Financial Burdens Due to Medical Bills

Many survey respondents have experienced financial burdens due to medical bills. Over one-third (39%) reported experiencing one or more of these struggles to pay their medical bills in the last year:

• 17%—Were contacted by a collection agency
• 14%—Used up all or most of their savings
• 14%—Were unable to pay for basic necessities like food, heat or housing
• 10%—Borrowed money, got a loan or another mortgage on their home
• 8%—Racked up large amounts of credit card debt
• 8%—Were placed on a long-term payment plan
• 4%—Asked for donations (GoFundMe campaigns)

Notably, the survey results found that respondents ages 18 to 24 and 25 to 34 reported the highest rates of medical cost burdens (both 47%), followed by those ages 35 to 44 and 45 to 54 (both 44%). Similarly, respondents of color reported experiencing at least one of the above medical cost burdens more frequently than white, non-Hispanic respondents. Respondents living in rural Oklahoma reported a financial burden due to medical bills at a higher rate (43%) compared to those living in suburban and urban Oklahoma. Likewise, respondents with a disability or who live with a person with a disability also reported navigating medical cost burdens more frequently than respondents without a disabled household member, and respondents with Medicaid coverage reported the highest rates of the above burdens due to medical bills (50%) compared to respondents with all other insurance types (see Table 1).

Medical Debt and Health Insurance

In the absence of affordable care options, individuals may find themselves burdened by medical costs. In 2024, nearly 100 million Americans owed over $220 billion in medical debt.² Medical debt is largely driven by unaffordable bills: many Americans with private coverage must pay thousands of dollars in out-of-pocket expenses to get care, including increasingly high premiums, deductibles, co-insurance, and copayments.^3,4,5 This lack of affordability is reflected in national survey findings that roughly half of adults say they could not pay a $500 unexpected medical bill, and would either have to incur debt to pay it or would not be able to pay the bill at all.⁶ These factors contribute to the rising amount of medical debt that many Americans face, which negatively impacts long-term financial security and ability to afford care in the future.

Medical debt is an issue for Oklahoma survey respondents as well: twenty-six percent (26%) of respondents reported that they or a family member had outstanding medical bills. Alongside outstanding bills, specific financial burdens related to medical debt included being contacted by a collection agency (17%), borrowing money or getting a loan or another mortgage on their home (10%), racking up large amounts of credit card debt (8%), and being placed on a long-term payment plan (8%).

Among those with outstanding medical bills, the most common amount of medical debt was $1,000-$2,499, reported by twenty-two percent (22%) of respondents. The next most frequently cited amounts were less than $500 (19%), over $10,000 (15%), and $1,000 – $2,499 (14%). The duration of medical debts varied, with the largest share having a medical debt in their family for less than a year (38%) followed by 1-2 years (35%) and 3-5 years (14%).

Medical debt affects both insured and uninsured people (see Table 2). Medical debt can be common among uninsured people in part because they are responsible for the full cost of care.^7,8 Those with employer-sponsored, individual, and marketplace insurance may also be exposed to medical debt through high cost-sharing.⁹ While Medicaid and Medicare enrollees often have low or no cost-sharing, they may have fewer covered services, such as dental care, or a lack of providers who will accept their insurance, requiring them to pay out-of-pocket. ^{10, 11} All of these factors can contribute to medical debt across insurance types.

Whether covered through an employer, the individual market, Medicare, or Medicaid, many respondents said cost limits their ability to access care. Nearly 3 in 4 (73%) of those with medical debt had health insurance at the time they incurred the debt. At the time of the survey, 38% of respondents reported being covered by employer-sponsored insurance, followed by SoonerCare (15%), Medicare (12%), and insurance bought on the Marketplace exchange (10%). Over three in four respondents (78%) had no gaps in coverage in the past 12 months.  

Medical debt is an outcome of the system’s cost-sharing design: insurers pay their portion of the claim, and patients absorb the remaining charges, which vary based on provider pricing and insurance coverage. Sixty percent of respondents said they incurred medical debt because after their plan paid its portion, the remaining charges were still too high for their budget. Another 16% said the service they needed wasn’t included in their plan’s coverage, leaving them responsible for the full amount.

Respondents most frequently identified the following services as the source of their medical debt:

• 67%—Hospital
• 35%—Doctor or technician in hospital
• 34%—Laboratory (lab tests, x-rays, scans)
• 21%—Doctor or technician not in hospital
• 15%—Urgent Care center

In fewer numbers, people selected dental offices (11%), pregnancy-related expenses (6%), physical therapist or pain management clinic (6%) and mental healthcare or addiction treatment (6%) as the source of their medical debt. 

Differences in Amount and Reasons for Medical Debt

Medical debt affects consumers across incomes, age groups, and other demographic characteristics; however, there are differences in the prevalence of medical debt across groups (see Table 3), as well as the amounts and reasons for incurring medical debt.

Income And Age

Those earning less than $50,000 reported the highest rates of medical debt, followed by those earning $100k or more (see Table 6). Respondents of different ages reported different incidences of medical debt. Those ages 45 to 54 reported the highest rates of medical debt, followed by those ages 25 to 34 (see Table 4).

