REPORT
January 2016
The Burden of Medical Debt:
Results from the
Kaiser Family Foundation/New York Times
Medical Bills Survey
Prepared by:
Liz Hamel, Mira Norton, Karen Pollitz, Larry Levitt, Gary Claxton and Mollyann Brodie
Kaiser Family Foundation
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey
Introduction ........................................................................................................................................................ 1
Section 1: Who Has Medical Bill Problems and What Are the Contributing Factors? ....................................... 1
Prevalence of problems paying medical bills among different groups ........................................................... 1
Circumstances leading to problems paying medical bills .............................................................................. 3
Financial status of those with medical bill problems .................................................................................... 8
Section 2: The Role of Health Insurance...........................................................................................................10
Medical bill problems among those with health insurance ..........................................................................10
The Uninsured and attempts to get coverage ............................................................................................... 13
Section 3: Consequences of Medical Bill Problems........................................................................................... 14
The impact of medical bills on families ........................................................................................................ 14
Sacrifices made to pay medical bills ............................................................................................................. 15
Effects of medical bills on ability to get needed health care ......................................................................... 16
Effects of medical bills on household finances and ability to afford basic needs ......................................... 17
Financial consequences of struggling to make payments ........................................................................... 20
Section 4: Patients as Consumers .................................................................................................................... 22
Conclusion ........................................................................................................................................................ 26
Appendix 1: Reported Problems Paying Medical Bills By Demographic Group .............................................. 27
Appendix 2: Survey Methodology .................................................................................................................... 28
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 1
The cost of health care has long been a concern in the U.S., on both a national and a personal level. For
individuals, this concern plays out most prominently among those who face difficulty paying medical bills or
who are unable to pay such bills at all. For people who are uninsured, lack of coverage not only hinders access
to care but also leaves them vulnerable to medical bills that cannot be paid. While insurance provides financial
protection, that protection can be incomplete for a number of reasons, including rising deductibles and other
forms of cost-sharing, out-of-network charges, the growing complexity of insurance that can leave consumers
with unexpected bills, and the fact that many people have only modest financial assets to cover medical
expenses.
Previous Kaiser surveys have found that about a quarter of people say they or someone in their household had
problems paying medical bills in the past year, and a 2014 Kaiser report provided a qualitative look at some of
the circumstances and consequences of unpaid medical bills through interviews with people who had sought
credit counseling for medical debt.
1
But to date, there has been little research providing a quantitative look at
the causes of medical bill problems and the impacts they have on people’s families, their finances, and their
access to health care.
To fill this gap, the Kaiser Family Foundation and The New York Times conducted an in-depth survey with
1,204 adults ages 18-64
2
who report that they or someone in their household had problems paying or an
inability to pay medical bills in the previous 12 months. To provide context, we also conducted a shorter
companion survey with 1,371 adults ages 18-64 who do not report having medical bill problems.
Overall, about a quarter (26 percent) of U.S. adults ages 18-64 say they or someone in their household had
problems paying or an inability to pay medical bills in the past 12 months. Though certain groups are more
likely than others to report such problems, the survey finds that people from all walks of life can and do
experience difficulty paying medical bills.
Insurance status has a strong association with medical bill difficulties, with over half (53 percent) of the
uninsured saying they had problems paying household medical bills in the past year. However, as previous
surveys have shown, insurance is not a panacea against these problems. Roughly one in five of those with
health insurance through an employer (19 percent), Medicaid (18 percent), or purchased on their own (22
percent) also report problems paying medical bills. In fact, overall among all people with household medical
bill problems, more than six in ten (62 percent) say the person who incurred the bills was covered by health
insurance, while a third (34 percent) say that person was uninsured. Among those with private insurance
(either through an employer or self-purchased), their plan’s deductible makes a difference in ability to afford
health care bills, with those in higher deductible plans more likely to report medical bill problems than those in
plans with lower deductibles
3
(26 percent versus 15 percent).
Not surprisingly, problems paying medical bills are also more common among those with lower or moderate
incomes. Just under four in ten (37 percent) of those with annual household incomes below $50,000 report
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 2
experiencing such problems, compared with about a quarter (26 percent) of those with moderate incomes
between $50,000 and $100,000, and 14 percent of those in the highest income category.
4
Those with poorer
health status and greater health needs are also more likely to report facing medical bill problems. This is true
among those who say they have a disability that prevents them from participating fully in daily activities (47
percent report problems versus 22 percent of those without such a disability), among those who rate their own
health as fair or poor (45 percent versus 22 percent of those in excellent, very good, or good health), and among
those who say they’re receiving regular or ongoing medical treatment for a chronic condition (34 percent
versus 23 percent of those who are not receiving such treatment).
Beyond insurance, income, and health status, several other demographic differences emerge in the rates at
which people report experiencing problems paying medical bills. Women are somewhat more likely than men
to report having such problems (29 percent versus 23 percent), as are adults under age 30 compared with those
ages 30-64 (31 percent versus 24 percent) and those with children in their household versus those without (29
percent versus 24 percent). Looking by region, residents of the South have the highest share reporting
problems (32 percent), while those in the Northeast have the lowest (18 percent). Likely due to differences in
income and insurance status, those without a college degree are more likely than college graduates to report
medical bill problems, as are Blacks and Hispanics compared with whites. (See Appendix Table 1 for more
detail).
To explore these relationships further, we used a statistical technique called logistic regression analysis to
isolate which demographic characteristics are the strongest predictors of problems paying medical bills when
holding other factors constant. In that analysis, income, insurance status, and all 3 measures of health status
(being in fair or poor health and having a disability or chronic condition) had a significant and strong
association with problems paying medical bills, even after accounting for the influence of the other
demographic factors. Having a private insurance plan with a high deductible also remained a significant
predictor, even after controlling for other factors, as did being under age 25 and having minor children at
26%
37%
26%
14%
53%
20%
26%
15%
47%
22%
Total adults ages 18-64
Less than $50,000
$50,000 to $99,999
$100,000 or more
Uninsured
Insured
Private insurance, high deductible*
Private insurance, low deductible
Have a disability
No disability
Figure 1
Shares Reporting Problems Paying Medical Bills In Past Year
Percent who say they or someone in their household had problems paying medical bills in the past 12 months:
*High deductibles defined as $1,500 and above for an individual or $3,000 and above for a family.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
By household income
By insurance status
By plan deductible
By disability status
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 3
home. Gender, race, and ethnicity were not statistically significant predictors of problems paying medical bills
when controlling for other factors, suggesting that the higher rates of reported problems among women,
Blacks, and Hispanics have to do with underlying differences in income and insurance status between these
groups and their counterparts.
