Health insurance is designed to protect patients from the full financial impact of medical care. However, having coverage does not necessarily prevent medical debt from piling up. Deductibles, copayments, coinsurance, hospital bills, prescription costs, denied claims and services that fall outside a plan’s coverage can often leave people responsible for thousands of dollars.

New data highlights just how widespread the problem has become among insured citizens. CBS News reported in September 2026 that roughly one in three working-age Americans with private health insurance are paying medical bills or debt over time. The report was based on a Commonwealth Fund analysis of a nationally representative survey of 6,353 U.S. adults ages 19 to 64. Among privately insured adults with medical debt, 46% owed at least $2,000, according to The Commonwealth Fund. Even more troubling, 37% said they had used all or part of their savings to pay medical costs, while 30% cut spending on necessities such as food, heat or rent. Another 30% said medical debt caused them to delay or avoid required healthcare.

Sara Collins, a health economist at the Commonwealth Fund and lead author of the research, told CBS News, “The primary reason why these people have debt is about the extent to which their insurance covers their out-of-pocket costs.” The findings represent a critical distinction: being insured and being able to afford healthcare are not always the same thing.

Which country has the highest medical debt?

While there is no comprehensive international database that calculates household medical debt across all countries, the United States consistently stands out among comparable wealthy countries when researchers examine difficulty paying medical bills and accessing care due to cost.

Further research found that U.S. adults were more likely to struggle with healthcare expenses than adults in other high-income countries included in its comparisons. Nearly half of U.S. adults surveyed in The Commonwealth Fund’s 2023 international study reported experiencing a medical bill concern during the previous year. The United States is also the only high-income country in that Commonwealth Fund comparison without universal health coverage.

Even among Americans who have insurance, deductibles and other out-of-pocket expenses can create significant financial exposure. The most accurate conclusion, therefore, is not that the U.S. definitively has the most medical debt in the world, but that medical bills and affordability problems are unusually prevalent in the United States compared with other high-income nations.

Average cost of healthcare

Healthcare spending in the United States is significantly higher than the amount an average individual pays out of pocket because national spending includes payments from private insurers, Medicare, Medicaid, employers, patients, and other sources. According to the Centers for Medicare & Medicaid Services, U.S. health expenditures reached $5.3 trillion in 2024, or approximately $15,474 per person. Health spending represented 18% of the country’s gross domestic product.

Out-of-pocket spending alone reached $556.6 billion, while hospital expenditures totaled about $1.63 trillion. Physician and clinical services accounted for approximately $1.11 trillion. Those figures should not be interpreted as the amount every individual pays. A person’s actual expenses can vary substantially depending on insurance coverage, health conditions, prescriptions, hospital use, deductible requirements and whether providers are in-network.

With insurance

Health insurance can dramatically reduce the cost of major medical care, but insured patients may still have substantial expenses. For people receiving insurance through an employer, the average annual premium in 2025 was $9,325 for individual coverage and $26,993 for family coverage, according to KFF 2025 Employer Health Benefits Survey. Employers typically pay much of that cost, but workers contributed an average of $6,850 toward family coverage.

Cost sharing begins beyond premiums. Eighty-eight percent of covered workers were enrolled in a plan with a general annual deductible in 2025. Among workers with such deductibles, the average deductible for individual coverage was $1,886. Workers at companies with 10 to 199 employees faced an even higher average deductible of $2,631. These costs help explain why insurance does not eliminate medical debt. The Commonwealth Fund found that 32% of continuously insured working-age adults with private coverage were paying medical bills or medical debt over time.

Without insurance

People without health insurance generally face greater financial exposure because no insurer pays its share of covered services or negotiates the patient’s benefits under an insurance contract. There is no meaningful single average cost for being uninsured because expenses depend heavily on whether a person needs routine care, prescription drugs, diagnostic testing, emergency treatment, surgery or hospitalization.

