Executive Summary

Medical debt remains a common consequence of high and unpredictable out-of-pocket medical costs. Findings from the Consumer Healthcare Experience State Survey (CHESS) illustrate how unexpected medical bills and affordability challenges contribute to financial strain for many Ohio households.

This brief describes findings from a survey of more than 1,400 Ohio adults, conducted by Altarum’s Healthcare Value Hub from June 30 to July 6, 2026, to examine experiences with unexpected medical bills, financial burden, medical debt, and support for policy solutions.

Key findings include:

• Unexpected medical bills are not uncommon: 26% received an unexpected medical bill in the past year.
• Financial strain affects many households: 36% experienced financial burdens due to medical bills, including using up all or most of their savings, going without basic necessities, accumulating credit card debt, or being contacted by a collection agency.
• Medical debt persists despite coverage: 26% reported that they or a family member had outstanding medical bills; among those with medical debt, 21% reported their insurance plan did not cover the service, and 24% reported their deductible was too high.
• Large debts exist but the majority of debt is under $5,000: 13% of respondents reported owing at least $10,000 in medical debt.59% of respondents reported owing less than $5,000.
• Support for solutions across party lines: Respondents across political affiliations express strong support for government-led solutions to reduce out-of-pocket costs and increase price transparency.

Together, these findings show that medical debt is closely tied to unpredictable medical bills and unaffordable out-of-pocket costs, even among insured Ohio respondents, and highlight broad public support for policies that prevent medical debt.

Background

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.¹ 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.^2,3,4 This lack of affordability is reflected in national survey findings showing that many medical debts stem from one-time or short-term medical expenses that are often unexpected,⁵ and 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 negatively impact long-term financial security and ability to afford care in the future.

The aim of this brief is to present findings from the Ohio CHESS survey on unexpected medical bills, financial burdens due to medical costs, medical debt, and support for policy solutions. Detailed information on the survey methods, sampling approach, and study population is provided in the Appendix.

Unexpected Medical Bills

Twenty-six percent (26%) of Ohio respondents received an unexpected medical bill in the past year. Among respondents who received an unexpected bill, experiences varied by coverage. Respondents enrolled in Medicare (80%), most frequently reported an unexpected medical bill followed by Ohio Medicaid (78%), employer-sponsored (71%) and individually purchased insurance (e.g., through the health care Marketplace (62%).

Financial Burdens due to Medical Debt

More than one-third of Ohio respondents (36%) reported experiencing at least one financial burden due to medical costs in the last year. Financial burdens were not evenly distributed across the population. Higher rates of medical cost-related burden were reported among younger adults, respondents of color, respondents with a disability or who live with a person with a disability, and respondents with Medicaid. The findings in Ohio are consistent with what we see across the National CHESS data set regarding the impact of financial burdens from medical costs (Table 1).

Respondents reported a range of strategies and consequences when trying to manage medical expenses. Thirteen percent reported being contacted by a collection agency. Twelve percent (12%) reported going without basic necessities like food, heat or housing due to medical bills, 11% reported using up all or most of their savings. Fewer respondents reported borrowing money or taking out a loan or another mortgage on their home (9%), being placed on a long-term payment plan (9%) or accumulating large amounts of credit card debt (8%).

Table 1. Percent of Respondents who Experienced a Financial Burden Related to Medical Bills, by Selected Characteristics

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
Note: The Respondents of Color category includes respondents who are: Black or African American, Hispanic or Latino, American Indian or Native Alaskan, Asian, Native Hawaiian or another Pacific Islander. The quantity of responses for individual groups not shown above were insufficient to report reliable estimates. The Disability Status category includes respondents who responded that they or someone in their household identifies as having a disability or long-term health condition related to mobility, cognition, independent living, hearing, vision, and self-care.

Medical Debt and Health Insurance

Twenty- five percent (25%) of Ohio respondents reported that they or a family member currently have outstanding medical bills (Table 2). Among respondents with medical debt, the most commonly reported amount was $1,000-$2,499 (24%), followed by less than $500 (21%), $500 – $999 (15%), $2,500 – $4,999 (13%), and $5,000 – $7,499 (10%). Still, more than 1 in 10 respondents (13%) report owing over $10,000 in medical debt.