Among those who report problems paying medical bills, two-thirds (66 percent) say the bills were the result of
a one-time or short-term medical expense such as a hospital stay or an accident, while 33 percent cite bills for
treatment of chronic conditions that have built up over time. These shares are similar for people who faced
medical bill problems with and without insurance coverage.
Many are still struggling to pay off bills for treatment that occurred in the past. Over six in ten (63 percent) say
they are no longer receiving the medical treatment that led to their problems paying bills, and almost half (46
percent) say the illness or injury that led to the bills occurred more than one year ago.
Most of those with medical bill problems say the bills are the result of their own or their spouse’s medical care.
One-quarter (44 percent of those with children under age 18 in their household) say they had problems paying
a child’s medical bills, and 10 percent cite another family member. Thirty-five percent say they’ve had problems
paying bills for more than one family member.
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Which of the
following comes closer to describing the medical bills you’ve had problems paying:
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Bills that have built
up over time, such
as treatment for a
chronic illness like
diabetes or cancer
33%
Don't know/
Refused
2%
Bills for a one-time
or short-term
medical expense,
such as a single
hospital stay or
treatment for an
accident
66%
Figure 2
More Say Medical Bill Problems Stem From One-Time Events
Than Treatment For Chronic Illnesses
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 4
The medical bills people report facing also come from a variety of sources. More than six in ten of those who
had difficulty paying say the medical bills were for doctor visits (65 percent), diagnostic tests (65 percent), lab
fees (64 percent) and emergency room visits (61 percent). About half say they had problems with bills for
prescription drugs (52 percent), hospitalization (49 percent), and outpatient services (49 percent), while four
in ten (41 percent) report problems with bills for dental care. Nearly all of those who had problems paying
medical bills (91 percent) report having trouble with bills from at least two of these categories, and over half (53
percent) had problems with bills from five or more different sources.
Asked which types of bills made up the largest share of what they owed, the most common responses are
emergency room visits (21 percent) and hospitalization (20 percent), followed by dental care (12 percent) and
diagnostic tests like X-rays and MRIs (11 percent). In general, people who had problems paying medical bills
with or without insurance report having similar types of bills, however the uninsured are more likely than the
insured to say that emergency room bills were the largest source of their bill problems (35 percent versus 15
percent), while those with insurance are more likely than the uninsured to point to diagnostic tests like X-rays
and MRIs (14 percent versus 6 percent).
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 3
Most Who Had Problems Paying Medical Bills Say The Bills
Were For Their Own Medical Care
73%
33%
25%
10%
Bills for their own medical care
Bills for their spouse or partner's medical care
Bills for their child's medical care
Bills for another family's members medical
care
Percent who say each of the
following represents the
largest share of the bills they
had problems paying:
Percent who say they’ve had
problems paying the following
types of bills:
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 5
When asked to describe in their own words the illness or injury that led to their medical bill problems, people
give a variety of responses. Overall, the largest share (36 percent) name a specific disease, symptom or
condition like heart disease or gastrointestinal problems, followed by issues related to chronic pain or injuries
(16 percent), accidents and broken bones (15 percent), surgery (10 percent), dental issues (10 percent), and
infections like pneumonia and flu (9 percent). Five percent each cite mental health or substance abuse issues
and pregnancy or childbirth as the cause of their bills.
Among who say their bill problems were the result of a one-time or short-term medical expense, just under one
in five (18 percent) cite an accident as the main cause. Most of the others name illnesses, pain, dental issues, or
surgery, suggesting that although most bill problems are caused by one-time events, these events are often
acute episodes of illness or expensive surgeries, medications or tests, rather than injuries caused by accidents.
Those who say their bills have built up over time are even more likely to cite specific diseases, the most
common being cancer (14 percent), heart disease (11 percent), and diabetes (11 percent).
9%
11%
4%
21%
5%
6%
20%
12%
8%
1%
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 4
Doctor Visits, Tests, Lab Fees Are Most Common Source Of Bills,
But Hospital And ER Make Up Largest Dollar Amount
65%
65%
64%
61%
52%
49%
49%
41%
15%
4%
Doctor Visits
Diagnostic tests, such as X-rays/MRIs
Lab fees
Emergency room
Prescription drugs
Outpatient services
Hospitalization
Dental care
Some other type of medical service
Nursing home/long-term care services
Percent who say each represents
the largest share of the bills they
had problems paying:
Percent who say they’ve had
problems paying the following
types of bills:
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 6
Heart disease/heart attack/stroke
8
6
11
Cancer/tumors
6
2
14
Gastrointestinal/stomach
6
6
8
Allergies/asthma/respiratory disease
5
4
7
Diabetes
4
1
11
High blood pressure
4
2
6
Neurological problems
3
2
4
Auto-immune disease
2
1
4
Kidney disease/problems
2
2
1
Cervical/ovarian/gynecologic
problems
2
2
<1
Thyroid issues
1
<1
1
Arthritis/joint pain/problems
8
8
9
Back/neck pain/problems
6
5
6
Chronic pain, other/unspecified
3
3
4
Broken bones
5
6
2
Accident, car/vehicle
5
6
1
Accident, unspecified
5
6
2
Accident, job-related
1
1
<1
Pneumonia/lung infection
3
2
4
Viral infections
3
5
1
Other/unspecified infection
2
3
1
Note: Percentages add up to more than 100 because multiple responses were accepted.
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 7
The open-ended responses to this question show that medical bill problems can arise from single health events
or chronic, ongoing conditions. Problems occur among people with and without insurance. They can affect one
person or multiple family members at a time. Unexpected bills may arise when people don’t realize how many
providers will bill separately for a single treatment event, or when insurance doesn’t pay for care people
thought would be covered. Medical bill problems may be short term, or drag on for years.
“A heart attack (MI) requiring 4 stents being placed. Also an appendectomy. Ongoing: diabetes and heart
disease that require monthly visits and prescriptions. My son also has epilepsy which has impacted our
medical expenses.”
“In 2002 I had a pancreatic attack, a tumor in my pancreas removed and my spleen removed, and I broke
2 arms at the same time, partial hysterectomy. And hepatitis.”
“Cancer. Current treatment not FDA approved for certain cancers, so even though the treatment is
working, it is no longer covered by insurance and costs approximately $11,000 per month.”
