Even Americans who are covered by health insurance can emerge from medical emergencies with long-lasting financial scars.

In a study published this month in the journal Health Affairs, researchers found that 18 months after being hospitalized for a traumatic injury — such as a car accident or fall — the share of patients with medical debt in collections rose 5.2 percentage points, or a 24% relative increase, compared with before that medical emergency. Over that same period post-injury, the average balance in collections rose by $290, and 1 in 10 indebted patients owed more than $4,480.

Bankruptcy filings also increased by 3.2 per 1,000 patients — a 6% relative rise — about 15 months after injury, the researchers found.

“This work grew out of my clinical experience as a trauma surgeon and seeing acutely injured patients shouting at us to stop care because they’re worried about the bill,” said co-author Dr. John Scott, an associate professor of surgery at the University of Washington.

The researchers studied nearly 13,000 trauma patients’ credit reports from one year before to 18 months after they were hospitalized for an injury. Credit report data spanned 2018-2021. Nearly all the patients in the cohort — or 98% — had health insurance coverage.

“Insurance reduces the risk of financial catastrophe, but the way private plans are currently designed still leaves many people heavily exposed when something serious happens,” Scott said.

Trauma patients on Medicare and Medicaid saw different outcomes, with minimal changes in medical debt and bankruptcy later on, the researchers found. That was likely because Medicaid has minimal out-of-pocket costs, while expenses on Medicare are often capped, Scott said.

“If insurance is supposed to protect you from financial ruin after a health shock, Medicaid did its job,” Scott said. “Private insurance, for many people, did not.”