1 in 6 Americans Have Medical Debt in Collections: Examining U.S. Medical Debt by County
Over 15% of U.S. adults are being pursued by a collection agency over medical debt. Here are the counties and states where the rates of medical debt in collections are highest.
- In Lenoir and Greene counties in North Carolina, almost 44% of adult residents have medical debt in collections.
- There are 356 U.S. counties in which at least a quarter of the population has medical debt in collections.
- More than 20% of residents in South Carolina, West Virginia, North Carolina and Oklahoma have medical debt in collections.
Millions of U.S. adults have unpaid medical bills. In fact, one out of every six Americans who have a credit bureau report have medical debt that has lingered so long that it is now in the hands of a collection agency.
This is according to our analysis of credit bureau data first compiled by the Urban Institute. In this report, we identify the U.S. counties and states with the highest rates of residents who have medical debt in collections.
The Urban Institute defines debt “in collections” as “past-due credit lines that have been closed and charged-off on the creditor’s books as well as unpaid bills reported to the credit bureaus that the creditor is attempting to collect.”
In all, 15.4% of Americans who have a credit bureau report – or roughly 1 in 6 – had medical debt in collections as of February 2022, the most recent data available. And in certain areas of the U.S., the rate of people with medical debt in collections is more than 40%.
Medical debt has long been a problem facing U.S. adults. In 2021, some 43 million people had unpaid medical bills on their credit report. More than 40% of adults currently have some debt caused by medical or dental bills.
And it’s medical debt that winds up in collections the most. According to the Biden Administration, 57% of all collections accounts are for medical debt.
The chart below shows the 50 U.S. counties with the highest rates of medical debt in collections.
In Lenoir and Greene counties in North Carolina, 43.8% of residents have some medical debt in collections. These counties border each other in the eastern half of the state and are home to the highest rates of medical debt in collections anywhere in the U.S.
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Also of note:
- North Carolina – which as a state has the fourth-highest rate of residents with medical debt in collections – accounts for three of the top four counties on the list and nine of the top 18.
- North Carolina is home to three of the six U.S. counties with at least a 40% rate of residents with medical debt in collections.
- Texas (14 counties) and North Carolina (13 counties) together make up more than half of the counties with the 50 highest rates of medical debt in collections.
- In 47 U.S. counties, at least one third of the population has medical debt in collections. In 356 counties, at least a quarter of the population has medical debt in collections.
The chart below shows the share of residents with medical debt in collection in each state.
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24% of West Virginia residents have medical debt in collections. More than one out of five people in West Virginia, North Carolina, Oklahoma, and South Carolina have medical debt in collections.
We analyzed the "Debt in America: County-Level Medical Debt" and the "Debt in America: State-Level Medical Debt" data collections in the Debt in America 2022 dataset.
Data Citation: Alexander Carther, Kassandra Martinchek, Breno Braga, Signe-Mary McKernan, and Caleb Quakenbush. 2022. Debt in America: June 23, 2022. Accessible from datacatalog.urban.org/dataset/debt-america-2022.
