A Plain Dealer analysis of plans offered through healthcare.gov, the exchange website, shows that deductibles, co-pays, and co-insurance expenses are putting up significant barriers to accessing medical care, particularly for middle-income earners. The average deductible for a silver-level plan – among the most affordable options for someone with medical needs – is $3,561 in Cuyahoga County for a 40-year-old male earning $30,000, according to the analysis. The maximum annual out-of-pocket expense for that individual averages $6,277.