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- Insured people still accumulate medical debt despite having health coverage.
- Rising health benefit costs may prompt employers to downgrade plans and shift more costs to employees.
- Loss of Affordable Care Act subsidies pushed many toward lower-quality plans with weaker protection for catastrophic or chronic care.
- Focus groups revealed people were surprised by large medical bills despite having insurance.
“Medical-debt issues often stem from routine care, including doctor’s office visits and treatment for chronic conditions,” says Sara R. Collins, a senior scholar at the Commonwealth Fund and one of the authors of the report. High deductibles are another common source. “People are just dealing with routine care and bills that build up over time.”
The study, which consisted of interviews among a nationally representative sample of more than 6,300 adults in 2025, also included analysis of focus groups in which people expanded on their experiences with health care. In the focus groups, many people expressed surprise at how high their medical bills were despite their insurance coverage, Collins says.
The problem of insured Americans with medical debt could grow in the coming years as health insurance becomes less affordable. Already, the cost of health benefits per employee is projected to rise 8.2% in 2027, the highest increase since 2003, according to an August survey by Marsh, and some employers may downgrade their plans and shift more costs to employees, employers told Marsh. What’s more, after Congress decided not to renew subsidies for people buying health insurance from Affordable Care Act Exchanges, many consumers switched to lower quality plans that will cost them more if they have catastrophic or chronic health issues, according to April data from the Center on Budget and Policy Priorities.
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