One in Three Insured Americans Are Paying Off Medical Debt, Commonwealth Fund Survey Finds

Nearly a third of working-age Americans with private health insurance are paying off medical debt right now. Not the uninsured. People with employer plans, Affordable Care Act marketplace plans, individual policies. People who did everything right.

A Commonwealth Fund survey released September 17 found this after interviewing 6,353 adults ages 19 to 64, including about 4,100 with private insurance. The survey was fielded from July 22 to October 27, 2025.

Hospitals Are the Main Driver

Sixty-four percent of insured people carrying medical debt say it came from hospital care: inpatient stays, outpatient procedures, emergency room visits. That's according to the Commonwealth Fund report and confirmed across coverage from CBS News, Healthcare Dive, and the American Journal of Managed Care.

But it's not just emergencies. Routine care piles up too. Forty-three percent of people with debt blame doctor's office visits. Thirty-nine percent tie it to an ongoing or chronic condition. Thirty-eight percent point to lab work or diagnostic testing. Twenty-five percent cite dental care.

Nearly half of people carrying medical debt, 46 percent, owe $2,000 or more. That works out to roughly 15 percent of all privately insured working-age adults nationwide, according to the Commonwealth Fund.

The Burden Isn't Even

The American Journal of Managed Care's breakdown of the data shows the debt load falls harder on some groups than others, naming Southern residents, low-to-moderate income adults, women, and Black and Hispanic adults as higher-burden subgroups.

Thirty-six percent of all privately insured adults said they couldn't cover an unexpected $1,000 medical bill within 30 days, according to Marketplace's reporting on the survey and AJMC's analysis.

Those are survey respondents' self-reported circumstances, not an independent financial audit. But the pattern is consistent across every outlet that covered the data.

Who's to Blame? Depends Who You Ask

Sixty-four percent of people with medical debt blame their insurance company. Fifty-seven percent blame the broader healthcare system. That's what respondents told the Commonwealth Fund. It's a perception, not a verdict on any specific insurer's conduct in any specific case.

"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," said Sara Collins, the study's lead author and a senior scholar at the Commonwealth Fund, in comments carried by CBS News, TIME, and the Epoch Times.

Collins told Marketplace that people are "shocked by the fact that they still owe quite a bit of money to the provider despite the fact that they've been paying premiums regularly."

Marketplace profiled Jennifer Bakowski, 57, who has been fighting terminal brain cancer for seven years and has insurance through her husband's job. She estimates she still carries about $8,000 in medical debt and says her family has pulled roughly $120,000 out of savings to cover her care. "We just pay the best we can, and it's just a snowball," she told Marketplace.

Denials Are Common, Appeals Are Rare

About one in five adults or their family members had coverage denied between July and October 2025, per a separate Commonwealth Fund study cited by the Epoch Times. A March study from KFF found 33 percent of insured adults had a claim denied at some point between 2022 and 2024.

KFF lists the usual reasons: noncovered services, out-of-network care, missing prior authorization, or an insurer deciding treatment wasn't medically necessary. Billing errors cause plenty of denials too. "Minor data errors are the most common culprit for claim denials," Blue Cross Blue Shield of Texas said in a report cited by both ZeroHedge and the Epoch Times, pointing to wrong codes or mismatched patient information.

Fewer than half of patients who spot a billing error or denial actually challenge it, mostly because they don't know they have the right to, according to a 2024 Commonwealth Fund survey cited by the Epoch Times. While about a third of prior-authorization denials in the ACA system get overturned when appealed, KFF found fewer than 1 percent of denied claims were appealed at all in 2024.

The Credit Report Fight Is Still Unresolved

A Biden-era Consumer Financial Protection Bureau rule meant to strip medical debt off credit reports was finalized before Trump took office, then vacated by a federal court in July 2025, according to TIME and Healthcare Dive. AJMC reports the rule would have stripped an estimated $49 billion in medical debt from the credit reports of 15 million Americans, and that a federal judge in Texas found the agency had exceeded its authority under the Fair Credit Reporting Act.

Healthcare Dive reports 16 states have banned medical debt from credit reports on their own, though the scope varies by state. TIME puts the number at 15. Either way, the three major credit bureaus, Equifax, Experian, and TransUnion, have voluntarily limited reporting since 2023, but unpaid medical bills above $500 still show up.

What's Actually Changing, and What Isn't

This isn't a problem likely to shrink soon. TIME reports health benefit costs per employee are projected to jump 8.2 percent in 2027, the steepest increase since 2003, according to an August survey by Marsh. Congress declined to renew enhanced ACA marketplace subsidies, and the Center on Budget and Policy Priorities found in April that many consumers responded by downgrading to cheaper, skimpier plans that leave them more exposed if they get seriously sick.

Rising hospital prices, thinner coverage, and a federal credit-report fix that's dead in court with no replacement on the table all compound the problem. Congress hasn't moved to revive the subsidies or write a new medical-debt credit rule. Both sit unresolved heading into 2027 enrollment season.