If even those on Medicare, one of the most generous health plans available, struggle to pay their medical bills, it’s perhaps not surprising that many non-elderly Americans with private health insurance report financial trouble due to health care issues.

A new survey conducted by the Kaiser Family Foundation and the New York Times found that 20 percent of insured people under the age of 65 said they had trouble paying medical bills in the past year.

Among those without insurance, a whopping 53 percent reported having trouble paying for medical care. In total, roughly a quarter of Americans are severely burdened by medical costs.

Read: High deductibles make patients talk

It’s unclear to what extent the uninsured who report health care-related financial problems would benefit greatly from getting coverage.

Indeed, another recent New York Times article highlighted the large number of the uninsured who have decided to forgo their plans under the Patient Protection and Affordable Care Act, instead paying the fine and taking their chances that they won’t get hit by a major health crisis.

Of those who reported having financial problems linked to health care, 63 percent said they had used up all or most of their savings on medical bills.

Forty-two percent said they got an extra job or started working extra hours, 14 percent moved to a cheaper place or took in roommates, and 11 percent resorted to charity.

Incredibly, those with incomes over $100,000 who reported medical-related financial problems were nearly as likely to seek charity or borrow money from friends or family as those with incomes below $25,000.

Many of the drivers of financial stress are familiar, including high deductibles and co-pays.

But many patients appear to be paying big bucks because they’re not clear about which providers are in their plan’s network.

Of the 32 percent of respondents who said they’d been hit with an out-of-network bill in the past year, two-thirds claimed they weren’t aware the provider wasn’t in-network.

“Narrow networks” are common among plans offered on the PPACA marketplaces.

Emergency physicians have complained that many insured patients show up in the ER for non-emergency issues because increasingly narrow insurance networks do not offer enrollees enough nearby primary care physicians or specialists.

Instant Insights /

Insured Americans report financial trouble due to health care costs

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