With medical costs continuing to rise along with the uncertainty about the future of health insurance coverage, new research shows more Americans are going without the health care they need.

A survey released Wednesday from Bankrate.com found that one in four American families have not sought medical care because they couldn't afford it. Thirteen percent of respondents had no insurance, while the rest had a mix of employer-sponsored, individual and Medicaid coverage. The bulk of uninsured respondents were millennials. Younger, healthier people traditionally go without coverage.

However, "Even insured people found co-pays and deductibles far less affordable than they expected," said Robin Saks Frankel, credit card analyst at Bankrate.com

Two years ago, a Kaiser Family Foundation study found that only three in five households have enough set aside to meet an individual deductible of $1,200 or a family deductible of $2,400. Only about half of U.S. households had enough money to cover higher deductibles than those.

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Health care advocates and economists agree that forgoing health care can have devastating long-term consequences. It can mean patients get sicker and require even more expensive treatment when they end up in the emergency room. These types of unexpected medical bills can lead to a huge financial burden for the patient that could take years to pay off, said Frankel.

If you're struggling with medical costs or skipping the care you need, here are four strategies that may help make your health care more affordable.

Schedule your annual physical. If you have insurance, there's no reason to skip this important appointment. Under the Affordable Care Act, annual physicals are 100 percent covered. That means no co-pay, and your deductible doesn't have to be met beforehand. Spotting medical problems while they're small can prevent big problems (and bigger medical bills) down the road. If your physical yields some unwelcome results, you can talk to your doctor about the cost of future diagnostics and care. See the next item.

Don't be afraid to negotiate. If you're due for an expensive test, procedure or a series of doctor visits, be sure to ask about the price and your out-of-pocket costs ahead of time. You can research the costs at various labs and facilities in your area at websites such as Healthcare Bluebook. Then talk to your doctor or insurer about what you've found and how you can get a lower price. Separately, your doctor may offer payment plans or discounts for extended treatments. Be sure to ask.

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When you do receive a medical bill, review it carefully. Always make sure it's itemized, and check for errors. All health care providers use special billing codes, so mistakes can easily creep in. If you suspect you've been overcharged or mischarged for something, check with your provider and your insurer.

Pay less for prescription drugs. For many people, medication is the biggest health expense. Consider ordering regular, long-term medicines in bulk for lower prices. For less frequent medications, shop for the best prices in your area using comparison websites such as GoodRx. And always discuss any possible generic alternative with your doctor. Low-income patients should check with drug companies directly for any prescription relief programs they may offer, especially for expensive specialized drugs.

Sign up for your FSA or HSA. If your employer offers a Flexible Spending Account or Health Savings Account, be sure to take advantage. For an FSA, your contributions are made pretax, and the money can be used, among other things, for co-pays and health expenses before your deductible. HSAs are used if you have a qualifying high-deductible insurance plan. Contributions are also pretax, and no tax is paid when money is withdrawn for qualified medical expenses. Employers often contribute to workers' accounts as an incentive to get them to sign up for high-deductible health plans.

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Are you skipping that doctor visit or pill you need? - CBS News