“It's a whole lot. Diabetes and claustrophobic and everything. TIA, a mini stroke, depression, anxiety.”
“I had a tooth that went bad and had to have it pulled. I now need another tooth in its place. The dentist
wants all the money for the procedure up front. I do not have thousands of dollars to give.”
“Was treated by my family doctor for a MRSA infection which led to C-Diff which I went to the ER for.
They ran several tests and diagnosed the illness but sent me home with no treatment. I had made
arrangements to pay the bill monthly and came to realize there were several other bills associated with the
visit that were specific to Doctor, CT scan, Lab all being separate bills.”
“I have been diagnosed with osteoarthritis throughout my body, as well as degenerative disc disease. I
have had to have at least 6 MRI's in past 5 years, 3 back injections, 5 foot surgeries, 2 knee surgeries, wrist
surgery, torn tendon repair, several joint replacement surgeries, etc.”
“I was pregnant and miscarried when I was 10.5 weeks a long. Prior to losing the baby, I had an
ultrasound which cost $636 and I don't have insurance. I was eligible for pregnancy-related Medicaid, but
it wasn't billed right and a year and a half later I got the bill. I am still trying to get it straightened out.”
“Eye glasses not covered. Orthotics not covered. Many different problems with feet.”
“Insurance not paying for wellness care of any kind, blood work, labs, physical and only 8o% of a
mammogram.”
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 8
About three in ten (31 percent) of those with medical bill problems say the total amount of the bills they had
problems paying was $5,000 or more, including 13 percent who report bills adding to at least $10,000.
Insurance appears to provide some protection from the highest bills, as the insured are less likely than the
uninsured to report having bills of $10,000 or more (8 percent versus 21 percent).
Many of those with medical bill problems report struggling with bills of lower amounts, including 24 percent of
the insured and 22 percent of the uninsured who say their bills amounted to less than $1,000. While these
lower amounts may seem small, even a bill of $500 or less can present a major problem for someone who is
living paycheck to paycheck. In fact, when asked to describe their financial situation, about six in ten (61
percent) of those who’ve had problems paying medical bills say they either just meet their basic expenses (43
percent) or don’t have enough to meet basic expenses (18 percent). Among the comparison group who did not
report problems paying medical bills, just a quarter (24 percent) report such a tenuous financial situation,
while the majority say they either live comfortably or meet their basic expenses with a little left over for extras.
Given their differing demographic profiles, it’s not surprising that those with health insurance are less likely
than those without insurance to say they struggle to meet basic expenses. However, even among the insured,
those who have faced medical bill problems are significantly more likely than their counterparts who haven’t
had such problems to say they are either just getting by or don’t have enough to make ends meet (55 percent
versus 22 percent).
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: What was the
TOTAL amount owed for the medical bills you’ve had problems paying?
NOTE: Don’t know/Refused responses not shown.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 5
People Report Problems Paying Medical Bills of Varying Dollar
Amounts
10%
10%
8%
14%
14%
14%
19%
21%
17%
24%
26%
20%
18%
17%
21%
13%
8%
21%
Total
Insured
Uninsured
Less than $500 $500 to less than $1000 $1000 to less than $2500
$2500 to less than $5000 $5000 to less than 10,000 $10,000 or more
By Insurance Status
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 9
Live comfortably
8%
35%
9%
37%
6%
18%
Meet your basic expenses with
a little left over for extras
31
41
36
42
20
36
Just meet your basic expenses
43
18
41
16
46
38
Don’t have enough to meet
basic expenses
18
6
14
6
26
8
NOTE: Don’t know/Refused responses not shown.
The financial accounts held by people who’ve had problems paying medical bills also paint a picture of a more
fragile financial situation. A large majority (78 percent) say they have a checking or savings account, though
this is lower than among those who have not had medical bill problems (90 percent). Compared to those
without medical debt, those who’ve had medical bill problems are also less likely to say they have a credit card
(53 percent versus 77 percent), a retirement savings account (43 percent versus 62 percent), or some other type
of savings (17 percent versus 38 percent). Again, not surprisingly, among those with medical bill problems, the
uninsured are less likely than the insured to report having each of these types of accounts.
Income loss due to illness is another complicating factor for some of those who face medical bill difficulties.
About three in ten (29 percent) say that someone in their household had to take a cut in pay or hours as a result
of the illness that led to the medical bills, either because of the illness itself or in order to care for the person
who was sick. Most of these (19 percent of the total who had problems paying medical bills) say their household
income decreased a lot as a result.
78%
53%
43%
17%
90%
77%
62%
38%
A checking or savings account at a
bank or credit union
A credit card
An IRA, 401K or similar kind of
retirment account
Another type of savings or
investment, such as stocks, bonds,
or mutual funds
Those who had problems paying household medical bills
Those who DID NOT have problems paying household medical bills
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 6
Those with Medical Bill Problems Less Likely to Report Having
Various Financial Accounts
Percent who say they or their spouse currently have each of the following:
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 10
The uninsured who had medical bill problems (36 percent) are somewhat more likely to report job losses or pay
cuts, but still about a quarter (26 percent) of the insured who had medical bill problems report facing such an
adverse employment outcome as a result of the illness that led to their bills.
While problems paying medical bills are more common among the uninsured, more than six in ten (62 percent)
of those who had problems paying medical bills say the person who incurred the bills was covered by health
insurance when treatment began, with most of that coverage (39 percent of the total) coming through an
employer. The vast majority (83 percent) of those who were insured when treatment began say they kept their
coverage throughout the treatment period, but 15 percent of them (9 percent of the total) say they lost or
dropped coverage at some point, mainly because of job loss or change or because they were no longer eligible
for coverage.
Among those with private insurance through an insurer or purchased on their own (46 percent of the total who
had problems paying medical bills), about half report having plans with high deductibles (at least $1500 for an
individual of $3000 for a family), while the other half report having lower-deductible plans.
Yes
29%
Don't
know/
Refused
1%
No
70%
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
Figure 7
About Three in Ten Report Job Loss Or Pay Cut Due to Illness
That Led to Medical Bill Problems
19%
9%
1%
Yes, decreased a lot
Yes, decreased a little
No, did not decrease
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
ASKED OF THE 29% WHO SAY SOMEONE LOST A JOB OR
TOOK A CUT IN PAY/HOURS: Did your overall household
income decrease as a result of this change in work status,
or not? Would you say it decreased a little or a lot?
