Independent research, official data and evidence on U.S. medical billing
MEDICAL BILLING · KEY RESEARCH FINDINGS
What U.S. research
shows in numbers.
Selected findings from independent studies, nationally representative surveys and official U.S. data on medical debt, affordability, billing problems and consumer awareness.
MEDICAL DEBT 36% of U.S. households reported medical debt
Research using two nationally representative surveys found that approximately 36% of U.S. households had some form of medical debt in 2024. About 21% had a past-due medical bill and approximately 23% were paying a medical bill over time directly to a provider. The study also found that medical collections and medical debt are not the same measure and should be distinguished carefully.
Health Affairs Scholar · Original study
HEALTH CARE DEBT 41% of U.S. adults reported medical or dental debt
The KFF Health Care Debt Survey found that 41% of U.S. adults had some form of debt caused by medical or dental bills for themselves or someone else in their household. The measure included unpaid bills, provider payment plans, credit-card balances, loans and collection debt. The findings demonstrate how health care expenses can extend far beyond a single medical invoice.
KFF · Health Care Costs and Affordability
HEALTH CARE AFFORDABILITY 44% said health care costs were difficult to afford
KFF polling found that 44% of U.S. adults said it was very or somewhat difficult to afford their health care costs. The burden was especially pronounced among uninsured adults and people with lower household incomes. Having health insurance did not eliminate affordability concerns. The findings help explain why an unexpected medical bill can create significant pressure even for insured households.
KFF · Americans’ Challenges with Health Care Costs
PROBLEMS PAYING 28% reported problems paying for health care
KFF reported that 28% of adults said they or a family member had experienced problems paying for health care during the previous 12 months. Younger adults, people with lower incomes and uninsured adults were especially likely to report payment difficulties. These results illustrate how medical expenses can affect the finances of an entire household rather than one individual.
KFF · Health Care Cost Research
CARE SKIPPED BECAUSE OF COST 26% went without some medical care because of cost
The Federal Reserve reported that 26% of adults went without some form of medical care in 2025 because they could not afford it. Dental care was the most frequently skipped service, followed by seeing a doctor or specialist. Lower-income adults were substantially more likely to go without care because of cost. Uninsured adults also reported much higher rates of forgone care.
Federal Reserve · Economic Well-Being of U.S. Households
PRIVATE INSURANCE & MEDICAL DEBT 32% of privately insured adults were paying medical debt
The Commonwealth Fund found that 32% of working-age adults with private insurance were paying medical bills or debt over time. Among those with medical debt, 68% reported worry or anxiety. Thirty-seven percent said they had used some or all of their savings, while 30% delayed or avoided needed health care. Nearly two-thirds of people paying medical balances reported debt connected to hospital services.
Commonwealth Fund · Original survey
CONSUMER AWARENESS 54% were unsure they had the right to challenge a bill
Forty-five percent of insured working-age adults reported receiving a bill or copayment for a service they believed should have been free or covered by insurance. Fewer than half of those who believed the bill was wrong attempted to challenge it. Among those who did not challenge the bill, 54% said they were unsure they had the right to do so. Among those who challenged a bill, 38% reported that the amount was reduced or eliminated.
Commonwealth Fund · Unforeseen Health Care Bills
PATIENT SELF-ADVOCACY 61.5% contacted the billing office about a problematic bill
In a representative U.S. survey, about one in five respondents reported a medical bill they disagreed with or could not afford. Among those people, 61.5% contacted the billing office. Reported outcomes included bill corrections, improved understanding, payment plans, price reductions, financial assistance and bill cancellation. People without a college degree, those with lower financial literacy and uninsured respondents were less likely to reach out.
JAMA Health Forum · Original study
UNINSURED & COMPLEX HEALTH NEEDS 72% struggled with medical bills
KFF found particularly serious affordability problems among uninsured adults being treated for multiple health conditions. Seventy-two percent reported problems paying medical bills during the previous year. Half said they had cut back on household expenses because of health care costs. Uninsured adults with multiple conditions were also substantially more likely than insured adults to skip needed care because of cost.
