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    Medical debt

    Medical debt: Stop medical debt before it starts.

    Medical debt is common, it keeps people from the care they need, and some of it never had to happen. So this chapter starts with prevention, then clears what's left.

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    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • It's common.

      In 2022, 41% of American adults had debt from medical or dental bills, counting what they owed on credit cards, to collectors and to family. In all, Americans owed at least $200 billion in medical debt at the end of 2023.

    • It keeps people from care.

      Adults with health care debt were far more likely than those without to say they or a family member had put off needed care because of the cost: 64% against 28%. One in seven with such debt had been denied care by a provider over unpaid bills.

    • The help exists. It doesn't reach people.

      Most hospitals offer financial assistance to patients on low incomes. Yet one analysis found at least $2.7 billion in bills at non-profit hospitals that qualified for it and were still sent to patients. In a survey by Dollar For, only 29% of patients with hospital bills they couldn't afford managed to learn about, apply for and receive that help.

    What works

    Proven, and ready to grow.

    • Getting the help changes the care people get.

      At Kaiser Permanente, patients who received financial assistance used more care, and more of their treatable conditions, such as diabetes, were found and managed. The researchers say the help may increase high-value care.

    • Help with the forms works.

      In Dollar For's survey, approval rates were highest, 67%, when patients had help applying, from Dollar For or the hospital itself.

    • Make it automatic.

      In North Carolina, every eligible hospital joined a state program that applies income-based discounts to bills automatically, instead of making patients apply. More than $6.5 billion in medical debt has been relieved for more than 2.5 million people.

    What a family could fund

    Where the money goes furthest.

    • People who help patients claim aid.

      Dollar For helps patients apply for the hospital aid they qualify for, and reports more than $175 million in bills cleared so far.

    • Relief that comes sooner.

      The researchers behind a large randomized study of debt relief point to a more promising kind: relief that comes soon after the medical bill, before it turns into old debt. A family could fund it, and the studies to prove it.

    • Clearing old debt, with clear eyes.

      Undue Medical Debt buys medical debt in bulk, millions of dollars at a time, for a fraction of its original cost, and erases it. Each dollar it receives erases about $100 of debt at face value, on average.

    Honest limits

    What money can't promise.

    • Erasing old debt didn't improve health.

      In two randomized experiments, erasing medical debt brought no measurable change in mental or physical health, use of health care, or financial wellness.

    • Much of that debt was years old.

      Debt bought from collectors in the study was typically 7 years old. Because collectors expect to recover little of it, the real relief to families may be a small fraction of its face value.

    • The root causes stay.

      Most efforts to soften medical debt, from buying it to new rules, leave its root causes untouched: high health costs and underinsurance.

    Hard questions

    Asked and answered.

    1. You might ask

      Doesn't buying debt just reward the collectors?

      Ryan

      They're paid very little. From 2018 to 2022, Undue, then called RIP Medical Debt, relieved $8.48 billion of debt for $35 million, about 0.42 cents per dollar. That low price is also the honest catch: debt sells that cheaply because collectors expect to recover little of it.

    2. You might ask

      Why not fix the system instead?

      Ryan

      High costs and underinsurance are the bigger job, and most efforts against medical debt leave them untouched. No family can buy that fix. What a family can fund now is help that reaches patients before a bill becomes debt, and honest research on what works.

    3. You might ask

      Is a dollar really worth a hundred?

      Ryan

      On paper, yes: Undue says each dollar erases about $100 of debt at face value. But collectors expect to recover little of that debt, so the real relief to families may be a small fraction of its face value. The slider counts face value, and says so.

    In the slider

    See what your fortune could do here.

    Medical debt

    The slider prices this cause with these numbers:

    • On average, every dollar erases about $100 of medical debt, bought for pennies through Undue Medical Debt.
    • The whole need is all the medical debt counted in America, at least $200 billion.
    • Honest limit: a large randomized study found erasing old medical debt brought no measurable gains in people's mental or physical health or financial wellness. Preventing new debt matters as much as erasing the old.
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    More of the Blueprint

    Keep reading.

    23 more chapters on the way

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: Americans' Challenges with Health Care Costs (opens in a new tab)

      KFF, 29 September 2026. Checked 16 October 2026.

      Survey figures for 2022. The debt counts bills owed on credit cards, to collectors and to family or friends.

    2. Source 2: Health Policy 101: Health Care Costs and Affordability (opens in a new tab)

      KFF, 8 October 2025. Checked 16 October 2026.

      Medical debt owed at the end of 2023, from the Census Bureau's Survey of Income and Program Participation. A floor: debt carried on credit cards or owed to family can be missed.

    3. Source 3: Health Care Debt In The U.S.: The Broad Consequences Of Medical And Dental Bills (opens in a new tab)

      KFF, 16 June 2022. Checked 16 October 2026.

      A national survey of adults. Putting off care counts the person or someone in their family.

    4. Source 4: The Impact of Financial Assistance Programs on Health Care Utilization: Evidence from Kaiser Permanente (Adams, Kluender, Mahoney, Wang, Wong and Yin) (opens in a new tab)

      American Economic Review: Insights, September 2022. Checked 16 October 2026.

      Compares Kaiser Permanente patients just above and just below the program's income limit. The effects faded within a year.

    5. Source 5: Medical Debt and Non-Profit Hospital Billing Practices (opens in a new tab)

      Consumer Financial Protection Bureau, 1 October 2024. Checked 16 October 2026.

      From an analysis of non-profit hospitals' own reports, which the CFPB says likely understates the gap. The page now sits in the CFPB's archive.

    6. Source 6: The Path to Charity Care: Exploring the Journey & Roadblocks to Financial Assistance for Medical Bills (opens in a new tab)

      Dollar For, 29 April 2024. Checked 16 October 2026.

      A survey Dollar For ran in late 2023. Dollar For helps patients apply for this aid, and is one of the groups a family could fund.

    7. Source 7: NC Medical Debt (opens in a new tab)

      North Carolina Department of Health and Human Services. Checked 16 October 2026.

      The relief figures were announced on 13 October 2025. Hospitals take part in return for higher Medicaid payments.

    8. Source 8: Impact Numbers (opens in a new tab)

      Dollar For. Checked 16 October 2026.

      A running total of hospital bills cleared through financial assistance, by Dollar For's own count.

    9. Source 9: The Effects of Medical Debt Relief: Evidence from Two Randomized Experiments, full working paper (Kluender, Mahoney, Wong and Yin) (opens in a new tab)

      National Bureau of Economic Research, April 2024. Checked 16 October 2026.

      The working paper behind the published study, with details of the debt relieved. RIP Medical Debt is Undue Medical Debt's former name.

    10. Source 10: How much medical debt will my donation abolish? (opens in a new tab)

      Undue Medical Debt. Checked 16 October 2026. Readable copy (opens in a new tab).

      An average, by face value: what the debt was worth on paper, not what families would otherwise have paid.

    11. Source 11: The Effects of Medical Debt Relief: Evidence from Two Randomized Experiments (Kluender, Mahoney, Wong and Yin) (opens in a new tab)

      Quarterly Journal of Economics (NBER working paper 32315), May 2025. Checked 15 October 2026.

      The study erased debt that had gone to collections. People did pay less on their existing medical bills.