(Percentages shown based on total who had problems
paying medical bills)
Did you or anyone else in your household lose a job or
have to take a cut in pay or hours due to the illness or
injury that led to these bills?
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 11
Of those who were insured when the bills were incurred, three-quarters (75 percent) say that the amount they
had to pay for their insurance copays, deductibles, or coinsurance was more than they could afford.
Interestingly, this is true among people in plans with higher deductibles (83 percent) and among those in plans
with lower deductibles (76 percent), suggesting that other types of cost-sharing can present a problem even for
people in lower-deductible health plans. For example, even under a plan with a relatively low deductible, large
medical bills could arise from repeated co-pays or from out-of-network coinsurance. This finding should not
be confused with the finding shown in the first section of this report – that people in plans with higher
deductibles are more likely to report problems paying medical bills in the first place. However, among insured
people who have medical bill problems, most find cost sharing unaffordable regardless of the deductible level.
Employer
coverage
39%
Self-
purchased
coverage
7%
Public/Other
Coverage
16%
Don't know/
Refused
4%
Uninsured
34%
Figure 8
Insurance Status of Those Who Had Problems Paying Medical
Bills
NOTE: *High deductibles defined as $1,500 and above for an individual or $3,000 and above for a family.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Fell short of
expectation
s
Met
expectatio
ns
2%
22%
22%
High deductible plan*
Lower deductible plan
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
ASKED OF THE 46% WITH EMPLOYER OR SELF-PURCHASED
COVERAGE: Percentages shown based on total who had
problems paying medical bills
Deductible level of those with employer-sponsored or self-
purchased coverage:
Unknown deductible amount
Insurance status of the person who was the main
source of the bills at the time treatment began:
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 12
About three in 10 (32 percent) of those who had problems paying medical bills while insured say they received
care from an out-of-network provider that their insurance wouldn’t pay for. For many, these bills came as a
surprise. Seven in 10 (69 percent) of those who had problems paying for care received from an out-of-network
provider say they were unaware that the provider was not in their plan’s network when they received the care.
Denied claims also contribute to medical bill problems among those with insurance. About a quarter (26
percent) of the insured who had medical bill problems say they had a claim denied by their insurance company.
Common reported reasons for denial include a particular treatment not being covered (25 percent of those with
75%
32%
26%
Copays, deductibles, or coinsurance were more than they
could afford
Received care from an out-of-network provider, and
insurance would not cover or would only cover a portion
Submitted a claim to insurance company but the claim
was denied
Figure 9
Most Who Had Problems Paying Medical Bills While Insured Say
Cost-Sharing Was More Than They Could Afford
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS WHO WERE
INSURED WHEN TREATMENT BEGAN: Percent who say each of the following was a reason they had problems paying
medical bills:
NOTE: Question wording abbreviated. See topline for full question wording.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS AND RECEIVED
CARE FROM AN OUT-OF-NETWORK PROVIDER THAT INSURANCE WOULD NOT COVER: Did you know that the health
care provider was not in your plan’s network at the time you received care, or not?
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Yes, knew the
health care
provider was not
in their plan's
network
28%
Don't know/
Refused
4%
No, did NOT
know the health
care provider was
not in their plan's
network
69%
Figure 10
Most Who Received Out-Of-Network Care Did Not Know the
Provider Was Out-Of-Network at Time of Treatment
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 13
denied claims) and receiving care from an out-of-network provider (14 percent); 21 percent of those who say
they had a claim denied did not know or could not provide a reason for the denial.
About a third (34 percent) of those who had problems paying medical bills say they were uninsured when the
treatment that led to their medical bill problems began. However, many of these (39 percent, or 13 percent of
the total who had problems paying medical bills) say they got coverage at some point while they were receiving
treatment, mainly from Medicaid (36 percent of those who were uninsured and gained coverage).
Among those who remained uninsured throughout the time they were receiving the treatment that led to their
medical bills, many say they tried to get coverage from Medicaid (52 percent), the health insurance
marketplace (28 percent) or directly from an insurance company or broker (16 percent). Most of those who
tried but were not able to get coverage from Medicaid say they were told they were not eligible for the program,
while the most commonly reported reason for not getting private coverage was because it was too expensive.
Covered by
health
insurance
62%
Don't know/
Refused
4%
Uninsured
34%
Figure 11
Six in Ten Had Insurance When Treatment Began, One-Third
Were Uninsured
52%
9%
Had insurance
coverage the
entire time
Lost or dropped
health insurance
coverage at some
time
ASKED OF THE 62% WHO WERE
INSURED WHEN TREATMENT BEGAN:
Did you have insurance coverage for the
entire time you were receiving
treatment, or did you lose or drop your
health insurance coverage at any time
during this period?
[Were you/Was the person who received
the bills] covered by any form of health
insurance or health plan at the time
treatment began, or were you uninsured?
ASKED OF THE 34% WHO WERE
UNINSURED WHEN TREATMENT
BEGAN: Were you uninsured the
entire time you were receiving the
treatment that led to the problems
paying medical bills, or did you get
health insurance at some point?
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
20%
13%
Uninsured the
entire time
Got health
insurance at
some point
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 14
Among the roughly one-quarter of Americans ages 18-64 who report having problems paying medical bills,
roughly equal shares say the impact of those bills on their families has been major (44 percent) and minor (47
percent). Relatively few (7 percent) say there has been no real impact. The survey shows that while insurance
may protect people from having medical bills problems in the first place, once those problems occur the
consequences are similar regardless of insurance status. Among those with medical bill problems, almost
identical shares of the insured (44 percent) and uninsured (45 percent) say the bills have had a major impact
on their families. Similarly, among those who had problems paying medical bills, those with higher incomes are
just as likely to report that the bills had a major impact as those with lower incomes (though as noted above,
people with lower incomes are more likely than those with higher incomes to report problems paying medical
bills in the first place).
A few groups among those with medical bill problems are more likely to say the medical bills have had a major
impact on their families, including people with bills amounting to $5,000 or more (66 percent), those who say
the family member who generated the bills has a disability (57 percent), and those who describe their financial
situation as not having enough to meet basic expenses (56 percent).
Among people with private health insurance, those in high-deductible plans are more likely than those in
lower-deductible plans to say the bills had a major impact on their family (49 percent versus 35 percent), which
may be related to the fact that high deductible plan enrollees report having higher bills on average. About two-
thirds (64 percent) of those in high-deductible plans say their bills amounted to $2,500 or more, compared to
four in ten with lower-deductible plans (40 percent).