KFF · Health Care Access and AffordabilityIllustrative stock photography via Unsplash. People and places pictured are not presented as study participants, customers, employees or endorsers.
TESTBERICHTEINSTITUT LLC · RESEARCH & EVIDENCE
Medical Billing
Research Reports
Independent research, official U.S. guidance and evidence on medical billing, medical debt, consumer awareness and patient experiences.
Testberichteinstitut reviews publicly available research, surveys, government guidance and institutional reports. The summaries below explain what the cited sources report; they do not imply that every medical bill is incorrect, reducible or legally disputable.
CONSUMER AWARENESSUnforeseen Health Care Bills & Coverage Denials
This national research examined experiences with unexpected health care bills and insurance coverage denials. A particularly important finding concerns people who believed that a medical bill contained an error but did not challenge it. Many reported uncertainty about whether they even had the right to question the bill. Among people who did challenge a bill, some reported that the amount was reduced or removed.
INSURANCE COMPLEXITYConsumer Experiences with Health Insurance
KFF surveyed insured adults about their experiences using health coverage in the United States. Many respondents reported difficulty understanding at least one part of their insurance. Areas of confusion included costs, coverage rules and insurance paperwork. Awareness of certain appeal rights was also limited, illustrating how difficult the system can be to navigate.
MEDICAL DEBTPaying for It: Health Care Costs & Medical Debt
This survey examined the financial consequences of health care costs for American households. Medical debt was associated with financial strain, worry and difficult household decisions. The findings show that a medical bill is often experienced as more than an administrative document. For many households it can become a significant source of uncertainty and financial pressure.
AFFORDABILITYHealth Care Costs Remain a Major Financial Concern
KFF polling in 2026 found that health care affordability remained a major concern for U.S. adults. The concern extends beyond one individual hospital invoice. Families may already be managing premiums, deductibles, prescriptions and other out-of-pocket expenses. A new medical bill can therefore arrive in an environment where financial pressure already exists.
HEALTH CARE AFFORDABILITYDifficulties Affording Health Care
Urban Institute research found substantial affordability difficulties among working-age adults. The findings place medical bills within a wider problem of access and household financial pressure. People facing affordability problems may need to understand exactly what they are being charged before deciding how to respond. Clear billing information is therefore an important part of informed consumer decision-making.
PRIVATE INSURANCEMedical Bills & Debt Among Privately Insured Americans
This research focuses on adults who had private insurance. It demonstrates that having health insurance does not necessarily eliminate problems with medical bills or debt. Respondents described both financial and emotional effects associated with unpaid medical balances. Hospital services were an important source of debt, while physician visits and diagnostic services also contributed.
OFFICIAL BILL REVIEW GUIDANCECheck Your Medical Bill for Errors
The Centers for Medicare & Medicaid Services provide consumer guidance for reviewing medical bills. Consumers are encouraged to compare billing information with other available documents and ask about charges they do not understand. CMS also discusses checking for possible duplicate charges and requesting additional billing details when appropriate. This guidance confirms that reviewing a bill is a normal consumer step.
SURPRISE MEDICAL BILLSNo Surprises Act Consumer Protections
Federal guidance explains protections that may apply to certain unexpected out-of-network medical charges. The law does not apply to every medical bill, but it created important protections for specific situations. Understanding whether those protections apply requires looking at the circumstances surrounding the care. The existence of these rules shows why consumers should understand a bill before assuming no further questions are possible.
FORMAL DISPUTE PROCEDURESPatient–Provider Dispute Process
Federal rules provide a formal dispute pathway for some uninsured or self-pay billing situations. The process is subject to specific eligibility requirements and does not apply universally. Its importance lies in demonstrating that formal mechanisms for questioning certain medical charges do exist. Consumers therefore benefit from understanding which type of billing situation they are facing before choosing a response.
PAYMENT DIFFICULTIESWhen a Consumer Cannot Pay a Medical Bill
The Consumer Financial Protection Bureau provides guidance for consumers facing medical bills they cannot afford. The information emphasizes understanding the bill, communicating with relevant organizations and exploring available options rather than simply ignoring correspondence. It also places medical bills within the larger framework of consumer financial protection. This is especially important when financial pressure is high.
