One in five (20%) working-age Americans with health insurance say problems paying medical bills often force them to work longer hours, take a second job, spend less on food, use up their savings, borrow from family or friends, or seek help from a charity.
Almost six in ten (58%) of those with problems paying medical bills say they have been contacted by a collection agency in the past year. More than a third (35%) say the bills left them unable to pay for basic necessities like food, heat, or housing.
These were among the findings of a comprehensive survey conducted by the New York Times and the Kaiser Family Foundation.
“While insurance can protect people from problem medical bills,” the Foundation noted, it is not uncommon for people with individual or employer-sponsored coverage to “suffer similar consequences as the uninsured once such problems occur.”
Among those facing problems with medical bills, the survey found, almost identical shares of the insured (44%) and uninsured (45%) say the bills had a major impact on their families.
Those with significant medical expenses reported a wide range of personal sacrifices. These included delaying vacations or major household purchases (77%), spending less on food, clothing and basic household items (75%), and using up most or all their savings (63%).
Almost as common were such steps as taking an extra job or working more hours (42%), increasing their credit card debt (38%), or borrowing money from family or friends (37%). Less common but more extreme steps included changing their living situation (14%), and seeking aid from a charity (11%).
These sacrifices by insured individuals were generally similar to those that uninsured people with problem medical bills had to make, the foundation said.
People with financial problems because of medical bills often skimped on other needed health care because of the cost, the survey found. Common results included postponing dental care (62%), skipping doctor-recommended tests or treatments (43%), or not filling a prescription (41%).
They were two to three times as likely to skip or postpone such medical care as those without problems paying medical bills.
Among the insured with problem medical bills, a quarter (26%) said one cause was an unexpected denial of their claim, and a third (32%) said they received care from an out-of-network provider their insurance would not cover.
Out-of-network charges were a surprise for a large majority: 69% were unaware that the provider was not in their plan’s network when they received the care.
Among people with private insurance, those in higher deductible plans were more likely to report medical bill problems than those in plans with lower deductibles (26% versus 15%).
The medical bills causing problems for these individuals were not necessarily large. One in four (24%) said their bills totaled less than $1,000, while 31% said the total reached at least $5,000, including 13% percent who said the total was $10,000 or more.
Relatively small amounts pose major problems for some families, the foundation said, because they are living paycheck to paycheck.
Most of those with medical bill problems (61%) said they are either just meeting their basic expenses (43%) or aren't able to do so (18%). More than half (55%) of those with insurance who have medical bill problems said they are either just getting by or don’t have enough to make ends meet.
The survey was conducted in September of 2015 among 2,575 adults ages 18-64, including 1,204 who reported problems paying medical bills and 1,371 who did not. The margin of error is plus or minus 4 percentage points.