44%
44%
45%
47%
47%
47%
7%
8%
6%
A major impact A minor impact No real impact
NOTE: Don’t know/Refused responses not shown.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 12
Over Four in Ten with Medical Bill Problems Report a Major
Impact on Their Family
Uninsured
By Insurance Status
Total
Insured
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Overall, how much
of an impact have these medical bills had on you and your family?
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 15
Even among those with health insurance, people who’ve faced medical bill problems report making various
sacrifices in order to pay these bills, including significant changes to their employment, financial situation, or
lifestyle. Overall, about seven in ten report cutting back or delaying vacations or major household purchases
(72 percent) as well as reducing spending on food, clothing and basic household items (70 percent). About six
in ten (59 percent) say they used up all or most of their savings in order to pay medical bills. Substantial shares
say that someone in their household took on an extra job or worked more hours (41 percent), borrowed money
from family and friends (37 percent), or increased their credit card debt (34 percent). Roughly a quarter (26
percent) say they took money out of a retirement, college, or other long-term savings account. Smaller – but
not inconsequential – shares say they changed their living situation (17 percent), took out another type of loan
(15 percent), borrowed from a payday lender (13 percent), or sought the aid of a charity or non-profit (12
percent) in order to pay medical bills. Very few (2 percent) report taking out a second mortgage on their home.
These sacrifices are reported by people in all walks of life, and not just the uninsured or those with precarious
financial situations. In fact, people who have problems paying medical bills despite having health insurance are
more likely than the uninsured with medical bill problems to say they’ve put off vacations or major household
purchases (77 percent versus 64 percent), cut back spending on food, clothing, or basic household items (75
percent versus 62 percent), used up all or most of their savings (63 percent versus 51 percent), increased their
credit card debt (38 percent versus 24 percent), or taken money out of long-term savings (31 percent versus 17
percent) in order to pay medical bills. The opposite is true in one case; the uninsured with medical bill
problems are more likely than those with insurance to say they had to change their living situation in order to
pay these bills (23 percent versus 14 percent).
Put off vacations or other major household purchases
72%
77%
64%
Cut back spending on food, clothing, or basic
household items
70
75
62
Used up all or most of savings
59
63
51
Taken an extra job or worked more hours
41
42
40
Borrowed money from friends or family
37
37
38
Increased credit card debt
34
38
24
Taken money out of retirement, college, or other long-
term savings accounts
26
31
17
Changed your living situation
17
14
23
Taken out another type of loan
15
17
11
Borrowed money from a payday lender
13
15
12
Sought the aid of a charity or non-profit organization
12
11
15
Taken out another mortgage on home
2
1
2
Made other significant changes to way of life
15
15
16
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 16
In addition to the sacrifices listed above, fifteen percent of people who had problems paying medical bills
report making other significant changes to their way of life in order to pay these bills.
“Apartment instead of house. Not getting groceries some weeks to get by.”
“Charges for my insulin exceeded $1200 a month (3 times the amount of my house payment). I had to
reduce the amount of insulin I took based on what I could afford; my health was negatively impacted as a
result.”
“Cold showers, can't fix plumbing. Other needed repairs have been patched as best as possible but not
fixed.”
“Medical Insurance / bills was the deciding factor in a job change. I gave up other benefits to choose a job
that had the best medical coverage.”
“Sold everything we could spare.”
“Can’t take the kids anywhere. Wish I could do more for my kids!”
“I need physical therapy after shoulder repair but I couldn't afford to finish it. I wish I could have.”
“I am losing my house.”
“I've cut back on just about everything for my family and the way we live.”
For many, problems paying household medical bills can impact their ability to get (or continue getting) the
health care services they need. Overall, about three in ten (31 percent) of those who faced problems paying
medical bills say they had problems getting other health care they needed directly as a result of these problems.
While the problem is worse for those without insurance – among whom 41 percent say they had trouble getting
needed care care because of medical bills – it is also reported by about a quarter (26 percent) of those who had
insurance when their medical bill problems occurred.
More broadly, many of those with medical bill problems report delaying or skipping health care over the past
12 months because of the cost – at rates 2 to 3 times those of their counterparts who did not have problems
paying medical bills, regardless of their insurance status. For example, among those with health insurance, 43
percent of those with medical bill problems say there was a time in the past year when they or a family member
did not get a recommended medical test or treatment because of the cost, compared with just 13 percent of
those without such medical bill problems. Similarly, 41 percent of the insured who faced medical bill problems
say they did not fill a prescription in the past 12 months because of the cost, compared with 14 percent of those
with health insurance who did not have bill problems. Access to dental care can be affected, too; among those
with health insurance, 62 percent of those with medical bill problems report postponing dental care in the
previous year due to cost, compared with 29 percent of those without such problems.
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 17
Put off/postponed getting dental
care/check-ups
65%
31%
62%
29%
72%
42%
Relied on home remedies/over the
counter drugs instead of going to
see a doctor
62
32
58
30
71
44
Put off/postponed getting health
care you needed
60
22
58
21
65
37
Not filled a prescription for medicine
43
14
41
14
45
13
Not gotten a medical test/treatment
that was recommended by a doctor
43
13
43
13
43
13
Chosen a less expensive treatment
than the one your doctor
recommended
40
15
38
14
47
26
Cut pills in half/skipped doses of
medicine
34
9
32
9
39
13
Skipped/postponed rehabilitation
care that your doctor recommended
22
5
20
5
28
6
Medical bills can also lead to problems meeting other financial obligations and paying for basic necessities.
Among those with medical bill problems, about six in ten of both the insured (62 percent) and the uninsured
(62 percent) say they’ve had difficulty paying other bills as a result of medical debt. Over a third in each group
(34 percent of the insured and 39 percent of the uninsured) say they were unable to pay for basic necessities
like food, heat, or housing as a result of medical bills.
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 18
Although this survey focuses on the problems Americans face in paying medical bills, for many, medical bills
represent just one source of bills or debt. Most of those with medical bill problems report having other kinds of
debt, including credit card debt (56 percent), car loans (46 percent), student loans (33 percent), mortgages (32
percent), payday loans (17 percent), and other outstanding loans (31 percent). Among those with medical bill
problems, those with health insurance are more likely than those without insurance to report having credit
card debt (63 percent versus 43 percent), a car loan (52 percent versus 33 percent), or a mortgage (41 percent
vs. 16 percent), which may reflect better access to these types of credit among the insured group. However,
similar shares of the insured and uninsured report having a student loan (34 percent of the insured and 32
percent of the uninsured) and a loan owed to a payday lender (17 percent each).
