen X (those born between 1965-1980) and Baby Boomers (those born between 1946-1964).

Half of Gen Z, Millennials, and Gen X, on average, would hold off non-urgent medical treatment if the cost of care was between $500 and $999. Approximately one-third of Boomers would postpone care.

Approximately 25% of Gen Z, Millennials and Gen X would hold off non-urgent medical treatment if the cost of care was less than $500 as compared to 16% of Boomers.

In addition, 65% of Millennials and 60% of Gen Xers were not financially prepared for their most costly out-of-pocket healthcare expense. This number falls to more than 40% for Boomers.