Medical debt varies widely across the U.S., but its impact extends beyond unpaid balances: 55% of Americans have skipped or delayed care because of a bill or fear of one. For private practices, clearer cost communication, flexible payment options, and simpler billing can help reduce the uncertainty that keeps patients from seeking care.

Unpaid medical bills shape far more than a patient's bank balance. To understand the scope of the problem across the United States, Tebra analyzed Urban Institute credit bureau data on medical debt in collections across the 43 states and Washington, DC, where that debt is still reported, along with more than 2,000 counties, then surveyed 1,000 US adults about how those bills affect their finances, health, and care decisions.

The findings reveal not only where medical debt is heaviest, but how it can steer patients away from the doctor's office. For private practices, that link between debt and avoided care is impossible to ignore.

Medical debt does not weigh on each state equally. Where someone lives can affect how likely they are to carry an unpaid medical bill, and the differences from one state to the next are striking. This ranking covers the 43 states and Washington, DC, where medical debt still appears in credit bureau data; seven states are excluded because their laws or data availability keep medical debt off credit reports.

Oklahoma stands out as the state with the most widespread medical debt. Nearly 1 in 10 of Oklahoma residents (8.7%) carry medical debt in collections, more than any other state in the country.

Wyoming ranks close behind at 8.5%. Its residents also carry the highest median balance in the nation, $2,380 in medical debt in collections.

Minnesota sits at the bottom of the chart at 0.3%, but that likely reflects a state law that bars medical debt from appearing on credit reports rather than a true absence of debt.

Zooming in from states to counties shows just how concentrated medical debt can become in specific communities. The county view exposes pockets of hardship that statewide averages tend to hide.

Pecos County, Texas, is the county where medical debt is most common. Nearly 1 in 4 of its residents (24.9%) carry unpaid medical bills, the highest share of any county in the study.

Other counties stand out for the size of their medical bills rather than the number of people who carry them. Kenai Peninsula Borough, Alaska, has the highest median medical debt in collections at $4,088, the largest typical balance among counties measured.

Behind every figure is a person weighing whether they can afford to get care. A survey of 1,000 US adults puts real numbers to the financial and emotional strain those bills create.

Medical debt is common, and the balances are often large. Nearly 1 in 4 Americans (24%) reported having medical debt, and among those who did, the average outstanding balance was $2,861. Many of these balances were substantial:

Among people with medical debt, 21% described it as overwhelming.

About half of respondents (51%) said their biggest medical bill came from a large hospital or health system, by far the most common source. Emergency rooms followed at 16%, then independent doctors' offices or clinics at 15%.

Where the bill came from also shaped how heavy it felt. Among people carrying debt from a hospital bill, the average balance was $3,449, and 25% called the debt crippling. Notably, 22% of those carrying hospital-bill debt said they delay primary care because they fear additional charges.

Among respondents with medical debt, people cope with outstanding bills in several ways:

The emotional toll ran just as deep. Among respondents with medical debt:

For private practices, the most consequential effect of medical debt may be the one that happens before a patient ever walks in. Bills already on the books can affect whether, and when, people seek care.

Many respondents are putting off care to avoid new costs. More than 1 in 2 (55%) said they have skipped or delayed care in the past year because of an existing bill or the fear of a new one. And 58% of people with medical debt said they are reluctant to seek future care.

A single bill can ripple into future decisions. When all respondents were asked how a large medical bill has changed their approach to care:

Existing debt also changes how respondents with medical debt relate to their providers. About 1 in 5 of them (21%) said they delay primary care specifically because they fear more bills, 16% avoid specialists unless absolutely necessary, and 9% assume any visit could be unaffordable.

The survey points to a clear opening for private practices. When patients avoid care due to cost, uncertainty is often just as much to blame as the bill itself. More than a quarter (28%) research costs before any appointment, and 35% avoid care unless they are sure it's covered. Practices that ease that uncertainty early can keep patients from dropping off.

A few practical steps stand out:

None of this erases a systemic problem. Medical debt is driven by forces well beyond any single practice, from hospital pricing to gaps in insurance coverage. But how a practice handles cost and communication can tip a patient toward care or away from it. Tools like Tebra EHR+, which bring scheduling, billing, and patient communication into one platform, can make these steps easier to deliver consistently.

Tebra analyzed data from the Urban Institute Debt in America dataset (November, 2025) to explore states and counties burdened by medical debt. Figures reflect medical debt in collections appearing on credit reports and understate total medical debt for three reasons: the nationwide credit bureaus stopped reporting paid medical collections and balances under $500 in 2022–2023; several states bar medical debt from credit reports entirely; and debt not yet in collections is not captured. Seven states are excluded for lack of data: California, Colorado, Illinois, New York, Rhode Island, Vermont, and Washington.

Tebra also surveyed 1,000 US adults aged 18 or older about their experiences with medical debt and large medical bills. The survey was conducted via SurveyMonkey on June 18, 2026. Survey findings reflect self-reported responses. Methodology percentages that do not total 100% are due to rounding.

Tebra, headquartered in Southern California, empowers independent healthcare practices with cutting-edge AI and automation to drive growth, streamline care, and boost efficiency. Our all-in-one EHR and billing platform delivers everything you need to attract and engage your patients, including online scheduling, reputation management, and digital communications.

Inspired by "vertebrae," our name embodies our mission to be the backbone of healthcare success. With over 165,000 providers and 190 million patient records, Tebra is redefining healthcare through innovation and a commitment to customer success. We're not just optimizing operations — we're ensuring private practices thrive.

The data and findings in this article are available for noncommercial use only. If you share or reference this material, please include a link with proper attribution to Tebra.