35%
61%
34%
62%
39%
62%
Been unable to pay for basic necessities
like food, heat or housing
Had difficulty paying other bills (besides
basic necessities)
Total Insured Uninsured
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 13
Reports of Difficulty Paying Other Bills and Basic Needs As A
Result Of Medical Bills
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Percent who say
they have experienced any of the following in the past 12 months as a result of these medical bills:
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 19
For some of those with problems paying medical bills, medical debt makes up a large share of their total debt.
About one in five (22 percent, including 17 percent of the insured and 34 percent of the uninsured) say their
medical bills represent all or almost all of their total non-mortgage debt. By contrast, just over half (56 percent)
of the insured and about a third (36 percent) of the uninsured say they have either paid off all their medical
bills, or that medical debt makes up less than half of their total debt.
The survey also finds that once medical bill problems start, it can be difficult to make them stop, and that for
some, medical bills can start a cascade of other bill problems. Six in ten (60 percent) say this is not the first
56%
46%
33%
32%
31%
17%
63%
52%
34%
41%
32%
17%
43%
33%
32%
16%
29%
17%
Credit card debt
A car loan
A student loan
A mortage or home loan
Any other outstanding debts/loans
(besides medical bills)
A loan owed to a payday lender
Total
Insured
Uninsured
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 14
Many People With Medical Bill Problems Report Having Other
Types Of Debt
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Percent who say
they currently have the following types of loans or debt:
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Not counting
your mortgage, what share of your total debt would you estimate is due to medical bills?
NOTE: All or almost all includes those who still owe money for medical bills and have no other loans or debts. None or almost none includes
those who have paid off all medical bills. Don’t know/Refused responses not shown.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 15
Share of Total Debt Due to Medical Bills
26%
30%
19%
24%
26%
17%
12%
12%
13%
14%
14%
15%
22%
17%
34%
None or almost none Less than half About half More than half All or almost all
Uninsured
By Insurance Status
Total
Insured
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 20
time they’ve faced medical bill problems, a share that is even higher among those who say their bills are the
result of an ongoing health problem (67 percent) and those who say the family member who generated the bills
has a disability (69 percent).
Further, while almost half (47 percent) say they’ve also had problems paying other unrelated bills in the past
year, medical bills appear to be either the sole problem or the main trigger of bill problems for the other half,
including 31 percent who say they’ve only had problems with medical bills, not other types of bills, and 19
percent who say their problems paying other bills started as a result of their medical bills.
Many of those who’ve faced household medical bill problems report struggling to make payments, both for
their medical bills and for other bills. Six in ten (61 percent) say they have been late on a payment for a medical
bill, and almost as many (56 percent) say they’ve missed a payment. Similar shares report being late or missing
payments for other (non-medical) bills (56 percent and 46 percent, respectively). Once a person has problems
paying medical bills, their insurance status appears to make little difference in their ability to pay bills on time.
Among those with medical bill problems, similar shares of the insured and uninsured say they’ve been late on a
payment (62 percent and 63 percent, respectively) or missed a payment (55 percent and 61 percent) for a
medical bill in the past year.
Far fewer, though still roughly two in ten, say they’ve defaulted on a loan for a medical bill (17 percent),
including a somewhat higher share of the uninsured (23 percent) compared to those with insurance (15
percent).
This is NOT the
first time you
have had such
problems
60%
Don't know/
Refused
3%
This is the first
time you have
had such a
problem
36%
Thinking about your most recent problem with medical bills,
would you say this was first time you had such a problem, or
have you had problems paying medical bills before that?
Figure 16
Many with Medical Bill Problems Have Problems with Other
Bills
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS:
No other bill
problems
besides
medical bills
31%
Have had
other bill
problems,
result of
medical bills
19%
Don't know/
Refused
2%
Have had
other bill
problems,
not a result
of medical
bills
47%
In addition to problems paying medical bills, have you also
had problems paying other types of bills in the past 12
months, or not? / Did your problems paying other types of
bills start as a result of your medical bills, or for some other
reason?
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 21
Likely as a result of missed or late payments, almost six in ten (58 percent) of those with medical bill problems
say they’ve been contacted by a collection agency in the past year, mostly because of medical bills alone (25
percent) or a combination of medical bills and some other type of debt (20 percent). Again, once medical bill
problems start, insurance offers little protection against such follow-up, with similar shares of the insured (56
percent) and uninsured (63 percent) saying they’ve been contacted by a collections agency in the past 12
months.
Yes, contacted by collection agency
58%
56%
63%
Because of medical bills
25
26
22
Because of some other type of bills
12
10
15
Because of both
20
19
24
No, not contacted by collection agency
41
44
34
NOTE: Don’t know/Refused responses not shown.
An indication of more serious financial problems, a small share (2 percent) of those with household medical
bill problems say they’ve declared personal bankruptcy in the past year, and another 16 percent report
declaring bankruptcy longer than 12 months ago. Overall, 11 percent say they’ve declared bankruptcy at some
point and that medical bills were at least a partial contributor to their bankruptcy. Among those with medical
57%
46%
19%
56%
48%
21%
62%
55%
15%
63%
61%
23%
Been late on a
payment for a
medical/other bill
Missed a
payment for a
medical/other bill
Defaulted on a
loan for a
medical/other bill
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS: Percent who say
they’ve done any of the following in the past 12 months:
Figure 17
Many of Those With Medical Bill Problems Report Being Late
and Missing Payments, But Fewer Have Defaulted
Medical bills Other types of bills
Insured
Uninsured
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 22
bill problems, reports of having declared bankruptcy are similar among the insured (21 percent) and those
without health insurance (14 percent).
Declared bankruptcy in the past 12 months
2%
3%
1%
Declared bankruptcy more than 12 months ago
16
18
12
Because of medical bills
3
3
3
Because of some other type of bills
7
9
4
Because of both
8
10
7
Never declared bankruptcy
82
79
86
NOTE: Don’t know/Refused responses not shown.
In today’s health care environment where information about the cost of health care services can be difficult to
find, patients and families often need to be savvy consumers in terms of estimating the cost of care (or their
share of the cost if insured), finding the best price, and working out a payment plan after services have been
received. The survey finds that some of those who faced medical bill problems found health care providers
willing to cooperate with them in setting up payment plans or reducing the amount they owed, while others
attempted to engage in cost-conscious health care shopping behaviors and met with little success.