MEDICAL COLLECTIONSMedical Debt, Collections & Consumer Rights
CFPB guidance addresses situations where a medical balance has reached a debt collector. Consumers may have specific rights concerning information, validation notices and disputes. The applicable rules depend on the collector, the timing and the circumstances. Understanding the difference between provider billing and third-party collection activity is therefore essential.
NATIONAL MEDICAL DEBTThe Burden of Medical Debt in the United States
KFF research has documented the substantial scale of medical debt in the United States. Medical debt can involve hospitals, physicians, diagnostic services and other forms of health care. The research helps demonstrate that billing problems affect a significant number of American households. It also provides important context for understanding why medical billing literacy has become a consumer issue.
CREDIT REPORTINGThe Federal Rule on Medical Debt
This policy explainer examines federal developments concerning medical debt and consumer credit reporting. Credit-reporting policy is separate from whether an underlying medical balance is legally owed. That distinction is important because consumers often combine billing, collection and credit issues into one problem. Research-based explanations help separate those questions and reduce misunderstanding.
STATE PROTECTIONSState Protections Against Medical Debt
Medical debt protections differ significantly across U.S. states. This report compares policies relating to collection activity, credit reporting and other consumer protections. The variation matters because a consumer’s options may depend partly on where the person lives. An institutional review of medical billing therefore must distinguish federal rules from state-specific protections.
COVERAGE DENIALSInsurance Claim Denials & Patient Financial Burden
A medical bill may sometimes be connected to an insurance coverage decision rather than a simple provider charge. Research on claim denials demonstrates how these decisions can create unexpected financial responsibility. Consumers may need to understand both the provider statement and the insurer’s explanation before deciding what to question. This distinction is fundamental to understanding complex medical billing situations.
PAST-DUE HOSPITAL DEBTPast-Due Medical Debt & Hospital Balances
Urban Institute research has examined where past-due medical debt originates. Hospital balances represent an important portion of the medical debt experienced by consumers. That finding reinforces the importance of understanding hospital billing practices and available assistance policies. It also demonstrates why hospital bills deserve careful, structured review before a consumer decides on next steps.
HOUSEHOLD HEALTH COSTSAmericans’ Challenges with Health Care Costs
KFF research repeatedly documents the financial pressure associated with health care in the United States. Medical bills interact with premiums, deductibles, prescription expenses and other household obligations. For consumers, a single bill can therefore arrive within a much larger affordability problem. This context helps explain why understandable billing information is so important.
BILLING & DEBT EVIDENCEMedical Bills & Debt Research Collection
The Commonwealth Fund maintains an extensive body of work addressing medical bills and medical debt. Its research covers affordability, insurance design, claim denials, debt and consumer protections. Reviewing the topic across multiple studies provides a more reliable picture than relying on a single statistic. This broader evidence base is valuable when evaluating how consumers experience the U.S. billing system.
FINANCIAL ASSISTANCEHospital Financial Assistance & Collection Requirements
Federal rules applicable to qualifying tax-exempt hospitals include requirements concerning financial assistance and certain collection practices. These protections do not mean that every patient qualifies for assistance or that all collection activity automatically stops. They do show, however, that consumers may have additional questions to ask before treating a hospital balance as a simple payment obligation.
RECORDS & INFORMATIONAccess to Existing Health & Billing Information
Federal HIPAA guidance explains rights concerning access to qualifying existing health information. Records can be useful when a consumer is trying to understand what services were documented and how those records relate to billing information. Access rights do not necessarily require a provider to create an entirely new document. Understanding that distinction helps consumers make more precise and realistic requests.
Making complex medical billing information easier to understand.
Testberichteinstitut specializes in researching U.S. medical billing, consumer information and practical self-help approaches. Our work focuses on helping ordinary people understand what a medical bill shows, what questions they can ask and which official procedures may be relevant to their situation. We translate complex research, public guidance and billing concepts into a structured system that can be followed step by step. Our objective is not to promise a particular result, but to make reliable information and practical organization easier to use.