Medical debt frequently occurred despite insurance coverage. Some respondents with medical debt (26%) reported having health insurance at the time they incurred the debt, and three in four respondents (84%) had no gaps in coverage in the past 12 months. At the time of the survey, just under half (40%) reported being covered by employer-sponsored insurance, followed by Ohio Medicaid (18%), Medicare (13%), insurance bought on the Marketplace exchange (9%). Medical debt affects both insured and uninsured respondents (Table 2).

Table 2. Percent with Outstanding Medical Bills in the Previous 12 Months, by Insurance Type

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Respondents identified multiple reasons for incurring medical debt, reflecting differences in insurance coverage (Figure 1). Fifty-seven (57%) stated my insurance only covered a portion of the service, and the remaining bill is too high. Followed by my insurance didn’t cover the service at all (10%), my deductible was too high to meet (10%), and 3% reported that their coinsurance was too high. Notably, larger shares of those with Ohio Medicaid reported their insurance plan did not cover the service, while those with Medicare more frequently reported high deductibles as the primary reason for debt.

Respondents most frequently identified hospital services (64%) and doctor or technician services in the hospital (35%) as the source of their medical debt. Other commonly reported sources included laboratory services (lab tests, x-rays, scans) (28%), doctor or technician services not in hospital (22%), and urgent care centers (14%). Smaller proportions cited dental offices (13%), mental healthcare or addiction treatment (12%), physical therapy or pain management services (9%) and pregnancy-related expenses (7%), as the source of their medical debt. 

Figure 1. Reasons for Accruing Medical Debt, by Coverage Type

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Differences in Amount and Reasons for Medical Debt

While insurance coverage plays a central role in how medical debt occurs, the prevalence and severity of medical debt also vary across income, age, disability status, and race and ethnicity.

Income

Medical debt was reported across income levels, though both the likelihood of having medical debt and the amounts owed varied by household income (Table 3). Among respondents with a household income below $50,0000, 1 in 4 (25%) reported having $2,500 or less in medical debt, while over 1 in 10 (13%) owe more than $10,000. Notably, a higher proportion of respondents with household incomes above $100,000 per year report owing at least $10,000 in debt (14%) than respondents in any other income bracket.

Table 3. Percent of Respondents with Outstanding Medical Bills in the Previous 12 Months, by Income

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Differences were also observed in the reasons respondents reported for incurring medical debt. While respondents across income groups cited similar reasons overall (Figure 2), lower‑income respondents more frequently reported incurring medical debt because services were not covered by their insurance (22%), whereas respondents in higher income brackets more often cited high deductibles as a contributing factor (17%). Coinsurance was reported as a contributing factor across income groups.

Figure 2. Reason for Incurring Medical Debt, by Income

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Age

Medical debt prevalence varied by age (Table 4). Respondents ages 35-44 reported the highest rates of medical debt (35%), followed by those ages 25-34 (32%) and 18-24 (25%). In contrast, those ages 65+ reported lower rates of medical debt (8%). Across all age groups, respondents most often reported lower amounts of medical debt, although a smaller share in each age group reported owing $10,000 or more.

Table 4. Percent of Respondents with Outstanding Medical Bills in the Previous 12 Months, by Age

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Reasons for incurring medical debt were generally similar across age groups, though the relative importance of specific factors varied (Figure 3). Respondents ages 18-24 (21%) and 25-34 (22%) report incurring medical debt because their insurance plan didn’t cover the service(s) they received. Higher rates of medical debt due to high deductibles were reported among respondents ages 18-24 (13%) and ages 45-54 (12%), while respondents age 18-24 more frequently cited high coinsurance (8% respectively).     

Figure 3. Reason for Incurring Medical Debt, by Age

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

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 (37%) compared to those without a disabled household member (20%). Reasons for incurring medical debt were similar among respondents with or without a household member with a disability. Compared with respondents without a disabled household member, respondents with a disabled household member reported similar rates of medical debt due to non-covered services (14% vs 18%), deductibles (9% vs 11%) and coinsurance (4% vs 2%) (Figure 4).

