Among the 20.4 million Americans who have unpaid medical bills totaling more than $250, almost a quarter—5 million people—owe between $2,001 and $5,000.  

Meanwhile 2.7 million are saddled with medical debt of between $5,001 and $10,000—and nearly 3 million Americans are on the hook for $10,001 or more.

The figures are from an analysis of the Census Bureau’s Survey of Income and Program Participation (SIPP) conducted by researchers at the nonprofit Peterson Center on Healthcare in New York City and KFF.

Reporting their findings Feb. 12, the team notes the SIPP survey suggests U.S. residents collectively owe at least $220 billion for medical services rendered.

First author Shameek Rakshit, last author Cynthia Cox, MPH, and colleagues underscore that medical debt affects all demographics—but those most likely to carry big-dollar burdens are people with disabilities, those in worse health, lower-income people and, unsurprisingly, the uninsured.

Other key findings from the analysis, which used data from December 2021:

• With a 13% portion of medically indebted Americans, non-Hispanic Black people are the most likely racial or ethnic subpopulation to owe healthcare providers at least $250.
• People with disabilities are more than twice as likely as those without, 13% to 6%, to rank among adults with medical debt.
• People in poor health make up 20% of the pie and are much more likely than those of any other health status to be indebted to healthcare providers.

Here the authors comment that people with chronic or complex conditions often fall behind on their medical bills, which tend to pile up for them over time.

In addition, those in worse health or those living with disabilities “may also experience unemployment or income losses, further contributing to their difficulty affording medical bills,” the authors write.  

In their discussion, Rakshit and co-authors reiterate that medical debt presents a difficult challenge even for Americans who have considerable incomes and private health insurance.

“For people with a chronic illness, even smaller copays and other cost-sharing expenses can accumulate to unaffordable amounts,” they write. “Insured patients can also incur medical debt from care that is not covered by insurance, including for denied claims, and for out-of-network care.”

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The fact that medical debt is a struggle even among households with health insurance and middle incomes indicates that simply expanding coverage will not erase the financial burden caused by high cost-sharing amounts and high prices for medical services and prescription drugs.

Full report here.