Nearly a Third With Private Insurance Are Paying Off Medical Debt

Nearly one-third (32%) of working-age adults with private insurance are paying off medical bills or debt over time, according to a new survey from the Commonwealth Fund.¹ Among those carrying medical debt, 37% used all or part of their savings to pay it down, 30% delayed or avoided needed care, and 30% cut back on necessities such as food, heat, or rent.

Hospital Care and Chronic Conditions Drive Most Debt

The brief draws on the Commonwealth Fund's 2025 Affordability Survey, fielded by SSRS from July 22 to October 27, 2025, among 6353 US adults ages 19 to 64, including 4,121 with continuous private insurance through an employer, the Affordable Care Act marketplace, or the individual market. Nearly two-thirds (64%) of adults with medical debt said it stemmed from hospital services—inpatient, outpatient, or emergency care—while 43% cited office visits and 38% cited lab or diagnostic tests. Two in 5 (39%) said their debt was tied to an ongoing or chronic condition.

Debt was not evenly distributed: 46% of those carrying medical debt owed $2000 or more, equal to an estimated 15% of all privately insured working-age adults. Burden was highest among adults in the South (39%), those with low or moderate incomes (38%), women (37%), and Black (41%) or Hispanic (38%) adults. More than one-third (36%) of privately insured adults overall said they could not cover an unexpected $1000 medical bill within 30 days, a share that rose above half for Black and Hispanic adults and those below 200% of the federal poverty level.

“Medical debt is often viewed as a problem limited to people who are uninsured or who face a major medical emergency,” Sara R. Collins, PhD, study coauthor and Commonwealth Fund senior scholar, stated.² “But this survey shows that it is also widespread among Americans with private insurance. 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.”

Financial Fallout and Elusive Protections

Beyond the immediate cost, medical debt carried lasting consequences: 68% of affected adults said it caused worry or anxiety, 25% said their debt had been reported to a credit bureau, and 22% said it had lowered their credit score.¹ A majority blamed insurers (64%) or the broader health care system (57%) for their situation, and nearly all respondents supported interest-free payment plans (93%), hospital financial assistance (94%), and removing medical debt from credit reports (90%) as remedies.

That last option remains largely unavailable at the federal level. A Biden-era Consumer Financial Protection Bureau rule that would have stripped an estimated $49 billion in medical debt from the credit reports of 15 million Americans was vacated by a federal judge in Texas in July 2025, who found the agency had exceeded its authority under the Fair Credit Reporting Act.³ Only 2 states, Illinois and Minnesota, require hospitals to offer a payment plan before referring a bill to collections, according to the Commonwealth Fund brief.¹ The study authors also pointed to eliminating deductibles in commercial insurance plans and capping the rates insurers pay providers as ways to address the underlying drivers of medical debt.

“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,” Joseph R. Betancourt, MD, MPH, president of the Commonwealth Fund, said in a statement.^{2 “}This can have real clinical consequences and be incredibly demoralizing for caregivers. 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.”

References

1. Collins SR, Richards C, Gupta A, Roy S. How medical bills and debt impact Americans with private insurance. Commonwealth Fund. September 17, 2026. Accessed September 17, 2026. https://www.commonwealthfund.org/publications/surveys/2026/sep/how-medical-bills-debt-impact-americans-private-insurance
2. New research: nearly one in three adults with private insurance are paying off medical debt. Commonwealth Fund. News release. September 17, 2026. Accessed September 16, 2026.
3. Picchi A. Federal judge reverses a CFPB rule to strip medical debt from credit reports. Here's what it means. CBS News. Updated July 16, 2025. Accessed September 16, 2026. https://www.cbsnews.com/news/federal-judge-reverses-medical-debt-rule-credit-reports-cfpb/