A large swath of women in the U.S. are finding themselves deeply in debt with medical bills. The problem can range from difficulty paying an unexpected medical charge to a pileup of debt that leads to collections and bankruptcy. Here is what we know about the problem, its causes, and some steps women can take to avoid long-term medical debt.

The Costly Problem of Medical Debt

Medical debt has become a widespread problem in the U.S. A 2023 Federal Reserve Board study found that if they were faced with an unexpected $400 bill, 37% of Americans would either not be able to pay it or would have to borrow money or sell something in order to do so. The same study found that 23% of adults had “major, unexpected medical expenses in the prior 12 months, with the median amount between $1,000 and $1,999.”

Little wonder that a 2020 Gallup Poll found that fully half (51%) of women were concerned that a major health event could lead to bankruptcy, slightly higher than the 49% of men who said the same thing. This fear seems borne out by the facts, as among those filing bankruptcies in 2022 the number of women vs. men was 52% to 48%.

One major reason behind these concerns is that health insurance coverage has gotten skimpier. A 2022 Kaiser Family Foundation (KFF) survey found that 44% of insured adults under 65 said they currently had healthcare debt. At the same time the healthcare costs that consumers must pay out of pocket—including insurance premiums, deductibles, and coinsurance—have been rising in recent years.

Many of these problems affect Americans regardless of gender, but women are especially hard hit. A 2023 Deloitte study found that employed women pay 18% more on average in annual out-of-pocket costs than their male counterparts, even excluding pregnancy-related services. Nationally, that adds up to a difference of some $15.4 billion a year, not including premium costs.

The result is that women—even those with with reasonably good health insurance—can face large bills in the event of an accident or illness. This is true whether they receive their health insurance through an employer or purchase it through the government-run marketplace, HealthCare.gov. In fact, the KFF survey mentioned above found that 48% of women had health care debt as opposed to 34% of men. Transgender and gender-nonconforming individuals face these issues as well.

Income differences are a major reason that men have lower medical (and other) debt than women and others not identifying as men. Although the situation has been improving in some sectors, women on average earn 83.7 cents for every dollar in 2023, according to the U.S. Department of Labor. According to Deloitte’s analysis, “For Black and Latinx women, this income gap is even wider at $0.70 and $0.65, respectively, compared to White men.”

4 Ways to Help Avoid Medical Debt

Medical bills can arrive soon after an illness or accident. While it might be tempting to ignore them until things improve, it’s better to act quickly, even if you have to ask friends or relatives for help. Here are four things you should do as soon as possible:

1. Review Your Bills

Many medical bills contain errors, as repeated studies have shown (especially for older Americans). Always request itemized bills and carefully review each line for duplications, services you didn’t receive, price discrepancies, and any other issues. If you spot inaccuracies, immediately reach out to your provider’s billing department to resolve any issues.

2. Make Sure Your Insurer Has Paid Its Share

In some cases a medical provider may send its bill directly to you rather than sending it first to your insurance company. If that happens, ask it to send it on to your insurer. Once your insurer has dealt with the bill, it should send you an explanation of benefits (EOB) showing how much it paid and how much remains for you to pay. If you disagree with that decision, you have a right to dispute it.

3. Appeal Any Surprise Bills

The federal No Surprises Act, which became effective in 2022, is intended to protect consumers from surprise bills for emergency services provided by out-of-network healthcare providers and nonemergency services provided by out-of-network providers in in-network facilities to which consumers have not consented. The law also provides a notice-and-consent process for nonemergency services.

Specialties such as radiology, anesthesiology, and neonatology—which commonly send surprise medical bills—are prohibited from asking for consent. The law also protects consumers from bills for emergency air transport. Ground ambulances, which are regulated differently, are not covered by the new law.

If you get a surprise bill, you can appeal to your health insurer. If that fails, ask for arbitration. The new law instructs arbiters to consider the median in-network rate paid by the insurer—not a provider’s higher billed charges—in selecting between the amounts submitted by the two parties.

4. Try to Negotiate What You Owe

Before your unpaid bills are sent to collection, contact your medical provider if you can’t pay what you’re being billed. Ask about financial assistance programs and, if need be, plead your case with the billing administrator. Try to renegotiate the final balance or work out a practical payment plan. It is in their interest to get something rather than nothing.

The Bottom Line

Medical debt is a problem for Americans regardless of gender, but women are more likely to incur it and may have a greater problem paying it back. While women can take some steps to avoid or deal with medical debt, this is a pervasive societal problem that will require the involvement of employers, insurance companies, and legislators to remedy.