In 2024, people in the US owed at least $220bn in medical debt, according to KFF, a nonprofit health research group. About 14 million owed more than $1,000 and 3 million owed more than $10,000. Emma Wager, a KFF senior police analyst, said costs are very high and some people have no health insurance, so when they get sick or injured or need healthcare they have no way to pay the extremely high charges. Even people with insurance often have high deductibles or high cost-sharing provisions in their plans, which can leave bills unaffordable, she said.
Patients often fall behind. In 2024, 21% of US households had a past-due medical bill, according to the journal Health Affairs Scholar. In 2021, more than half of the bills sent to collectors were for medical care, according to the Consumer Financial Protection Bureau.
Undue Medical Debt, founded in 2014 by former debt collection executives, buys large portfolios of debt from healthcare organisations and collection agencies at a steep discount. According to the organisation, a $1 donation erases about $100 of medical debt. It does not take requests from individuals, but people who earn four times the federal poverty level or less, or whose medical debt is 5% or more of their annual income, are eligible. Recipients learn by surprise notice that their debt has been absolved. The organisation states it has provided $53.3bn in medical debt relief, about half of that this year, which it attributes to investment in technology that lets it process files more quickly and to increased partnerships with governments. In Illinois, the state provided $10m to Undue Medical, which used the funds to provide more than $1.1bn in relief for residents, according to the state.
Allison Sesso, president and CEO of Undue Medical, said she is hopeful that everyone who receives a letter feels more comfortable going back to the doctor and getting the care they need and is not scared about the financial consequences. But Sesso acknowledges the assistance is a "stopgap for people that need help today". "We have set up a system that incentivizes profits over people," she said.
"Addressing the affordability crisis in healthcare is what will ultimately get at the heart of the issue," said Mary Shannon, director of Care Over Collections, a nonprofit that educates patients who receive bills about their options.
Other groups work on different parts of the problem. Dollar For, a nonprofit, lets patients apply for financial assistance to forgive or reduce their medical debt and has provided more than $117m, according to the organisation. The HealthWell Foundation helps with prescription copays, insurance premiums and deductibles, among other expenses.
Advocates argue providers must do more to make patients aware that they offer financial assistance. In Missouri, almost all general hospitals offer free or discounted care, but less than a quarter of adults said they received information about the programs from a provider, according to a 2025 study from the Missouri Foundation for Health and the Lown Institute. Federal law requires nonprofit hospitals to establish a financial assistance policy but does not specify minimum eligibility requirements; 18 states have gone further and required all hospitals, including for-profit ones, to offer financial assistance with minimum eligibility standards, according to the Commonwealth Fund. Six states also have "presumptive eligibility" laws requiring hospitals to screen patients to determine if they qualify for assistance and, if so, proactively erase the debt, KFF Health News reported.
The Biden administration passed a rule banning the inclusion of medical debt on credit reports, but the Trump administration and trade groups asked a federal court to block the measure, which a judge did. Sixteen states prohibit or restrict the inclusion of such debt on credit reports, according to the Commonwealth Fund. "It has a major impact on people's credit ratings," said Sara Collins, Commonwealth senior scholar for expanding coverage and access. "People have healthcare problems that are not their fault, and yet they are being saddled with medical debt because they don't have the coverage to pay it off."
Tiffany Miller, 40, a mental health caseworker who lives in Aurora, Illinois, went into labor at 26 weeks in 2019. Her daughter Brie spent more than three months in a neonatal intensive care unit and then required physical and occupational therapies. Even though Miller had insurance, she accumulated more than $2,000 in debt. "I'm a very faith-based person, so I had just been praying a lot because a lot of this debt was on my credit report," she said. In May she received a letter from Undue Medical informing her the debt had been erased. She thought it was a scam but did some research and learned it was real. Brie is now a healthy seven-year-old.