One in three working-age Americans with health insurance are currently paying off medical debt, according to a survey by the Commonwealth Fund. The findings show that health coverage frequently fails to protect patients from steep out-of-pocket costs, with 46% of those carrying debt owing at least $2,000 and some reporting balances in the hundreds of thousands of dollars.
Why Insured Americans Face Mounting Medical Bills
The Commonwealth Fund survey examined a nationally representative sample of 6,353 adults and found that insured patients routinely accumulate debt from standard doctor visits, diagnostic tests, and chronic condition management rather than solely from catastrophic medical events. Sara Collins, a health economist at the Commonwealth Fund and lead author of the study, told CBS News that the primary driver of debt is the extent to which insurance policies leave patients exposed to out-of-pocket costs.
High deductibles remain a central mechanism pushing patients into debt. According to data from the Kaiser Family Foundation’s Health System Tracker, individuals face thousands of dollars in out-of-pocket expenses to meet deductibles before coverage applies. For patients managing chronic illnesses, smaller recurring copays and cost-sharing fees accumulate rapidly into unaffordable sums. Patients also incur debt from care excluded by insurance policies, including denied claims and out-of-network treatment.
Deductible costs continue to climb. Following the expiration of enhanced premium tax credits, average Affordable Care Act Marketplace deductibles rose 37% to $3,786. Meanwhile, the average general deductible for single coverage in employer-sponsored plans reached $1,886.
The Financial and Personal Toll of Insured Medical Debt
The debt burden exacts a heavy toll on household stability and health decisions. The Commonwealth Fund report notes that 68% of respondents with medical debt experienced anxiety and stress. To manage these financial obligations, 37% of affected adults drained their savings, while 30% cut back on basic living necessities such as food, heat, or rent.
Some patients attempted to cover bills using credit cards, but resulting finance charges increased their total debt load.
Harold, a survey respondent in his 40s who received emergency care for a cardiac event, described receiving a bill for nearly $5,000 despite holding employer-sponsored health insurance. “I said to myself, ‘What did they even cover here?'” he told surveyors.
Steps Patients Can Take to Mitigate Medical Debt
Health and consumer agencies outline several steps patients can pursue to reduce out-of-pocket medical expenses and manage billing disputes:
- Verify Bills: Review medical receipts and bills to confirm personal information is correct, services billed were actually received, and no duplicate charges exist, as recommended by the Centers for Medicare & Medicaid Services.
- Compare Standard Pricing: Search medical billing codes online to compare standard pricing against charged amounts.
- Inquire About Costs Ahead of Time: When possible, request cost estimates from providers before undergoing procedures, per Kaiser Family Foundation guidelines.
- Use Consumer Protections: Contact insurers and healthcare providers to negotiate payment plans, or arbitrate payment disputes through channels provided by the No Surprises Act.
- Seek Assistance: Reach out to patient advocates, consumer programs, or non-profit organizations that offer financial assistance or debt negotiation support.