Nationally, rates of medical debt are higher among middle age and young adults, who are more frequently exposed to the combined high cost of care for themselves, children, spouses, and aging relatives.¹³ Studies have also found that large shares of non-elderly households cannot afford to pay typical cost-sharing amounts, especially those with low incomes.¹⁴ Medical debt impacts long-term financial security, with many adults delaying buying homes and education.¹⁵

Although the prevalence of health care debt can decline with age, one in five adults ages 65 and older still have medical debt nationwide, with roughly one-third taking money out of retirement, college, or other long-term savings accounts.¹⁶ In addition, adults of all ages have reported medical debt negatively impacting their credit scores.¹⁷ These conditions can make it more difficult for adults of all ages to afford needed care in the future.

This may be reflected in Oklahoma respondents’ rates of worry about their ability to afford health care in the present and the future. Respondents aged 18 to 24 reported the highest rates of worry about not having enough money to pay for a major unexpected illness or injury (64%). In addition, the same age group (18 to 24) reported the highest rates of worry about being able to afford maternity or reproductive care (51%).

Respondents ages 45 to 54 also reported the highest rates of being concerned about affording nursing home or home care costs (72%), and all respondents under age 65 reported this at a higher rate than those aged 65 and older (44%). This could suggest that Oklahoma respondents may be worried about affording the cost of care for both themselves and aging relatives.

Disability

Some of the highest rates of medical debt were seen among households that include a person with a disability. Respondents whose households included a member with a disability reported higher rates of medical debt for themselves or their family (39%) compared to those without a disabled household member (20%) (see Table 5).

While medical debt occurs across demographic groups, people with disabilities and health issues often report higher rates of medical debt.¹⁸ People with complex health needs require ongoing care and can incur high out-of-pocket costs as a result.¹⁹ They may also experience unemployment and income loss, further impacting their ability to afford medical bills.²⁰

Respondents with and without a household member with a disability reported similar reasons for accruing medical debt. Sixty-two percent of respondents who have a household member with a disability said they accrued medical debt because their plan covered only part of the service and the remaining bill was too high. This compares to 57% of respondents in households without a member with a disability. Interestingly, 18% of those without a household member with a disability had medical debt because their insurance didn’t cover the service needed at all and 14% because their deductible was too high, both higher rates than households with a member with a disability (see Figure 5).      

Race and Ethnicity

Differences in medical debt exposure were also seen across racial/ethnic groups. Respondents of color reported higher rates of medical debt (30%) compared to white, non-Hispanic respondents (24%) (see Table 6). Respondents of color most commonly reported owing less than $500 in medical debt (25%) whereas respondents who were white, non-Hispanic most commonly reported owing between $1,000 and $2,499 in medical debt (25%). 

Support for Solutions Across Party Lines

The burden of health care costs and the widespread support for solutions indicate that policymakers can prioritize addressing these consumer challenges. Oklahoma respondents endorsed several strategies, including:

• 92% — Prohibit extra fees that aren’t connected to the cost of your care, like hospitals charging facility fees at offices and clinics miles away from the hospital campus; 
• 91% – Prevent hospitals from charging more for routine health care services that are most often provided in a doctor’s office;
• 91% — Limit the price of expensive prescription drugs; 
• 90% — Rein in how quickly prescription drug prices can increase in the private health insurance market (Medicare and Medicaid already do this); 
• 89% – Limit the prices at expensive hospitals in the private health insurance market (Medicare and Medicaid already set hospital prices for their markets); 
• 88% – Integrate the Medicaid and Medicare programs for people who are eligible for both to make it simpler for them to navigate those programs;
• 84% – Change the way we pay doctors and hospitals to reward quality outcomes rather than quantity of services; 
• 84% – Make it easier for people to apply for and renew their Medicaid coverage; and
• 82% — Allow the government to limit and prevent health care mergers that could reduce competition and increase health care prices.

In addition, 81% of respondents thought that it was moderately or extremely important for the state to maintain or in some cases expand Medicaid funding to prevent medical debt and improve access to care for those who need it most. Support for solutions extended across the aisle, reflecting bipartisan agreement on the need for greater health care price transparency and policies designed to reduce the frequency of unexpected medical bills and out-of-pocket costs (see Table 7). It must be noted that, although price transparency tools can help identify unexplained price variation, these tools alone do not make markets more efficient and generally fail to encourage consumers to shop for lower-priced services.²¹ Instead, policymakers may consider a combination of transparency tools and evidence-based policies to effectively address these issues.

Conclusion

Oklahoma respondents report receiving unexpected medical bills that are often higher than anticipated. While some disputed their bills, many ended up paying them in full. In some cases, respondents experienced financial burdens to pay their medical bills, such as using up all their savings and going without other necessities. In other cases, respondents were unable to pay and had outstanding bills resulting in medical debt, or experienced other financial burdens due to medical bills such as credit card debt, loans, and bills going to collections. Respondents largely incurred medical debt due to unaffordable out-of-pocket costs. The majority had health insurance, and most reported incurring medical debt because their insurance plan did not cover the service, or because their deductible or co-insurance was too high and they could not afford to pay it.

Respondents across the political spectrum expressed support for policies to increase health care price transparency and curb excess prices that could lead to high out-of-pocket costs. However, while some system level changes can reduce prices and make them more transparent to consumers, if the resulting costs remain unaffordable for consumers, medical debt will continue to be an issue. Given the financial impacts of high medical bills and medical debt, state policymakers can use these insights to investigate policies that protect consumers from unaffordable out-of-pocket costs and prevent medical debt before it occurs. For more information on healthcare affordability in Oklahoma and strategies that survey respondents support, please see the Oklahoma Health Care Affordability Consumer Healthcare Experience State Survey.