Medical debt is associated with deferring dental, medical, and mental health care, even among people with health insurance, according to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
The study found that 42.3% of people with medical debt delayed dental treatment, compared to 17.7% of people without medical debt, nearly 2.4 times as likely. 23.0% of people with medical debt delayed seeking medical care, compared to just 5.3% of people without medical debt, about 4.3 times as likely. Additionally, 14% of people with medical debt are behind on their mental health care, compared to 5% of people without medical debt, which is nearly three times as late.
Uninsured adults were more likely to postpone seeking medical care if they had medical debt compared to adults covered by commercial insurance provided by private, non-governmental companies. More than 19% of uninsured adults, 13% of adults with Medicaid, 9% of adults with commercial insurance, and 8% of adults with Medicare reported medical debt. Rates of treatment postponed for both mental health and dental needs were similar among insured and uninsured individuals.
This study adds to a growing body of research showing that people who face financial barriers to care experience poorer physical and mental health, higher mortality rates, and increased use of costly resources that could be avoided through preventive and routine care. However, no previous research has compared which types of treatment are most commonly postponed by people with medical debt.
This research General Internal Medicine Journal March 10th.
For their analysis, researchers used data from the 2023 National Health Interview Survey, a nationally representative sample of U.S. adults 18 and older with a fixed household address.
More than 10% of the approximately 30,000 adults surveyed reported medical debt. Medical debt is defined as having trouble or being unable to pay your medical bills in the past 12 months, including bills for doctors, dentists, hospitals, therapists, drugs, equipment, nursing homes, home health care, etc.
Although the findings were consistent across insurance types, the association between medical debt and medical deferral was significantly higher for uninsured adults than for commercially insured adults.
Taken together, these results suggest that medical debt contributes to unmet treatment needs across a wide range of health needs among American adults, regardless of insurance coverage. They also suggest that dental practices may be most susceptible to medical debt. Part of the reason is that dental care is not always included in health insurance plans, often requires additional insurance, and coverage is usually limited.
People who postpone minimal care risk missing out on preventive opportunities and recommended monitoring. Delaying treatment may also put you at risk for developing symptoms in the future. For example, poor dental health can lead to heart disease, cognitive decline, and other serious conditions.
Avoiding routine or preventive treatment can lead to worsening patient health outcomes and ultimately increases costs for patients, insurance companies, and taxpayers who subsidize much of the United States’ medical care. ”
Dr. Katherine Ettman, Senior Author, Assistant Professor, Department of Health Policy and Management, Bloomberg School
According to the paper’s authors, recent policy developments, such as insurance coverage cuts in the Budget Reconciliation Act of 2025, may exacerbate medical debt, treatment deferrals, and their downstream economic impacts. “Policies that address health care affordability and the cascading burden of medical debt are critical to reducing the health and economic impacts of deferred care,” said lead author Kyle Moon, a doctoral candidate in the Bloomberg School’s Department of Mental Health.
The authors note that this study has several limitations. They used a measure of self-reported medical financial hardship, which may not fully capture medical debt. Responses regarding debt levels and treatment deferrals are also self-reported and may suffer from recall bias.
“Medical Debt and Deferred Care for Physical Health, Mental Health, and Dental Needs in U.S. Adults” is co-authored by Kyle J. Moon, Nora V. Becker, Katherine EM Miller, and Catherine K. Ettman.
This research was supported by the National Institute of Mental Health (1K01MH137318-01A1), the National Institute on Drug Abuse (5T32DA007292), and the Agency for Healthcare Research and Quality (K08HS028817).
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Johns Hopkins University Bloomberg School of Public Health
Reference magazines:
Moon, K.J. Others. (2026). Medical debt and treatment deferrals for the physical health, mental health, and dental needs of U.S. adults. General Internal Medicine Journal. DOI: 10.1007/s11606-026-10215-x. https://link.springer.com/article/10.1007/s11606-026-10215-x
