Summary

Unexpected Medical Bills

Forty-two percent (42%) of Kansas respondents received an unexpected medical bill in the past year. When asked about the nature of their bill, half (50%) of respondents reported that the amount was higher than anticipated, and 34% reported that the bill was from a provider that they didn’t expect to receive a bill from. In smaller numbers, 13% reported being charged out-of-network rates by a provider they believed was in-network,7% reported being charged for services they did not receive, and 17% reported experiencing something else unexpected.

Unexpected medical bills were most frequently reported as coming from a hospital (56%), doctor’s office (42%), and lab (28%) followed by a medical clinic (24%), pharmacy (12%), ambulance services (12%), and pregnancy-related services (4%). Unexpected bills can be a major contributor to health care debt. A national survey found that many medical debts come from one-time or short-term medical expenses, which are often unexpected, and that many households don’t have the cash to cover an unexpected $500 health care bill.¹

Among respondents with unexpected bills, those with employer-sponsored and individually purchased insurance (e.g., through the health care Marketplace) most frequently reported unexpected medical bills (52% and 50%, respectively), followed by respondents enrolled in KanCare, the state Medicaid program (42%) and the VA (35%).

Respondents made various attempts to resolve their unexpected medical bills, with nearly half (44%) taking more than one step. Many contacted their health plan (45%) or provider (49%), and some attempted to challenge the bill or negotiate a lower bill (21%), while few others paid the bill without disputing it (4%), filed an insurance appeal (3%) or formal complaint (7%) (see Table 1).

Just 38% of respondents with an unexpected medical bill indicated that the issue was resolved to their satisfaction (see Table 2). Notably, there was not a significant difference between the effort taken to resolve a bill and if the bill was resolved satisfactorily. Additionally, respondents who took extra effort to resolve their bill more frequently reported the issue being resolved, but not to their satisfaction (34%) than those who took no extra effort (22%).

Regardless, most respondents reported that they settles their bills by paying in full (37%) or through a payment plan (19%), while a smaller number successfully negotiated a lower bill (9%) or had their bill dismissed (7%) (see Table 3). Some respondents (10%) were contacted by a collection agency, while few (2%) filed for bankruptcy.

Financial Burdens Due to Medical Bills

Many survey respondents have experienced financial burdens due to medical bills. Almost half (43%) reported experiencing one or more of these struggles to pay their medical bills in the last year:

• 17%—Used up all or most of their savings
• 16%—Were contacted by a collection agency
• 12%—Were unable to pay for basic necessities like food, heat or housing
• 11%—Were placed on a long-term payment plan
• 9%—Borrowed money, got a loan or another mortgage on their home
• 9%—Racked up large amounts of credit card debt
• 5%—Asked for donations (GoFundMe campaigns)

Notably, the survey results found that respondents ages 25-34 reported the highest rates of medical cost burdens (59%), followed by those age 18-24 (57%). Similarly, Respondents of Color reported experiencing at least one of the above medical cost burdens more frequently than white, non-Hispanic respondents. 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 marketplace coverage reported the highest rates of the above burdens due to medical bills (60%) compared to respondents with all other insurance types (see Table 4).

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 Kansas survey respondents as well: 30 percent 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 (16%), borrowing money, getting a loan or another mortgage on their home (9%), racking up large amounts of credit card debt 9%), and being placed on a long-term payment plan (11%).

Among those with outstanding medical bills, the most common amount of medical debt reported was less than $500, reported by 59% of respondents. The next most frequently cited amounts were $1,000-$2,499 (11%), $2,500 – $4,999 (9%) and $500 – $999 (8%). Still, some respondents (5%) report owing over $10,000 in medical debt. The duration of medical debts varied, with the largest share having a medical debt in their family for less than a year (70%) followed by 1-2 years (17%) and 3-5 years or more than 5 years (both 7%). Most respondents had never been given an opportunity to have their medical debt relieved (66%) or erased (65%).

Medical debt affects both insured and uninsured people (see Table 5). 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.

Nearly three in every four (72%) respondents with medical debt had health insurance at the time they incurred the debt. At the time of the survey, just under half (44%) reported being covered by employer-sponsored insurance, followed by Medicare (23%), insurance bought on the Marketplace exchange (13%), and KanCare (8%). Most respondents (83%) had no gaps in coverage in the past 12 months.  

When asked why they incurred medical debt, almost half (40%) of all respondents reported incurring medical debt because their insurance only covered a portion of the service and the remaining bill was too high, while 17% reported that their insurance did not cover the service at all. Notably, larger shares of those with KanCare reported insurance not covering the service at all as the reason for their medical debt compared to other coverage tyles. In contrast, those with employer-sponsored or individually purchased insurance reported higher rates of incurring medical debt because their insurance only covered a portion of the service when compared to other coverage types (see Figure 1).

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

• 56%—Hospital
• 42%—Doctor
• 28%— Laboratory (lab tests, x-rays, scans)
• 24%—Medical Clinic

In lesser numbers, people selected pharmacies (12%), ambulance services (9%), and pregnancy-related expenses (4%) 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 6), as well as the amounts and reasons for incurring medical debt.

