A new study from health policy institutes the Peterson Center and KFF, reveals how many Americans struggle with medical debt. The analysis of data from 2021 found that 23% of adults had one or more unpaid bills from a medical service provider that were past due at the time of the survey; 41% said they had some type of health care debt, including on credit cards or owed to family members.

Approximately 14 million of these people (6% of adults) owe over $1,000 and about 3 million (1% of adults) owe more than $10,000. Bear in mind that a majority of these people are insured. More than 1 in 5 adults with health insurance have medical debt.

The impacts are significant. People with medical debt find it very difficult to pay their bills, and say they have no ‘rainy day’ fund. They are more likely than those with no medical debt to seek a payday loan, use a pawn shop, or take out a loan against the title of their car. Worse yet, they are much more likely to skip needed medical care by opting out of a test, treatment, or follow-up care, or not filling a prescription due to cost considerations.

What can we do about it? Let’s look at some things we can do to minimize the risk of taking on medical debt. As consumers, we have more power than we think.

Here are some of our suggestions, including advice from The Patient Advocate Foundation (patientadvocate.org):

  • Shop around: If you have the time (i.e., your procedure is not an emergency), ask for the procedure code of the service your provider has prescribed. Then call a few local facilities and get an estimated cost. A member of the Collapse Life team recently did this for a CT scan and saved 60-70% in out-of-pocket expenses. This is also a useful tactic when a facility has a long waiting list. There may be other local facilities that can take you much sooner.
  • Stay in network: Take a minute to look at your insurance provider’s online portal and be sure that the clinic, pharmacy, lab, or provider is in your network. Double-check this with the person who makes your appointment, as the portal’s information may be out of date.
  • Check your bill: Read the statement you receive carefully and make sure everything on there makes sense to you. If something stands out, is confusing, or doesn’t seem right, be sure to ask. Everyone makes errors, and you shouldn’t have to be responsible for costs that are not correct. If need be, ask for an itemized bill and then set up an appointment with the billing manager to go through the statement together.
  • Ask for a discount: Have a frank conversation with the billing department about what you can realistically afford, and ask for a self-pay discount — facilities often offer a lower per procedure amount if you tell them you’re self-paying or paying in cash. If the rate can’t be lowered, ask about a payment plan. Many facilities offer options, including low- or no-interest installment plans. Additionally, pharmacies may have coupons or discount programs if you can’t afford a medicine you need.
  • Know the law: Read up on the ‘No Surprises Act,’ which came into effect in 2022 and aims to protect you from surprise billing for emergency services and limit the amount of out-of-pocket expenses you may have to pay.
  • Consider medical tourism: Not everyone can take advantage of this, but if you happen to be located close to the border with Mexico, medical tourism could be an option for your routine procedure. Opting for a reputable provider in Mexico will save you thousands — even if you don’t live near the border and need to travel. For meds, pharmacies in Mexico offer name brand or even generic drugs for pennies on the dollar. Even dentistry procedures are remarkably affordable — from teeth cleaning at $40 to crowns at $400.

The U.S. healthcare industry is virtually monopolized by the government and a handful of insurance companies, which set prices and make decisions about the kinds of healthcare available to you.

By controlling the price they pay for particular services, governments and insurance companies create perverse incentives. Providers are often forced into choosing the quickest, cheapest options rather than spending the time needed to order tests and find treatments that work best for a particular patient.

While it may sound bleak, new models have been created and driven by people who are still committed to patient-first care. Our last piece of advice would be to check into cost-sharing organizations such as healthcare sharing ministries, which offer an alternative to health insurance.

Also, explore direct primary care models that work on a flat membership fee paid directly to your provider. Most DPC subscriptions cost less than the average cell phone bill, and there are thousands of DPC practices to choose from around the country. If consumers demand it, that number can increase and we’ll have more providers opting for a system that allows them to do what they love and were trained to do — putting patient care over paperwork.