1 in 3 Insured Americans Carry Medical Debt, Commonwealth Fund Survey Finds, as Routine Care Bills Pile Up

WASHINGTON — One in three working-age Americans with private health insurance say they are paying off medical debt, according to a survey released September 17 by the Commonwealth Fund, a nonprofit health policy research group, a finding that challenges the idea that coverage alone protects people from financial harm when they need care.

The report, based on the group's 2025 Affordability Survey and follow-up focus groups, found that debt is not confined to people who are uninsured or who have suffered a catastrophic illness. Hospital visits are the biggest source, with nearly two-thirds of adults who carry medical debt reporting balances tied to hospital care, CBS News reported. But routine services also contribute, including doctor's office visits, lab work and diagnostic tests. "Medical-debt issues often stem from routine care, including doctor's office visits and treatment for chronic conditions," Sara Collins, a senior scholar at the Commonwealth Fund and a co-author, told Time. High deductibles are another common source, according to the same report.

Collins, the study's lead author and a health economist, said the main driver is how much of the bill insurance leaves to the patient. "The primary reason why these people have debt is about the extent to which their insurance covers their out-of-pocket costs," she told CBS News.

The amounts can be significant. Almost half of those with medical debt, or about 15% of all working-age, privately insured adults, owe at least $2,000, according to the survey. To pay their bills, 37% of people with debt said they drained their savings, and 30% said they cut back on essentials such as food, heat or rent. Another 30% reported delaying or forgoing medical care.

The burden is not spread evenly. Overall, 32% of working-age adults with private insurance carry some amount of medical debt, but the rate rises to 38% among people with low or moderate incomes, 41% among Black adults, 38% among Hispanic adults and 39% among people living in the South, according to TechTarget's summary of the report. Collins said budgets for lower-income households can be especially tight. "Most Americans don't have a lot of extra cash lying around, and when they are hit with an unexpected expense in a month when their income is allocated across all necessities of life, it can push people into medical debt they are unable to pay," she said. "Especially among people who are low-income, they are on pretty regimented household budgets, and medical bills can really tip that budget over into the realm of not being able to pay for certain things and having to cut back."

Collins framed the findings as a challenge to a common assumption. "Medical debt is often viewed as a problem limited to people who are uninsured or who face a major medical emergency. But this survey shows that it is also widespread among Americans with private insurance," she said in a press release. She added that the results point to a gap in what coverage is supposed to do. "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."

Uninsured adults still fare worse. Research cited in reporting on the study shows that more than six in 10 uninsured adults under 65 report medical debt, compared with about four in 10 insured adults, and that uninsured adults are almost twice as likely to say affording care is difficult. The new survey's point is that insurance leaves many people exposed nonetheless.

Respondents were quick to assign blame. About 64% to 65% said they blamed health insurance companies for their debt, and 57% blamed the broader health care system, while others pointed to providers, the government or themselves. In the focus groups, many people expressed surprise at how high their bills were despite having coverage, Collins told Time.

The financial consequences can extend to credit. About one in four adults surveyed said their debt had been reported to a credit rating agency, according to Healthcare Brew. A federal rule finalized in January 2025 would have barred medical debt from affecting lending decisions, but a judge overturned it in July 2025. The three major credit reporting agencies stopped counting medical debt under $500 in 2023, and 16 states had prohibited or restricted medical debt in credit reports as of January 2026, the outlet reported. Commonwealth Fund researchers urged policymakers to consider banning medical debt from credit reports nationwide, eliminating deductibles in commercial plans or capping provider payment rates. Other proposed steps include interest-free payment plans and more financial assistance from hospitals.

Collins also offered practical advice for people already carrying balances. Providers sometimes send bills with erroneous charges, which consumers should dispute if they believe there is a mistake, she said, though some people hesitate for fear that not paying will hurt their credit scores. "It's a tough situation to be in, but it's important to make sure what you are being asked to pay is correct," she said. When coverage for a service is denied, people can contact their insurers and providers to negotiate a payment plan that lowers out-of-pocket costs.

The pressure on households may grow. Employer health benefit costs per employee are projected to rise 8.2% in 2027, the largest increase since 2003, according to an August survey by the consulting firm Marsh, and some employers told Marsh they may downgrade plans and shift more costs to workers. In its report, the Commonwealth Fund also said millions of Americans currently lack health insurance and that millions more are expected to lose coverage because of congressional and administration policy changes, a projection the group presents as its own assessment.

Joseph Betancourt, the Commonwealth Fund's president, said solutions are within reach. "No patient should have to avoid or delay care or experience anxiety about medical bills and debt," he said in a statement. "We can and should do better."

The findings come from a telephone and online survey with a nationally representative sample of 6,353 adults conducted in 2025, according to CBS News. Healthcare Brew reported that 4,121 of those respondents were ages 19 to 64 with private coverage through an employer, the Affordable Care Act marketplace or the individual market. Because the data are self-reported, they reflect what people say they owe rather than credit or billing records. This article is a report on the study and is not financial or legal advice.