NCHS Data Brief ■ No. 357 ■ February 2020

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Problems Paying Medical Bills, 2018

Amy E. Cha, Ph.D., M.P.H., and Robin A. Cohen, Ph.D.

Key findings

Data from the National 

Health Interview Survey

● Overall, the percentage of 

persons who were in families 

having problems paying 

medical bills in the past 12 

months decreased from 19.7% 

in 2011 to 14.2% in 2018.

● In 2018, the percentage of 

persons who were in families 

having problems paying 

medical bills was higher among 

females (14.7%), children 

(16.2%), and non-Hispanic 

black persons (20.6%) 

compared with males, adults, 

and other racial and ethnic 

groups, respectively.

● Among persons under age 

65, those who were uninsured 

were more likely than those 

with Medicaid or private 

coverage to have problems 

paying medical bills.

● Among adults aged 65 and 

over, those with Medicare and 

Medicaid, and Medicare only 

were more likely than those 

with Medicare Advantage 

or private coverage to have 

problems paying medical bills.

Previously published data from the National Health Interview Survey (NHIS) 

found that in 2017 one in seven persons under age 65 was in a family having 

problems paying medical bills (1). Significant expenses for one family 

member may adversely affect the whole family (2). People who are in 

families with problems paying medical bills may experience serious financial 

consequences, such as having problems with paying for food, clothing, or 

housing, and filing for bankruptcy (3). Health insurance coverage status 

(i.e., uninsured, public coverage, or private coverage) may also impact the 

ability to afford health care costs (4). This report examines characteristics of 

persons who live in families that have problems paying medical bills.

The percentage of persons who were in families having 

problems paying medical bills in the past 12 months 

decreased from 2011 through 2018.

0

2011 2012 2013 2014 2015 2016 2017 2018

Percent

Figure 1. Percentage of persons who were in families having problems paying medical bills in the 

past 12 months, by year: United States, 2011–2018

Year1

1Significant quadratic trend from 2011 through 2018 (p < 0.05).

NOTES: “Problems paying medical bills” is based on a positive response to the question, “In the past 12 months, did you or anyone 

in the family have problems paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, 

medication, equipment, nursing home, or home care.” Estimates are based on household interviews of a sample of the civilian 

noninstitutionalized population. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/

db357_tables-508.pdf#1. 

SOURCE: NCHS, National Health Interview Survey, 2011–2018.

NCHS reports can be downloaded from: https://www.cdc.gov/nchs/products/index.htm.
NCHS Data Brief ■ No. 357 ■ February 2020

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● The percentage of all persons who were in families having problems paying medical bills in 

the past 12 months decreased 4.5 percentage points from 19.7% in 2011 to 15.2% in 2015 

and then decreased 1.0 percentage point from 2015 through 2018 (14.2%) (Figure 1).

● The percentage of all persons who were in families having problems paying medical bills 

did not change significantly between 2017 (14.6%) and 2018 (14.2%).

In 2018, the percentages of persons who were in families having problems 

paying medical bills in the past 12 months varied by demographic 

characteristics.

● Females (14.7%) were more likely than males (13.8%) to be in a family having problems 

paying medical bills in the past 12 months (Figure 2).

● The percentage of persons who were in families having problems paying medical bills was 

highest among children aged 0–17 years (16.2%) and decreased as age increased.

● The percentage of persons who were in families having problems paying medical bills 

was highest among non-Hispanic black persons (20.6%), followed by Hispanic (15.6%), 

non-Hispanic white (13.0%), and non-Hispanic Asian (7.1%) persons.

1Significantly different from females (p < 0.05). 2Significant cubic trend with age (p < 0.05). 3Significantly different from non-Hispanic white persons (p < 0.05). 4Significantly different from non-Hispanic black persons (p < 0.05). 5Significantly different from non-Hispanic Asian persons (p < 0.05).

NOTES: “Problems paying medical bills” is based on a positive response to the question, “In the past 12 months, did you or anyone in the family have problems 

paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care.” 

Estimates are based on household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 2 at: https://www.cdc.gov/

nchs/data/databriefs/db357_tables-508.pdf#2. 

SOURCE: NCHS, National Health Interview Survey, 2018.

Figure 2. Percentage of persons who were in families having problems paying medical bills in the past 12 months, by sex, 

age group, and race and ethnicity: United States, 2018

0 10 20 30 40

Non-Hispanic Asian

Non-Hispanic black

Non-Hispanic white

Hispanic

75 years and over

65–74 years

18–64 years

0–17 years

Female

Male

Total

Percent
NCHS Data Brief ■ No. 357 ■ February 2020

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Among persons under age 65, those who were uninsured were more likely 

than those who had Medicaid or private coverage to be in families having 

problems paying medical bills in the past 12 months.

● Among persons under age 65, 27.7% of those who were uninsured, 20.1% of those with 

Medicaid, and 11.9% of those with private coverage were in families having problems 

paying medical bills in the past 12 months (Figure 3).