Income

Those earning less than $50,000 reported the highest rates of medical debt, followed by those earning $50,001 – $75,000 annually (see Table 6). While 75% of respondents with household incomes of less than $50,000 per year report having less than $2,500 in medical debt, roughly 1 in 10 (9%) owe more than $10,000 in medical debt (see Figure 2). Interestingly, a higher proportion of respondents with household incomes above $100,000 per year report owing less than $500 in medical debt (70%) than respondents in any other income bracket.

Medical debt affects people across the income spectrum. While medical debt is most prevalent among low- and middle-income households, even high-income households are exposed to medical debt for similar reasons, including being unable to afford medical bills and expecting insurance to pay for services.¹²

Those earning $50,000 – $75,000 reported the highest rates of accruing medical debt because their plan only covered a portion of the service and the remaining bill was too high (49%). Likewise, this was the most cited reason for accruing medical debt across all other income brackets (see Figure 3).

Those earning $50,000 – $75,000 also reported the highest rates of accruing medical debt because their insurance didn’t cover the service at all (18%). This was also the second most cited reason for accruing medical debt across all other income brackets. Finally, all income brackets cited their deductible being too high as the third leading cause of accruing medical debt.

Age

Respondents of different ages reported different incidence of medical debt. Those ages 25-34 reported the highest rates of medical debt, followed by those ages 18-24 (see Table 7). The most commonly reported amount of medical debt owed among respondents was less than $500. Of those who owed less than $500, respondents age 65+ had the highest rate of owing this amount (90%), followed by those ages 55 – 64 (72%). For debt of a higher amount, such as debt between $1,000 and $4,999, respondents ages 25-34 had the highest rate of owing this amount (27%) followed by those ages 35-44 (22%) (see Figure 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 Kansas respondents’ rates of worry about their ability to afford health care in the present and the future. Respondents ages 18 – 24 and 45 – 54 reported the highest rates of worry about not having enough money to pay for a major unexpected illness or injury (both 68%). In addition, respondents ages 18 – 24 reported the highest rates of worry about being able to afford maternity or reproductive care (53%).

Interestingly, worry about affording the cost of nursing home or home care services and medical costs when elderly was most frequently reported by middle aged and respondents: 66% percent of respondents between the ages of 25-34 and 78% of respondents aged 45-54 reported being worried about affording medical care when elderly, and 61% of respondents 18-24 reported being concerned about affording nursing home or home care costs. This could suggest that Kansas respondents may be worried about affording the cost of care for both themselves and aging relatives.

Across age groups, respondents report similar reasons for accruing medical debt. 59% of respondents ages 18 – 24 and half (50%) of respondents ages 25 – 34 report accruing medical debt because their plan only covered a portion of their service and the remaining bill was too high (see Figure 5). Respondents ages 25 – 34 also reported higher rates of accruing medical debt because their insurance did not cover the needed service at all (21%) compared to other age groups. The third most cited reason for all ages for accruing medical debt was because their deductible was too high, and respondents ages 35-44 reported this more frequently than respondents of other ages (11%).

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 (47%) compared to those without a household member with a disability (23%) (see Table 8). Both respondents with a household member with a disability and those without most frequently reported owing less than $500 in medical debt (see Figure 6).

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 a household member with a disability reported similar reasons for accruing medical debt as those without. 46% of respondents with a household member with a disability reported that they accrued medical debt because their plan only covered a portion of the service and the remaining bill was too high compared to 38% percent of those without a household member with a disability. Similarly, 20% of those with a household member with a disability had medical debt because their insurance did not cover the service at all and 16% of those without a household member with a disability cited the same reason (see Figure 7).

Race and Ethnicity

Differences in medical debt exposure were also seen across racial/ethnic groups. Respondents of color reported higher rates of medical debt (36%) compared to White alone non-Hispanic respondents (29%) (see Table 9). Hispanic/Latino respondents reported owing more than $10,000 in medical debt at a higher rate than other races/ethnicities (7%). And Black/African American respondents reported owing $1,000 – $2,499 more frequently than other races/ethnicities (19%). White alone non-Hispanic respondents owed less than $500 at a higher rate than other races/ethnicities (62%) (see Figure 8). 

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. Kansas respondents endorsed several strategies, including:

• 94%—Show what a fair price would be for specific procedures;
• 94%—Require insurers to provide up-front cost estimates to consumers;
• 93%—Require hospitals and doctors to provide up-front cost estimates to consumers;
• 89%—Establish standard payments to hospitals for specific procedures;
• 90%—Expand health insurance options so that everyone can afford quality coverage

In addition, 84% of respondents thought that it was moderately or extremely important for the state to maintain 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 10). It must be noted that, although price transparency tools can help identify unwarranted 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

Kansas 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 Kansas and strategies that survey respondents support, please see the Kansas Health Care Affordability Consumer Healthcare Experience State Survey.