Many Americans, whose budgets have already been stretched by rising prices of basics like groceries, gasoline and home heating, are having trouble keeping up with health care costs.
More than a quarter of American adults in a recent survey by the think tank Urban Institute said they or family members owed medical debt at the end of last year, a problem the institute described as “pervasive.” More than half of those with debt owed $1,000 or more, and about one in six owed $5,000 or more. About a third of American families, the report found, went without needed medical care last year because of the cost.
“Many people are dealing with large medical bills, and they’re struggling,” said Michael Karpman, a principal research associate in the institute’s health policy division and the report’s author.
The debt included past-due medical bills, bills that people were unable to pay, medical debt on credit cards and medical debt sent to collectors. The analysis was based on December 2025 data from 10,000 adults who participated in the institute’s annual national survey that monitors well-being.
The findings, Mr. Karpman said, can help provide a base line to measure the impact of recent changes in government policies, including tighter work requirements for Medicaid, the federal-state health program for low-income people, and cuts in subsidies for coverage under Affordable Care Act marketplace plans.
Rising costs are also hitting Americans who have workplace health insurance. The cost of job-based health coverage is forecast to increase by an average of about 11 percent per employee next year unless employers trim benefits, according to a survey of large and small employers by Marsh, a benefits consultant.
That follows a significant increase in insurance costs this year for employer-based coverage, according to research published Thursday by the health research group KFF, which conducts annual surveys of large and small employers.
The average worker contribution to family health insurance premiums rose to nearly $7,500 this year, up 9 percent, or $621, from 2025. And the average deductible — the amount paid out of pocket, before insurance pays — for a worker with individual coverage stood at about $2,000. Employees at small firms had higher deductibles, averaging more than $2,600.
While research from the Urban Institute and others doesn’t suggest that the overall level of medical debt is increasing, the findings come as consumers are facing higher costs for most of their daily needs.
“People are starting to feel that pinch,” said Dr. Vikas Saini, a cardiologist and president of the Lown Institute, a think tank focused on a more affordable health care system. “Amounts for co-pays and deductibles are rising.”
Do people with insurance have medical debt?
Having health coverage doesn’t insulate people from medical debt. While the Urban Institute found debt was more prevalent among the uninsured, more than a quarter of people with health insurance had medical debt as well. Other recent research by the nonprofit Commonwealth Fund found that about a third of working-age adults with private insurance, including employer plans and those sold through Affordable Care Act marketplaces, had medical debt.
What is the source of most medical debt?
Medical debt most commonly stems from hospital care, including emergency room visits and outpatient and inpatient care, researchers said. About half of adults with medical debt owed money for hospital services, the Urban Institute found.
Amaya Dryden, 22, a social worker in Nashville, said she ended up with just over $1,900 in hospital bills after two medical episodes, including an emergency room visit, while she was a college student on a tight budget. She had insurance through her family’s health plan, she said, but it didn’t cover all of her costs. “I didn’t know how to get help,” she said.
Another patient, Maggie Williams, 28, a mother in Omaha, said she ended up with more than $20,000 in hospital bills she couldn’t pay after she required treatment last year for a high-risk pregnancy. She had qualified for Medicaid but lost eligibility, she said, after her husband’s income rose. While she was able to obtain coverage through his policy, she said, she still had the five-figure bill.
Is help available if I can’t afford to pay my medical bills?
Yes, particularly for hospital debt. Hospitals may offer no-interest payment plans, sometimes for reduced amounts. They may also offer to cancel bills for people who can’t afford to pay them. But hospitals don’t always make it easy for patients to know that, or how to apply.
Under the Affordable Care Act, nonprofit hospitals must have formal policies on patient financial assistance — sometimes known as charity care — to help people who can’t afford their bills. But the hospitals are not required to meet specific standards, so programs vary widely, said Sara R. Collins, a senior scholar who studies health coverage and access at the Commonwealth Fund. (Some states set their own requirements that may also apply to for-profit hospitals.)
Some nonprofit groups have emerged to help people pay off medical debt. “When you have a medical crisis in America, you have a financial crisis,” said Jared Walker, founder of Dollar For, a nonprofit that helps patients apply online, at no cost, for hospital charity care.
Other nonprofit groups offering help navigating the health care system and covering medical costs include the Patient Advocate Foundation and the HealthWell Foundation, which offers help with co-payments and prescription drug costs. Another, Undue Medical Debt, buys medical debt in bulk at a discount, and pays it off. Patients can’t apply for relief directly, but the group offers tips on its website.
“I do think we are near the place of unaffordability in health care,” Mr. Walker said, so patients should ask about charity care even if they feel uncomfortable seeking financial help.
Eligibility is typically based on income and family size, he said, and a family of four making slightly more than $100,000 may often qualify for some type of discount, although eligibility can be higher in some states. “They’re more generous than people think.”
Some hospitals may offer help to patients with much higher incomes, he said, depending on the size of the bill as a percentage of the patient’s income.
Both Ms. Dryden, in Nashville, and Ms. Williams, in Omaha, said they were able to have their hospital bills canceled by using Dollar For. Ms. Williams said that once she submitted her online application via the group’s website, she was contacted by the hospital and asked to submit bank statements to verify her financial status. She received notices within weeks, she said, stating that her debt was forgiven.
What should I do if I can’t pay my hospital bills?
Always ask if the hospital offers financial assistance, Mr. Walker said. But be specific and persistent. Otherwise, you may be routed to the hospital’s billing office and offered a payment plan or an application for a medical credit card rather than a discount or forgiveness of the amount owed.
“Say, ‘I’m trying to see if I’m eligible for a discount or free care,’” he suggested.
Does medical debt affect my credit report?
It depends. Medical providers may send unpaid bills to collection agencies, which report the debt to the three major credit bureaus — Equifax, Experian and TransUnion. The bureaus have voluntarily agreed to exclude medical collections for amounts under $500. Larger amounts, however, could eventually appear on your report, depending on where you live.
Fourteen states prohibit medical debt from appearing on consumer credit reports, according to the Commonwealth Fund.
Chi Chi Wu, director of consumer reporting and data advocacy at the National Consumer Law Center, recommended against putting medical debt on credit cards, if you can avoid it. You’ll accrue high interest if you don’t pay it off right away and may owe late fees or have damaged credit if you fall behind. And because the bills aren’t readily identifiable as medical debt once they’re part of your card balance, they become ineligible for protections that exclude the debt from credit reporting.
Ms. Wu also advised avoiding special medical credit cards. They often feature “deferred” interest, which results in high interest rates if you don’t pay off the balance within a certain amount of time.
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