Nearly one-third of working-age Americans with private insurance are paying off medical bills or debt over time, and many are delaying healthcare because of it, according to a Sept. 17 report from the Commonwealth Fund.
The findings are based on the Commonwealth Fund’s 2025 Affordability Survey, which included 4,121 adults ages 19 to 64 who had private insurance continuously for the previous 12 months. The survey sample represents about 115.2 million privately insured working-age adults in the U.S.
Six things to know:
1. Nearly one-third of privately insured adults are paying off medical debt. Thirty-two percent of working-age adults with private insurance said they were paying medical bills or debt over time. The share rose to 38% among people with low or moderate incomes, 41% among Black adults, 38% among Hispanic adults and 39% among adults living in the South.
2. Medical debt is causing some patients to delay or avoid care. Thirty percent of respondents with unpaid medical bills said they had delayed or avoided needed healthcare because of their debt. Sixty-eight percent said their bills caused worry or anxiety, while 30% said they cut spending on necessities such as food, heat or rent.
3. Hospital care is the leading source of medical debt. Sixty-four percent of adults paying off medical balances said their debt stemmed from inpatient, outpatient or emergency department hospital services. Physician office visits accounted for debt among 43% of respondents, while lab work or diagnostic tests accounted for 38%. Respondents could cite multiple sources of debt.
4. Nearly half of people with medical debt owe at least $2,000. Forty-six percent of working-age adults paying off healthcare bills or medical debt reported balances of $2,000 or more. The Commonwealth Fund estimated that this translates to about 15% of all working-age adults with private insurance carrying more than $2,000 in medical debt.
5. More than one-third of privately insured adults could not readily cover an unexpected $1,000 medical bill. Thirty-six percent said they would be unable to pay an unexpected $1,000 medical expense within 30 days. The share exceeded 50% among adults with incomes below 200% of the federal poverty level and among Black and Hispanic adults.
6. Medical debt is draining savings and reaching collections. Thirty-seven percent of people with unpaid medical bills said they used all or part of their savings to pay them. About one-quarter were making payments to a collection agency, and one-quarter said their medical debt had been reported to a credit bureau. When asked who was responsible for their debt, 64% blamed their insurance company and 57% blamed the healthcare system generally.
Click here to access the full report.
