Medical debt isn't just an uninsured problem, survey finds

Private insurance is not a guarantee against medical debt dragging down the personal finances and attitudes of patients, according to the latest findings from The Commonwealth Fund.

The organization published “How Medical Bills and Debt Impact Americans with Private Insurance,” a report based on survey findings that 32% of working-age adults with private insurance also are paying off medical bills or debt over time.

“Medical debt is often viewed as a problem limited to people who are uninsured or who face a major medical emergency,” report co-author Sara R. Collins, Ph.D., said in a news release.

“But this survey shows that it is also widespread among Americans with private insurance,” said Collins, a Commonwealth Fund senior scholar for expanding coverage and access and tracking health system performance. “Moreover, it often stems from more routine care, including doctors’ office visits and treatment for chronic conditions. When insured people are left owing thousands of dollars for their care, coverage is falling short of its most basic purpose: protecting people financially when they get sick.”

The survey found that among adults with medical debt:

• 37% used all or part of their savings to pay their bills.
• 30% delayed or avoided needed health care.
• 30% cut back on basic necessities such as food, heat or rent.

The report, “How Medical Bills and Debt Impact Americans with Private Insurance,” drew on the Commonwealth Fund’s 2025 Affordability Survey, a national survey of adults ages 19 to 64 who had private insurance through an employer, an Affordable Care Act marketplace plan or an individual market plan over the previous 12 months. Researchers also held eight online focus groups to help develop the survey questions.

Debt piles up quickly

Nearly half of adults paying off medical debt, 46%, owed $2,000 or more, representing an estimated 15% of all working-age adults with private insurance. As for debt amounts:

• 19% owed less than $500
• 36% owed $500 to just under $2,000
• 27% owed $2,000 to just under $5,000
• 19% owed $5,000 or more

Hospital care drives debt

Hospital services were the most common source of medical debt. Hospital care was the origin of debt for 64% of adults. That included emergency department visits (31%), hospital outpatient care (30%) or hospital inpatient care (27%).

But debt also stemmed from more routine care: 43% cited doctor’s office visits and 38% cited lab work or diagnostic tests. Almost two in five respondents, 39%, said their debt was tied to an ongoing or chronic condition.

Burden falls unevenly

Medical debt was not distributed evenly across the population, the report found. It was more common among adults in the South (39%) than in the Northeast or West (26% each), and more common among people with low or moderate incomes (38%) than those earning 400% or more of the federal poverty level (24%). Women were more likely than men to report medical debt, 37% compared with 28%, and Black adults (41%) and Hispanic adults (38%) reported debt at higher rates than White adults (31%) or Asian and Pacific Islander adults (20%).

More than one-third of adults with private insurance, 36%, said they would be unable to pay an unexpected $1,000 medical bill within 30 days. That share rose above half among Black adults (54%), Hispanic adults (52%) and people with incomes below 200% of the federal poverty level, or $31,300 for an individual and $64,300 for a family of four, 55% of whom said they could not cover such a bill.

Anxiety and credit damage

Medical debt took a psychological and financial toll on those affected. A full 68% of respondents with unpaid medical bills said the debt caused worry or anxiety. In focus groups, participants described feeling overwhelmed by aggressive efforts from providers and collection agencies to obtain payment.

A quarter of survey respondents said their bills or debt had been reported to a credit bureau, and 22% said their medical debt had negatively affected their credit score. Most people with medical debt, 78%, were making payments directly to a doctor, dentist, hospital or other provider, while 23% were paying a collection agency.

“As a primary care physician, one of the most difficult things is seeing a patient who can’t afford something they truly need, whether it’s important testing, a critical follow-up visit or necessary treatment,” Commonwealth Fund President Joseph R. Betancourt, M.D., M.P.H., said in the news release.

“This can have real clinical consequences and be incredibly demoralizing for caregivers,” he said. “No patient should have to avoid or delay care or experience anxiety about medical bills and debt. We can and should do better. There are clear steps policymakers, insurers and hospitals can take to ensure people can get and afford the care they need, when they need it most.”

Who’s held responsible

Survey respondents largely blamed the industry for their debt. Nearly two-thirds of adults with medical debt, 64%, held insurers responsible, and 57% blamed the health care system overall. Fewer respondents pointed to providers (40%), the government (34%), themselves (23%) or their employer (8%).

Nearly all respondents supported policy changes to ease the burden of medical debt. Interest-free payment plans were seen as helpful by 93% of respondents, financial assistance from hospitals by 94% and removing medical debt from consumer credit reports by 90%.

The report’s authors also pointed to eliminating deductibles in commercial insurance plans and capping the rates insurers pay health care providers as ways to address the underlying causes of medical debt.