● Among children aged 0–17 years and adults aged 18–64, the patterns were similar to 

persons under age 65 years overall. Those who were uninsured were more likely to be 

in families having problems paying medical bills than those with Medicaid and private 

coverage.

1Significantly different from those with Medicaid coverage (p < 0.05). 2Significantly different from those who are uninsured (p < 0.05).

NOTES: “Problems paying medical bills” is based on a positive response to the question, “In the past 12 months, did you or anyone in the family have problems 

paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care.” 

Persons with more than one type of health insurance were assigned to the first appropriate category in the following hierarchy: private, Medicaid, other coverage, 

and uninsured. Persons with other coverage are not shown. Estimates are based on household interviews of a sample of the civilian noninstitutionalized 

population. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db357_tables-508.pdf#3. 

SOURCE: NCHS, National Health Interview Survey, 2018.

Figure 3. Percentage of persons under age 65 who were in families having problems paying medical bills in the past 12 

months, by age group and health insurance status: United States, 2018

1,211.9

Under 65 0–17 18–64

Age (years)

Percent
NCHS Data Brief ■ No. 357 ■ February 2020

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Among adults aged 65 and over, the percentages of those who were in 

families having problems paying medical bills varied by health insurance 

type.

● Among adults aged 65 and over, the percentages of those who were in families having 

problems paying medical bills in the past 12 months were higher among those with 

Medicare and Medicaid (12.3%) and Medicare only (12.4%) than among those with 

Medicare Advantage (8.3%) or private coverage (5.6%); those with Medicare Advantage 

were more likely than those with private coverage to have problems paying medical bills 

(Figure 4).

● Among adults aged 65–74, the percentages of those who were in families having problems 

paying medical bills were higher among adults with Medicare and Medicaid (14.3%) and 

Medicare only (13.6%) than among those with Medicare Advantage (9.1%) or private 

coverage (6.4%); those with Medicare Advantage were more likely than those with private 

coverage to have problems paying medical bills.

● Among adults aged 75 and over, the percentages of those who were in families having 

problems paying medical bills were higher among adults with Medicare only (10.6%), 

Medicare and Medicaid (9.6%), and Medicare Advantage (7.2%) than among those with 

private coverage (4.2%); those with Medicare only were more likely than those with 

Medicare Advantage to have problems paying medical bills.

1–35.6

1–36.4

1–34.2

212.3

214.3

9.6

38.3

39.1

37.2

12.4

13.6

10.6

1Significantly different from those with Medicare and Medicaid coverage (p < 0.05). 2Significantly different from those with Medicare Advantage coverage (p < 0.05). 3Significantly different from those with Medicare only coverage (p < 0.05).

NOTES: “Problems paying medical bills” is based on a positive response to the question, “In the past 12 months, did you or anyone in the family have problems 

paying or were unable to pay any medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, nursing home, or home care.” 

Adults with more than one type of health insurance were assigned to the first appropriate category in the following hierarchy: private, Medicare and Medicaid, 

Medicare Advantage, and Medicare only (no Advantage). Adults with other coverage and those who are uninsured are not shown. Estimates are based on 

household interviews of a sample of the civilian noninstitutionalized population. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db357_tables-508.pdf#4. 

SOURCE: NCHS, National Health Interview Survey, 2018.

Figure 4. Percentage of adults aged 65 and over who were in families having problems paying medical bills in the past 12 

months, by age group and health insurance status: United States, 2018

65 and over 65–74 75 and over
NCHS Data Brief ■ No. 357 ■ February 2020

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Summary

In the United States, the percentage of all persons who were in families having problems paying 

medical bills decreased 5.5 percentage points from 19.7% in 2011 to 14.2% in 2018. In this 

same year, the percentage of persons who were in families having problems paying medical bills 

varied by sex, age, race and ethnicity, and health insurance status. Among persons of all ages, 

the percentage who were in families having problems paying medical bills was higher among 

females, children aged 0–17 years, and non-Hispanic black persons than among males, adults, 

and other racial and ethnic groups, respectively. Among persons under age 65, the percentage 

having problems paying medical bills was highest among those who were uninsured, followed 

by those who were covered with Medicaid and private health insurance. Among adults aged 

65 and over, those with Medicare and Medicaid, and Medicare only had similar percentages of 

having problems paying medical bills; both were higher than those with Medicare Advantage and 

private coverage.

Definitions

Family: Defined in NHIS as an individual or a group of two or more related persons living 

together in the same housing unit. Thus, a family can consist of only one person. In some 

instances, unrelated persons sharing the same household, such as an unmarried couple living 

together, may also be considered a family.

Problems paying medical bills: Based on a positive response to the survey question, “In the past 

12 months, did you or anyone in the family have problems paying or were unable to pay any 

medical bills? Include bills for doctors, dentists, hospitals, therapists, medication, equipment, 

nursing home, or home care.”

