Medical debt burdens more than 1 in 4 adults in the U.S., survey finds

Health insurance is supposed to offer some financial protection against high healthcare costs, but that protection is fraying, leaving approximately 1 in 4 adults in the U.S. with medical debt, according to results of an Urban Institute survey released today.

The survey, which was conducted in late 2025, showed that 26.6% of adults reported that they or their family members were in debt to a medical provider. Just over 15% had medical bills they were unable to pay, while a similar percentage were paying a bill in installments, and 10.9% had paid for medical services with a credit card and were paying over time.

Not surprisingly, the prevalence of medical debt varied with income, the survey showed, although it was not the highest among those with the lowest income (less than 100 of the federal poverty level), presumably because of Medicaid coverage and its limits on cost sharing. At 37.8%, the percentage of those with medical debt was highest among those at the next income level up, between 100% and 199% of the federal poverty level, and the next-highest prevalence, at 33.8%, was among those with incomes between 200% and 399% of the federal poverty rate.

The survey showed also showed differences in medical debt by race and ethnicity. Medical debt was more prevalent among Black adults (37.5%) and Hispanic adults (34.8%) than it was among White adults (23.1%) and Asian adults (11.3%).

Hospital care was the largest source of medical debt. Just over half (52.1%) of those with medical debt had unpaid bills related to hospital services. Specialist services (41.5%) and dental care (37.6%) were also major sources of putting people in the red as far as their medical bills were concerned.

More than half of the adults reported medical debts of $1,000 or more, and 15.5% owed $5,000 or more.

All of these figures come from the Urban Institute’s Well-Being and Basic Needs Survey, an annual survey of more than 10,000 adults. The survey was conducted in December 2025. Today’s news release says that the Robert Wood Johnson Foundation supported the analysis of the results.

Gaps insurance leave patients financially vulnerable

Medical debt is partly a function of the prices charged by providers. Although there is some data suggesting that it has reversed recently, over the past couple of decades, medical care price inflation has outpaced overall price inflation. Medical debt is also influenced by insurance coverage, and the Urban Institute and Robert Wood Johnson Foundation report about the survey results emphasized the growing number of gaps in health insurance in the U.S. For example, with the end of enhanced subsidies, 3 million fewer people had coverage through Affordable Care Act (ACA) marketplace plans in early 2026 than in early 2025, according to the report that accompanied the Urban Institute survey results. Of those that have bought ACA plans, more are choosing bronze-level plans that have lower premiums but higher deductibles, creating a risk of incurring medical debt among those who use healthcare services.

The report also mentions the cuts to Medicaid coverage that were an important part of the One Big Beautiful Bill Act that President Donald Trump signed on July 4, 2025.

“Collectively these policy changes, combined with rising health care costs, are likely to increase households’ risks of incurring medical debt, jeopardizing their financial stability and health care access and potentially leading to higher uncompensated care costs for health care providers,” the report says.

“Health insurance does not shield people from rising healthcare costs and the crushing burden of medical debt,” said Katherine Hempstead, Ph.D., senior policy officer at the Robert Wood Johnson Foundation, in a news release about the survey findings.

Federal and state lawmakers have introduced bills or passed legislation that would blunt the effects of medical debt. Sen. Sheldon Whitehouse, a Rhode Island Democrat, and Rep. Steve Cohen, a Tennessee Democrat, have introduced the Medical Bankruptcy Fairness Act of 2026 that would, among other things, keep medical bankruptcies off consumer credit reports and protect $250,000 of home equity from bankruptcy proceedings.

According to a Commonwealth Fund report in August 2026, 14 states prohibit medical debt from appearing on consumer credit reports, and 23 states prohibit healthcare providers and other medical creditors from garnishing wages or foreclosing on a patient’s home to collect on unpaid medical bills. Twenty states and the District of Columbia require hospitals to make free or discounted care available to some patients, reducing their chances of incurring medical debt. But the Commonwealth Fund says those programs have gaps. For example, five of those states limit the free or discounted care to people without insurance, leaving those who are underinsured vulnerable to unpaid bills. In addition, the protections related to medical debt often don’t apply to other providers and medical debt on a credit card.