Figure 4. Reason for Incurring Medical Debt, by Disability Status

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Race and Ethnicity

Differences in medical debt exposure were also seen across racial/ethnic groups (Table 5). Respondents of color reported higher rates of medical debt (28%) compared to White alone non-Hispanic respondents (24%). Hispanic/Latino respondents most commonly report owing less than $2,500 in medical debt (53%), followed by Black/African American respondents (35%) and white alone non-Hispanic respondents (18%).

Table 5. Percent of Respondents with Outstanding Medical Bills in the Previous 12 Months, by Race and Ethnicity

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
Note: The Respondents of Color category includes respondents who are: Black or African American, Hispanic or Latino, American Indian or Native Alaskan, Asian, Native Hawaiian or another Pacific Islander. The quantity of responses for individual groups not shown above were insufficient to report reliable estimates. The Disability Status category includes respondents who responded that they or someone in their household identifies as having a disability or long-term health condition related to mobility, cognition, independent living, hearing, vision, and self-care.

Why This Matters

Differences in the amount and reasons for medical debt often reflect variation in financial resources, life stage, and exposure to health care costs. Lower income households may be less able to absorb uncovered services or cost-sharing,^6,7 and younger and middle aged adults may face higher combined costs related to family responsibilities.¹¹ People with disabilities and chronic health conditions may have more frequent health care needs and out-of-pocket costs, and may also experience income disruptions that make medical bills harder to manage^.7,12,13 Prior research has also documented racial and ethnic disparities in medical debt linked to differences in income, insurance design, and access to care.^14,15 Across groups, medical debt can have lasting effects on financial security, including depleted savings, damaged credit, and delayed major life decisions.^11,16

Support for Solutions Across Party Lines

Support for addressing medical debt extended across political affiliations, with respondents expressing strong support for policy approaches aimed at reducing out‑of‑pocket costs, increasing price transparency, and preventing unexpected medical bills (Table 6). Taken together, these findings indicate that medical debt is widely viewed as a shared affordability challenge and that there is broad public support for policy efforts to prevent medical debt before it occurs.

Why This Matters
Support for addressing medical debt across political affiliations underscores that health care affordability is a shared concern. Bipartisan support for policies that reduce out‑of‑pocket costs, increase price transparency, and prevent unexpected medical bills points to opportunities for policy action with broad public backing

Table 6. Percent Who Agreed or Strongly Agreed that the Government Should Employ Select Strategies, by Political Affiliation

Source: 2026 Poll of Ohio Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey

Why This Matters
Taken together, these findings show how unexpected medical bills and unaffordable out-of-pocket costs can translate into financial strain and medical debt for many Ohio households. The combination of widespread experiences and broad support for prevention-focused policies underscores the importance of strategies that reduce the likelihood of medical debt before it occurs.

Conclusion

Findings from the Ohio Consumer Healthcare Experience State Survey show that unexpected medical bills, financial strain, and medical debt are common experiences for Ohio residents. Many respondents reported significant financial burdens related to medical costs, including using savings, taking on credit card debt, or carrying unpaid medical bills.

Medical debt was most often driven by unaffordable out-of-pocket costs, even among respondents with health insurance. Many respondents incurred medical debt because their insurance plan did not cover the service, or because their deductible or co-insurance was too high to afford. Differences in exposure to medical debt were observed across income, age, disability status, and race and ethnicity, underscoring that medical debt affects a wide range of Ohio households.

Respondents across the political spectrum expressed support for policies aimed at reducing out-of-pocket costs, increasing price transparency and preventing unexpected medical bills. Together, these findings highlight medical debt as a shared affordability challenge and point to broad public support for efforts to prevent medical debt before it occurs.

By grounding policy discussions in Ohio residents’ lived experiences, these findings can help state policymakers identify and evaluate strategies that protect consumers from unaffordable out-of-pocket costs and prevent medical debt. For more information on healthcare affordability in Ohio and strategies that survey respondents support, please see the Ohio Health Care Affordability Consumer Healthcare Experience State Survey, August 2026.

