Journal / Essay

The Math of Medical Debt

The healthcare-cost piece in this journal covered what care costs and how much shorter Americans live for that spending. This one covers what happens after the bill arrives and the money isn't there — and why two honest surveys can report wildly different numbers for the same problem.

And Then You're Dead · August 2026 · 6 min read

The emergency entrance of an American hospital — The bill starts here. Where it ends up — a payment plan, a credit card, a family loan, a collections account — is a separate, much longer story.

Ask how many Americans have medical debt and the honest answer depends entirely on what's allowed to count as medical debt. That's not evasion — it's the actual, documented gap between two legitimate ways of measuring the same underlying problem.

The Narrow Number

The federal government's own survey data, tracking debt that households explicitly report as unpaid medical bills, produces a comparatively modest figure.

American adults — nearly 1 in 12 — owe medical debt by the strict survey definition, per federal data

$0B

total medical debt owed nationally under that same narrow measure

This is the number that shows up in most official statistics, and it's real. It's also missing most of how people actually cover a medical bill they can't pay outright.

The Number Underneath It

A 2022 investigation broadened the definition to include the ways people actually finance care they can't afford up front: hospital installment plans, credit card balances, and money borrowed from family. Counted that way, the picture changes entirely.

More than 100 million people in America — 41% of adults — are carrying some form of health care debt, once payment plans, credit cards, and family loans are counted alongside overdue bills.

adults — roughly 1 in 5 — are paying off medical or dental bills through an installment plan with a provider

of all debt recorded in collections nationwide is for a medical bill

Both figures are correct. They're just measuring different things: money owed directly and reported as such, versus the much larger universe of debt that started as a medical bill and got restructured into something that doesn't show up in a "medical debt" column anymore — a Visa balance, a personal loan, an IOU to a parent.

Who Carries It

Insurance status changes the odds, but doesn't eliminate them — a specific, uncomfortable finding given how much of the national conversation about medical debt assumes it's an uninsured-only problem.

of adults uninsured for part of the year report medical debt

of adults insured the entire year report medical debt — lower, but far from zero

Among seniors carrying medical debt specifically, 37% report having to cut spending on food, clothing, or other essentials to manage it — a population that is, by definition, insured through Medicare.

And Then You're Dead

The narrow number and the broad number aren't in conflict. They're the same debt, measured before and after it gets absorbed into the rest of a household's finances — restructured into a payment plan, a credit card minimum, a loan from someone who loves you. Either way it started with a bill for care that wasn't optional, sent to someone who didn't have the money sitting ready for it. That's the plan. That's the math.

That's it. That's the whole thing.

Read about healthcare spending · or see every essay

Sources

Narrow medical debt figures (20 million adults, $220 billion, insured vs. uninsured rates, debt over $10,000) — Peterson-KFF Health System Tracker
Broad medical debt figures (100 million people, 41% of adults, payment plans, family loans, collections share, senior spending cuts) — KFF Health News, "Diagnosis: Debt" investigation
Additional context and 2019 baseline estimate — KFF, "The Burden of Medical Debt in the United States"

Photo: Holyoke Medical Center emergency entrance, via Wikimedia Commons (CC BY 3.0).