The health and financial consequences can be significant. Dr. Diana Rangaves, Pharm D, explains to Blavity Health, “The constant state of panic induced by monetary insecurity triggers a cascade of physiological reactions that, over time, can severely damage the heart and circulatory system. The human body is equipped with an evolutionary survival mechanism known as the fight-or-flight response. When the brain perceives a threat, it activates the sympathetic nervous system, signaling the adrenal glands to release a surge of hormones, primarily cortisol and adrenaline. This persistent activation keeps blood pressure artificially high and heart rate elevated. It creates a constant state of inflammation. While acute inflammation helps heal injuries, chronic inflammation caused by long-term stress damages the lining of the arteries. This arterial damage is the precursor to atherosclerosis, which restricts blood flow and significantly increases the risk of heart attack and stroke.”

On the financial side, KFF’s Key Facts About The Uninsured Population reported that 38.6% of uninsured adults ages 18 to 64 delayed, skipped or did not receive needed care or medication because of cost in 2024. By comparison, 17% of privately insured adults reported the same problem. Uninsured adults are also more likely to carry healthcare debt. KFF also found that 34% of uninsured adults younger than 65 had past-due medical debt, compared with 26% of insured adults. Using a broader definition that includes medical expenses charged to credit cards or money owed to relatives, 62% of uninsured adults reported healthcare debt, compared with 44% of insured adults.

Factors that affect cost

Several components of health insurance determine how much a patient ultimately pays. A premium is the recurring cost of maintaining coverage, while the deductible is the amount a patient generally must pay out of pocket for covered services before the health plan begins paying under its terms. Copayments require a fixed payment for certain services, while coinsurance requires patients to pay a percentage of the negotiated cost of a covered service.

Provider networks also matter. Receiving care outside an insurance company’s network can result in higher costs or, depending on the plan and circumstances, limited coverage. Insurance plans also have out-of-pocket maximums for covered, in-network services. For Marketplace plans in 2026, the maximum cannot exceed $10,600 for an individual or $21,200 for a family. However, premiums, services the plan does not cover, and many out-of-network expenses do not count toward that maximum, Healthcare.gov explains.

The type and amount of medical care a person needs remain major factors as well. Hospitalization, emergency room treatment, specialist appointments, chronic illness management, diagnostic testing and prescription medications can create repeated cost-sharing expenses. Hospital treatment is particularly important in medical debt. The Commonwealth Fund found that 64% of privately insured adults paying medical balances said at least some of their debt resulted from hospital services, including inpatient, outpatient or emergency care. Doctor’s office visits contributed to debt by 43%, while laboratory work or diagnostic testing contributed by 38%.

How to save money

Reducing healthcare costs often starts with understanding an insurance plan before ever setting foot into a doctor’s office. Patients can review the plan’s deductible, copayments, coinsurance, prescription drug coverage, provider network and out-of-pocket maximum instead of comparing plans based only on the monthly premium. When possible, patients can verify that doctors, laboratories, imaging centers and facilities are in network before receiving nonemergency care. They can also ask whether prior authorization is required and request an estimate of their expected responsibility.

Patients should carefully examine medical bills rather than assuming every charge is accurate. Collins told CBS News that people dealing with large medical expenses should make sure they are being charged correctly. Billing errors can be disputed, and insurance denials may sometimes be appealed. Another option is hospital financial assistance. Federal tax rules require tax-exempt hospitals to maintain written financial assistance policies for emergency and other medically necessary care, according to the IRS. Those policies must explain eligibility requirements and how patients can apply for free or discounted care.

What’s the best way to get out of medical debt?

The first step in addressing medical debt is determining whether the amount is correct. Request an itemized bill and compare it with the Explanation of Benefits provided by the insurance company. Look for duplicate charges, unfamiliar services, incorrect insurance information, and claims that the insurer denied or processed differently from what was expected. If a claim was denied, contact the insurance company and ask for the reason. Depending on the circumstances, patients may have appeal rights. The healthcare provider may also be able to correct billing or coding information and resubmit the claim.