Health insurance coverage: At the time of interview, respondents reported their type(s) of 

coverage. This information was used to form two health insurance hierarchies: one for persons 

under age 65 and another for adults aged 65 and over. For persons under age 65, a hierarchy 

consisting of four mutually exclusive categories was developed (5). Persons with more than one 

type of health insurance were assigned to the first appropriate category in the following hierarchy: 

private coverage, Medicaid (includes state-sponsored health plans including the Children’s Health 

Insurance Program [CHIP]), other coverage (includes Medicare, other government, and military 

coverage), and uninsured. Persons with “other coverage” are included in the totals but are not 

shown separately.

For adults aged 65 and over, a health insurance hierarchy of six mutually exclusive categories 

was used (6,7). Adults with more than one type of health insurance were assigned to the first 

appropriate category in the following hierarchy: private coverage, Medicare and Medicaid, 

Medicare Advantage, Medicare only (no Advantage), other coverage, and uninsured. Due to small 

sample sizes, those with “other coverage” and those who are uninsured are included in the totals 

but are not shown separately.
NCHS Data Brief ■ No. 357 ■ February 2020

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Data source and methods

This analysis used data from the 2011–2018 NHIS, a nationally representative, household survey 

of the civilian noninstitutionalized U.S. population. It is conducted continuously throughout 

the year by the National Center for Health Statistics (NCHS). Interviews are conducted in the 

respondent’s home, but follow-ups to complete interviews may be conducted by telephone when 

necessary. For more information about NHIS, visit the survey website: https://www.cdc.gov/

nchs/nhis.htm.

Point estimates and the corresponding variances were calculated using SAS-callable SUDAAN 

version 11.0 (RTI International, Research Triangle Park, N.C.) to account for the complex sample 

design of NHIS. All estimates in this report meet NCHS standards of reliability as specified in 

“National Center for Health Statistics Data Presentation Standards for Proportions” (8). Linear, 

quadratic, and cubic trends by year were evaluated using orthogonal polynomials in logistic 

regression. Differences between percentages were evaluated using two-sided significance tests at 

the 0.05 level. 

About the authors

Amy E. Cha and Robin A. Cohen are with the National Center for Health Statistics, Division of 

Health Interview Statistics.
NCHS Data Brief ■ No. 357 ■ February 2020

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References

1. Terlizzi EP, Cha AE, Cohen RA. QuickStats: Percentage of persons in families having 

problems paying medical bills in the past 12 months, by age group—National Health Interview 

Survey, 2011–2017. MMWR Morb Mortal Wkly Rep 68(14):334. 2019. Available from: 

https://dx.doi.org/10.15585/mmwr.mm6814a6.

2. Cohen RA, Kirzinger WK. Financial burden of medical care: A family perspective. NCHS 

Data Brief, no 142. Hyattsville, MD: National Center for Health Statistics. 2014.

3. Sommers A, Cunningham PJ. Medical bill problems steady for U.S. families, 2007–2010. 

Track Rep (28):1–5. 2011.

4. Cohen RA, Zammitti EP. Problems paying medical bills among persons under age 65: Early 

release of estimates from the National Health Interview Survey, 2011–June 2017. National Center 

for Health Statistics. 2017. Available from: https://www.cdc.gov/nchs/data/nhis/earlyrelease/

probs_paying_medical_bills_jan_2011_jun_2017.pdf.

5. Bloom B, Simpson G, Cohen RA, Parsons PE. Access to health care part 2: Working-age 

adults. National Center for Health Statistics. Vital Health Stat 10(197). 1997. Available from: 

https://www.cdc.gov/nchs/data/series/sr_10/sr10_197.pdf.

6. National Center for Health Statistics. 2015 National Health Interview Survey (NHIS) 

public use data release: Survey description. 2016. Available from: ftp://ftp.cdc.gov/pub/Health_

Statistics/NCHS/Dataset_Documentation/NHIS/2015/srvydesc.pdf.

7. National Center for Health Statistics. Technical notes for summary health statistics tables: 

National Health Interview Survey. Available from: https://www.cdc.gov/nchs/data/nhis/SHS_

Tech_Notes.pdf.

8. Parker JD, Talih M, Malec DJ, Beresovsky V, Carroll M, Gonzalez Jr. JF, et al. National 

Center for Health Statistics data presentation standards for proportions. National Center for 

Health Statistics. Vital Health Stat 2(175). 2017. Available from: https://www.cdc.gov/nchs/data/

series/sr_02/sr02_175.pdf.
NCHS Data Brief ■ No. 357 ■ February 2020

Keywords: private coverage • Medicare • Medicaid • National Health 

Interview Survey

Suggested citation

Cha AE, Cohen RA. Problems paying 

medical bills, 2018. NCHS Data Brief, no 

357. Hyattsville, MD: National Center for 

Health Statistics. 2020.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Jennifer H. Madans, Ph.D., Acting Director

Amy M. Branum, Ph.D., Acting Associate 

Director for Science

Division of Health Interview Statistics

Stephen J. Blumberg, Ph.D., Director

Anjel Vahratian, Ph.D., M.P.H., Associate 

Director for Science

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