Broadly, the survey finds that a majority of people both with medical bill problems (61 percent) and without
(63 percent) say doctors rarely, if ever, discuss the costs of recommended treatments and whether they would
be covered by insurance.
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 23
The survey does find, however, that those who’ve had difficulty paying medical bills are more likely than their
peers to report taking extra measures to negotiate prices or shop around for health care.
Compared to those who have not experienced medical bill problems, those who have faced such problems are
more likely to say that in the past 12 months, they have checked with a doctor’s office about the cost a visit
beforehand (49 percent versus 34 percent), shopped around to find the best price for a medical service (34
percent versus 17 percent), or negotiated with a provider to get a lower price before receiving services (22
percent versus 6 percent). However, those with medical bill problems are also more likely than those without
such problems to say they have been told by a provider they must pay in full up front before services are
provided (36 percent versus 14 percent).
Figure 18
Few in Either Group Say Doctors Regularly Explain Costs of
Procedures
16%
16%
22%
21%
26%
29%
35%
34%
Those who had problems
paying household medical
bills in the past 12 months
Those who did NOT have
problems paying
household medical bills in
the past 12 months
Almost always Sometimes Rarely Never
When you visit a doctor, how often does the doctor explain to you the costs associated with recommended procedures,
and whether they would be covered by your health insurance?
NOTE: Don’t know/Refused responses not shown.
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 24
Despite these extra efforts, many of those who say they tried to engage in cost-conscious behaviors found it
difficult or unproductive. Seven in ten (69 percent) of those who shopped around for a lower price on medical
services say it was difficult to find information about how much they would have to pay, and 67 percent of
those who attempted to negotiate with a provider for a lower price say they were unsuccessful in doing so.
Just over half (53 percent) of those who had problems paying medical bills say they worked out a payment plan
with a provider for at least some of what they owed. Most of these (28 percent of the total) say they did not pay
34%
14%
17%
6%
12%
49%
36%
34%
22%
21%
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
Figure 19
Those with Medical Bill Problems More Likely to Report
Engaging in Cost-Conscious Behaviors
Percent who say they have done each of the following in the past 12 months:
AMONG THOSE WHO HAD
PROBLEMS PAYING HOUSEHOLD
MEDICAL BILLS IN THE PAST 12
MONTHS:
AMONG THOSE WHO DID NOT
HAVE PROBLEMS PAYING
HOUSEHOLD MEDICAL BILLS IN
THE PAST 12 MONTHS:
Received free care or reduced fees from a doctor,
hospital, or health care clinic
Been asked to pay up front for the full cost of
medical care (not just your insurance copay)
Tried to negotiate with a doctor, hospital, or other
health care provider to get a lower price before
receiving services
Attempted to shop around at different providers
to find the best price for a medical service
Checked with a doctor’s office or health plan
before a visit to find out how much you would
have to pay
Yes
32%
Don't know/
Refused
<1%
No
67%
Very easy
8%
Somewhat
easy
21%
Don't know/
Refused
1%
Somewhat
difficult
46%
Very difficult
23%
Figure 20
Many Say Shopping and Negotiating for Health Care Services
Can Be Difficult and Unproductive
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD
MEDICAL BILLS IN THE PAST 12 MONTHS AND SAY THEY
SHOPPED AROUND FOR HEALTH CARE PRICES: When you
shopped around for prices or checked before a visit, how
easy or difficult was it to find the information about how
much you would have to pay?
AMONG THOSE WHO HAD PROBLEMS PAYING
HOUSEHOLD MEDICAL BILLS IN THE PAST 12 MONTHS
AND SAY THEY TRIED TO NEGOTIATE FOR A LOWER PRICE
FOR HEALTH CARE SERVICES: When you negotiated with a
health care provider, were you able to get a lower price,
or not?
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 25
a finance charge to the provider, while 12 percent say they did pay a finance charge and another 12 percent are
not sure.
[My wife] had an issue in her lower abdomen with chronic pain and went to see her OB/GYN for a
professional opinion. She had the initial visit and needed to have some diagnostic lab testing done as well as a
further ultrasound. She got no notification of the fees that were expected to be paid and the doctor told her
that there was nothing to pay except the co-pay. Fast forward a few months and she gets a notice from the
office saying that her unpaid bill is being forwarded to collections and will need to be paid immediately. She
was never given notice before this collections notice and the fees seemed to be hidden or unknown to the
doctor's office. The disconnect between the medical services provided, and payment processing for those
services provided, seems to be one of the largest issues, where one party is unaware of what the other needs
to charge and does not give the patient the appropriate financial information in regards to the services being
rendered.
Many hospitals have programs available to reduce or waive bills for people who have trouble paying, and non-
profit hospitals are required to have such programs.
5
Among those who report problems paying hospital bills,
about half (47 percent) do not know if the hospital where they received care has such a program or not. Over a
quarter (27 percent) say the hospital does have such a program, and 15 percent signed up for it. Additionally,
fourteen percent of those who had problems paying medical bills other than hospital bills say a health care
provider agreed to reduce the amount they owed.
12%
28%
12%
Yes
53%
Don't know/
Refused
5%
No
43%
Figure 21
More Than Half of Those with Medical Bill Problems Have
Worked Out a Payment Plan with a Health Care Provider
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOUSEHOLD
MEDICAL BILLS IN THE PAST 12 MONTHS: Did you work out a
payment plan with any health care provider for at least some
of what you owed, or not?
ASKED OF THE 53% WHO SAY THEY WORKED OUT A
PAYMENT PLAN: (Percentages shown based on total who
had problems paying hospital bills)
Are you or were you paying interest or a finance charge to
the provider, or not?
Yes, paying interest or
a finance charge
No, not paying
interest or a finance
charge
Not sure
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 26
These survey findings confirm that problems related to unaffordable medical bills and medical debt are
prevalent, affecting roughly 1 in 4 non-elderly adults in the United States. Certain groups are more vulnerable,
including individuals and families with lower incomes and limited financial assets, people with chronic medical
conditions and disabilities, the uninsured, and people insured by plans with high deductibles. Even so, people
are not immune who have higher incomes, who are insured, or who are otherwise in good health and then
experience unexpected health problems.