Next, contact the hospital or medical provider before taking on any additional debt. Ask about financial assistance, hardship discounts and interest-free payment plans. Tax-exempt hospitals are required to establish financial assistance policies that cover emergency and medically necessary care. Avoid immediately paying a large medical balance with a high-interest credit card if other options are available. Doing so can turn a potentially negotiable hospital balance into credit card debt that accumulates interest. The scale of medical debt also varies widely. A 2022 peer-reviewed study in JAMA Network Open found that among adults with medical debt in 2018, the median balance was $2,000, although the mean was much higher because a relatively small group of people carried extremely large balances.

More recent Commonwealth Fund research shows the problem persists among insured Americans: 46% of privately insured adults currently paying medical debt reported balances of $2,000 or more. The goal should be to verify the debt, identify any insurance or billing errors, apply for available assistance, and negotiate manageable terms before resorting to more expensive forms of borrowing.

Bottom line

Health insurance can protect patients from the full cost of medical treatment, but it does not eliminate financial risk. For roughly one-third of working-age adults with private insurance who pay medical bills or debt over time, understanding insurance benefits, checking bills and pursuing financial assistance can be important tools for limiting long-term medical debt.

Frequently Asked Questions

What is the average medical debt for adults in the US?

There is no single current national average because researchers measure medical debt differently. A JAMA Network Open study using 2018 data found a median debt of approximately $2,000 among adults who carried medical debt, while the 2026 Commonwealth Fund survey found that 46% of privately insured adults with medical debt owed at least $2,000.

How many people in America can’t afford healthcare?

There is no official number representing everyone who cannot afford healthcare, but cost causes millions of Americans to delay or skip treatment. In 2024, approximately 17% of U.S. adults reported delaying or going without medical care, prescription drugs or mental health treatment because of cost, according to Health System Tracker.

Citations

Cerullo M. 1 in 3 Americans with health insurance have medical debt, survey finds. CBS News. Published September 17, 2026. https://www.cbsnews.com/news/1-in-3-insured-americans-medical-debt/

Collins SR, Richards C, Gupta A, Roy S. How Medical Bills and Debt Impact Americans with Private Insurance: Findings from the Commonwealth Fund 2025 Affordability Survey and Focus Groups. The Commonwealth Fund. Published September 17, 2026. doi:10.26099/q1fx-nw50. https://www.commonwealthfund.org/publications/surveys/2026/sep/how-medical-bills-debt-impact-americans-private-insurance

Gunja MZ, Gumas ED, Williams RD II, Doty MM, Shah A, Fields K. The Cost of Not Getting Care: Income Disparities in the Affordability of Health Services Across High-Income Countries. The Commonwealth Fund. Published November 16, 2023. doi:10.26099/jbe9-c870. https://www.commonwealthfund.org/publications/surveys/2023/nov/cost-not-getting-care-income-disparities-affordability-health

Centers for Medicare & Medicaid Services. NHE Fact Sheet: Historical National Health Expenditures, 2024. CMS. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet

KFF. 2025 Employer Health Benefits Survey. Published October 22, 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/

Tolbert J, Cervantes S, Bell C, Damico A. Key Facts about the Uninsured Population. KFF. Published June 16, 2026. https://www.kff.org/uninsured/key-facts-about-the-uninsured-population/

Rakshit S, Cotter L, McGough M, Claxton G. How does cost affect access to healthcare? Peterson-KFF Health System Tracker. Published March 10, 2026. https://www.healthsystemtracker.org/chart-collection/cost-affect-access-care/

Himmelstein DU, Dickman SL, McCormick D, Bor DH, Gaffney A, Woolhandler S. Prevalence and Risk Factors for Medical Debt and Subsequent Changes in Social Determinants of Health in the US. JAMA Network Open. 2022;5(9):e2231898. doi:10.1001/jamanetworkopen.2022.31898. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796358

Internal Revenue Service. Financial Assistance Policies (FAPs). IRS. https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit/