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 Virginia households.

This brief describes findings from a survey of more than 1,300 Virginia adults, conducted by Altarum’s Healthcare Value Hub from July 9 to July 16, 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: 28% received an unexpected medical bill in the past year.
• Financial strain affects many households: 37% 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: 22% reported that they or a family member had outstanding medical bills; among those with medical debt, 57% reported their insurance plan only covered part of the service and 21% reported their insurance did not cover the service at all.
• Large debts exist, but the majority of debt is under $5,000: More than one in every ten (11%) respondents reported owing at least $10,000 in medical debt. 72% of respondents reported owing less than $5,000 in medical debt.
• 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 Virginia 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 Virginia 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

More than a quarter (28%) of Virginia respondents received an unexpected medical bill in the past year. Among respondents who received an unexpected bill, experiences varied by coverage.

Respondents with individually purchased insurance (e.g., through the health care Marketplace) and those with Medicare Advantage most frequently reported an unexpected medical bill (40% and 31% respectively), followed by respondents with insurance from their employer or family member (26%), respondents with traditional Medicare (25%), and those enrolled in Virginia Medicaid (24%).

Financial Burdens Due to Medical Cost

More than one-third of Virginia respondents (37%) reported experiencing at least one financial burden due to medical costs in the last year. Financial burdens were not evenly distributed across the population (Table 1). 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 health insurance they purchased on their own (e.g. through the Health Insurance Marketplace).

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

Source: 2026 Poll of Virginia 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.

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

Medical Debt and Health Insurance

Twenty-two percent (22%) of Virginia respondents reported that they or a family member currently have outstanding medical bills. Among respondents with medical debt, the most commonly reported amount was $1,000-$2,499 (20%) and $2,500 – $4,999 (20%) followed by less than $500 (18%) and $500 – $999 (14%). Still, more than 1 in 10 respondents (11%) report owing over $10,000 in medical debt.

Virginia respondents incurred medical debt more frequently when they were uninsured. Only 29% of respondents with medical debt reported having health insurance at the time they incurred the debt. However, some insured Virginia respondents did report having insurance coverage and medical debt simultaneously (Table 2). Among these groups, respondents with insurance purchased individually (such as through the health insurance Marketplace) and those with Virginia Medicaid reported the highest prevalence of debt.

Table 2. Percent of Insured Virginia Respondents with Outstanding Medical Debt, by Insurance Type

Source: 2026 Poll of Virginia 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. Over half (57%) reported their insurance only covered part of the service, and 21% reported that their insurance didn’t cover the service at all.

Respondents most frequently identified hospital services (62%) and doctor or technician services in the hospital (33%) as the source of their medical debt. Other commonly reported sources included laboratory services such as an x-ray or MRI (32%), doctor or technician services not in hospital (23%), and urgent care centers (19%). Smaller proportions cited dentist’s offices and dental providers (14%), physical therapy or pain management services (9%), mental healthcare or addiction treatment (9%), and pregnancy-related expenses (4%) as the source of their medical debt. 

Why This Matters

Medical debt can occur across insurance types for different reasons. Uninsured individuals are responsible for the full cost of care,^6,7 while those with employer based, individual, or Marketplace coverage may face high cost-sharing.⁸ Although Medicaid and Medicare often have lower cost sharing, limited covered services or difficulty finding participating providers can still result in out of pocket costs.^9,10

Differences in the 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 the likelihood of having medical debt varied by household income (Table 3). Individuals living in households earning equal to or less than $50,000 annually reported outstanding medical debt more frequently than higher earning respondents.

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

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

Age

Medical debt prevalence varied by age among Virginia respondents (Table 4). Those aged 25-34 reported the highest rates of medical debt (30%), followed by those ages 18-24 (29%) and 35-44 (27%). In contrast, older adults reported lower rates of outstanding medical bills; which likely reflects more comprehensive insurance through higher tiered coverage options or coverage under Medicare or a Medicare Advantage plan.

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

Source: 2026 Poll of Virginia Adults, Ages 18+, Altarum Healthcare Value Hub’s Consumer Healthcare Experience State Survey
* CV exceeds the 0.2 threshold, please interpret this data with caution.

Disability

Some of the highest rates of medical debt were seen among households that include a person with a disability. More than a third (36%) of respondents with a disability, or who live with a person with a disability, reported outstanding medical debt compared to less than a fifth (16%) of those without a disability or a disabled family member. Respondents with a household member with a disability most frequently reported owing less than $500 (19%) and $2,500 – $4,999 in medical debt (19%). Those without a disability or a household member with a disability most frequently reported outstanding medical debt of $1,000 – $2,499 (23%).

Reasons for incurring medical debt were similar among respondents with or without a household member with a disability. Both groups reported incurring medical debt due to their insurance coverage only covering a part of the service as the primary reason for their outstanding medical debt, although respondents with a disability or a household member with a disability reported this more frequently (61% of the time) compared to those without a disability or a disabled household member (53% of the time).

Race and Ethnicity

Differences in medical debt exposure were also seen across racial and ethnic groups (Table 5). Respondents of color reported higher rates of medical debt (24%) compared to White alone non-Hispanic respondents (20%). Hispanic or Latino respondents reported the highest rates of outstanding medical debt (38%), which may reflect challenges accessing affordable health insurance coverage or preventive care among this group. This figure greatly exceeds the statewide percentage of respondents who reported outstanding medical debt (22%), indicating an opportunity for growth in Virginia.

Table 5. Percent who Had Outstanding Medical Bills in the Previous 12 Months, by Race and Ethnicity

Source: 2026 Poll of Virginia 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.

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.

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

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

Conclusion

Findings from the Virginia Consumer Healthcare Experience State Survey show that unexpected medical bills, financial strain, and medical debt are common experiences for Virginia 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 Virginia 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. 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 Virginia 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.

By grounding policy discussions in Virginia 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 Virginia and strategies that survey respondents support, please see the Virginia Health Care Affordability Consumer Healthcare Experience State Survey.

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.

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/