Insurance features like cost-sharing, provider networks, and confusing billing practices can all lead to medical
bill problems among the insured. While higher deductibles and other forms of cost-sharing have helped to keep
health insurance premium growth at historically low levels in recent years, the survey highlights the
consequences these changes can have for people. Price transparency is another issue; while many say they tried
to research treatment option costs in advance, most say such information was difficult to find.
The survey also shows that medical bill problems can have real and often lasting impacts on individuals and
families in terms of their standard of living, their financial stability, and their ability to access needed health
care. While insurance provides some protection against incurring medical bill problems in the first place, once
these problems occur, the effects on individuals and families are often as serious for the insured as they are for
the uninsured. As the nation moves beyond the debate over the Affordable Care Act, issues of health care costs
and affordability like those highlighted by this survey are likely to play a prominent role in health policy
discussions. Information about the causes of medical debt and its impacts on people can play an important part
in these discussions and help policymakers and others as they work on solutions to alleviate the burden of
medical debt on American families.
12%
15%
Yes
27%
No
25%
Don't know
47%
Figure 22
Many Who Had Hospital Bill Problems Are Unaware of Hospital
Fee Reduction Programs
SOURCE: Kaiser Family Foundation/New York Times Medical Bills Survey (conducted August 28-September 28, 2015)
AMONG THOSE WHO HAD PROBLEMS PAYING HOSPITAL
BILLS IN THE PAST 12 MONTHS: Does any hospital where
you received care have a program to reduce or waive
bills for people who have trouble paying, or not?
ASKED OF THE 27% WHO HAD PROBLEMS PAYING
HOSPITAL BILLS IN THE PAST 12 MONTHS AND SAY THEIR
HOSPITAL HAS A PROGRAM TO REDUCE BILLS:
(Percentages shown based on total who had problems
paying hospital bills)
Did you enroll or sign up for the program, or not?
Yes, enrolled or signed up for
the program
No, did not enroll or sign up
for the program
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 27
Insurance status
Uninsured
53
Employer coverage
19
Non-group coverage
22
Medicaid
18
Deductible level (among those with
employer or non-group coverage
Private insurance, high deductible
6
26
Private insurance, lower deductible
15
Annual household income
Less than $50,000
37
$50,000-$99,999
26
$100,000 or more
14
Disability prevents from participating
fully in work, school, housework, other
activities
Yes
47
No
22
Self-reported health status
Fair/poor
45
Excellent/very good/good
22
Receiving regular medical treatment
for any chronic health problem
Yes
34
No
23
Gender
Male
23
Female
29
Age
18-29
31
30-49
24
50-64
25
Children in household
Yes
29
No
24
Education
High school or less
32
Some college
30
College graduate
16
Race/ethnicity
White, non-Hispanic
24
Black, non-Hispanic
31
Hispanic
32
Other/mixed race
25
Census Region
Northeast
18
Midwest
23
South
32
West
26
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 28
The Kaiser Family Foundation/New York Times Medical Bills Survey is based on interviews with a probability-
based sample of 2,575 respondents between the ages of 18 and 64 conducted August 28 through September 28,
2015. Interviews were administered online and by telephone in English and Spanish, including a longer
interview with 1,204 adults who reported problems paying household medical bills in the past 12 months and a
shorter comparison survey with 1,371 who did not report such problems. Teams from the Foundation and The
Times worked together to develop the questionnaire and analyze the data, and both organizations contributed
financing for the survey. Each organization is solely responsible for its content.
NORC at the University of Chicago conducted sampling, interviewing, and tabulation for the survey using the
AmeriSpeak Panel, a representative panel of adults age 18 and over living in the United States. AmeriSpeak
Panel members are recruited through probability sampling methods using the NORC National Sample Frame,
an address-based sampling frame. Panel members who do not have internet access complete surveys via
telephone, and internet users complete surveys via the web (for the current survey, 619 respondents completed
via phone and 1,956 via web).
The combined results have been weighted to adjust for the fact that not all survey respondents were selected
with the same probability, to address the implications of sample design, and to account for systematic
nonresponse along known population parameters. The first weighting stage addressed differences in
probability of selection for the AmeriSpeak Panel and to account for differential nonresponse to the
AmeriSpeak screening interview. At this stage, an adjustment was also made to account for the undersampling
of panelists who did not report problems paying household medical bills and to account for differential
nonresponse to the survey screening interview.
In the second weighting stage, the sample was adjusted to match known demographic distributions of the U.S.
population ages 18-64 by age, gender, education, race/ethnicity, Census region, and household income.
Demographic weighting parameters were based on the U.S. Census Bureau’s 2015 March Supplement to the
Current Population Survey.
The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage
points. All statistical tests of significance account for the effect of weighting. Numbers of respondents and
margin of sampling error for key subgroups are shown in the table below. For results based on other
subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other
subgroups are available by request. Note that sampling error is only one of many potential sources of error in
this or any other public opinion poll.
Group
N (unweighted)
M.O.S.E.
Total adults ages 18-64
2,575
±3 percentage points
Problems paying household medical bills past 12 months
1,204
±4 percentage points
No problems paying household medical bills past 12 months
1,371
±4 percentage points
Insured
802
±5 percentage points
Uninsured
369
±8 percentage points
Kaiser Family Foundation public opinion and survey research and NORC at the University of Chicago are both
charter members of the Transparency Initiative of the American Association for Public Opinion Research.
The Burden of Medical Debt: Results from the Kaiser Family Foundation/New York Times Medical Bills Survey 29
1
Medical Debt Among People With Health Insurance, Kaiser Family Foundation, January 2014. http://kff.org/private-
insurance/report/medical-debt-among-people-with-health-insurance/
2
People ages 65 and older also experience problems paying medical bills. However, since nearly all of them have access to health
insurance coverage through Medicare, and since their family budget considerations are often quite different from those of younger
adults, we limited this survey to those ages 18-64.
3
Throughout this report, higher deductibles are defined as $1,500 and above for an individual or $3,000 and above for a family.
4
Results are similar if respondents are grouped by an estimate of their income as a percentage of the federal poverty level (FPL) using
information on income and family size, rather than based on household income alone.
5
New Requirements for 501(c)(3) Hospitals Under the Affordable Care Act, Internal Revenue Service, https://www.irs.gov/Charities-&-
Non-Profits/Charitable-Organizations/New-Requirements-for-501(c)(3)-Hospitals-Under-the-Affordable-Care-Act
6
Throughout this report, higher deductibles are defined as $1,500 and above for an individual or $3,000 and above for a family.
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