About one-third of working-age adults with private health insurance in the United States currently owe money to hospitals, doctors, or other health care providers, underscoring the financial challenges many face even when covered, according to a recent survey by the Commonwealth Fund. The findings, released on September 17, highlight how medical debt rapidly accumulates for insured individuals, with nearly half of those carrying unpaid medical bills owing $2,000 or more.

The survey, conducted over three months in 2025 with 6,353 adults, reveals that millions of Americans struggle to manage health care costs despite coverage through employers, the Affordable Care Act, or other private plans. Deductibles, copayments, and coinsurance mean patients often bear significant out-of-pocket expenses before insurance fully covers costs. Experts point to rising prices charged by hospitals, physicians, pharmaceutical companies, and pharmacies as key drivers of increasing financial burdens.

Patricia Kelmar, senior director of health care campaigns at U.S. Public Interest Research Group (PIRG), noted that many individuals face difficult choices between paying medical bills, rent, and other essential expenses. “We’re struggling to pay for medical bills that are due in 90 days and then sent to collections,” she said. Rising health care costs have also prompted employers to prepare for steep increases in benefits expenses. Major companies like Starbucks and Walt Disney are taking measures to control costs, while 73% of small- and mid-sized businesses consider cutting traditional health benefits, according to data from eHealth, an insurance advisory firm. Kelmar attributed some of this cost inflation to hospital consolidation, which has increased prices and fees charged to both consumers and employers.

The survey highlights that medical debt commonly arises from hospital-related charges: about two-thirds of adults with debt reported bills stemming from hospital stays, emergency room visits, or hospital-owned clinics. Routine care also contributes to debt burdens, with 43% owing money for doctor visits and 38% for lab tests or diagnostic services. Financial preparedness remains limited; 36% of respondents lacked sufficient savings to pay an unexpected $1,000 medical bill within 30 days. Vulnerable groups, including over half of Black, Hispanic, and moderate-income households (those earning up to twice the federal poverty level), faced even greater difficulty covering such expenses promptly.

Emotional tolls are evident, as more than two-thirds of respondents expressed worry or anxiety about unpaid medical bills. Follow-up discussions revealed many feel overwhelmed by aggressive collection tactics, including lawsuits. One Virginia study found that over 15 years, hospitals and providers filed 1.15 million lawsuits to collect $1.4 billion in medical debt, reflecting widespread legal action to recoup payments.

Sara Collins, coauthor of the survey and senior scholar at the Commonwealth Fund, emphasized that medical debt is not limited to the uninsured. “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,” she said.

Survey participants most frequently blamed health insurers for their medical debts, with 64% citing them as responsible, while 57% pointed to the broader health care system. Sabrina Corlette, codirector of Georgetown University’s Center on Health Insurance Reforms, noted that insurers are an easy target due to their direct role in claim denials and coverage disputes. However, she stressed that the factors behind rising costs are complex, involving high drug prices, increased use of services, billing practices such as upcoding, and the market power of large health systems. “Patients have become human ATM machines to a lot of these entities,” Corlette said, concluding that the current health care landscape bears little resemblance to that of previous decades.