Notes

1. Bell, C. (2024, October 1). CFPB Takes Action to Protect Consumers from Illegal Medical Debt Collection Practices. CR Advocacy. https://advocacy.consumerreports.org/press_release/cfpb-takes-action-to-protect-consumers-from-illegal-medical-debt-collection-practices/

2. State Health Access Data Assistance Center (SHADAC). (2025). Median medical out-of-pocket spending [Data set]. State Health Compare, University of Minnesota. https://statehealthcompare.shadac.org

3. State Health Access Data Assistance Center (SHADAC). (2025). Average annual employer sponsored insurance premium [Data set]. State Health Compare, University of Minnesota. https://statehealthcompare.shadac.org

4. State Health Access Data Assistance Center (SHADAC). (2025). Average annual employer sponsored insurance deductible [Data set]. State Health Compare, University of Minnesota. https://statehealthcompare.shadac.org

5. Lopes, L., Kearney, A., Montero, A., Hamel, L., & Brodie, M. (2022, June 16). Health Care Debt in the U.S.: The broad consequences of medical and dental bills – main findings – 9957. KFF.  

6. Health Care Debt in the U.S., KFF, 2022. https://www.kff.org/health-costs/kff-health-care-debt-survey/

7. Rakshit, S., Rae, M., Claxton, G., Amin, K., & Cox, C. (2024, February 12). The Burden of Medical Debt in the United States. Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/brief/the-burden-of-medical-debt-in-the-united-states/#Share%20of%20adults%20who%20have%20medical%20debt,%20by%20demographics,%202021

8. Young, G., Rae, M., Claxton, G., Wager, E., & Amin, K. (2022, March 10). How many people have enough money to afford private insurance cost sharing? Peterson-KFF Health System Tracker. https://www.healthsystemtracker.org/brief/many-households-do-not-have-enough-money-to-pay-cost-sharing-in-typical-private-health-plans/

9. Elani, H. W., & Sommers, B. D. (2025). Fillings needed for gaps in government dental coverage. JAMA Health Forum, 6(2), e250370. https://doi.org/10.1001/jamahealthforum.2025.0370

10. Ludomirsky, A. B., Schpero, W. L., Wallace, J., Lollo, A., Bernheim, S., Ross, J. S., & Ndumele, C. D. (2022). In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians. Health Affairs, 41(5), 760–768. https://doi.org/10.1377/hlthaff.2021.01747  

11. Cottrill, A., Neuman, T., Lopez, L., & Hamel, L. (2024, July 26). What are the consequences of health care debt among older adults?. KFF. https://www.kff.org/medicare/issue-brief/what-are-the-consequences-of-health-care-debt-among-older-adults/  

12. Park, S., & Stimpson, J. P. (2024). Health care expenses and financial hardship among Medicare beneficiaries with functional disability. JAMA Network Open, 7(6), e2417300. https://doi.org/10.1001/jamanetworkopen.2024.17300  

13. Goodman, N., Morris, M., & Boston, K. (2017). Financial inequality: Disability, race and poverty in America. National Disability Institute. https://www.nationaldisabilityinstitute.org/wp-content/uploads/2019/02/disability-race-poverty-in-america.pdf

14. Urban Institute. (2022). Communities of color disproportionally suffer from medical debt. https://www.urban.org/urban-wire/communities-color-disproportionally-suffer-medical-debt

15. Zahnd, W. E., Hung, P., Crouch, E. L., Ranganathan, R., & Eberth, J. M. (2025). Health care access barriers among metropolitan and nonmetropolitan populations of eight geographically diverse states, 2018. The Journal of Rural Health, 41(1), e12855. https://doi.org/10.1111/jrh.12855

16. Levey, N. N. (2022, January 16). 100 million people in America are saddled with health care debt. KFF Health News. https://kffhealthnews.org/news/article/diagnosis-debt-investigation-100-million-americans-hidden-medical-debt/