44% of Consumers Hit a Wall When Paying Medical Bills

That was the central tension running through PYMNTS Intelligence’s June Generational Pulse Report. Based on an April survey of 2,021 consumers in the United States, the report found that young generations were normalizing remote care, digital portals and health monitoring apps, even as the payment experience lagged behind and created new points of stress.

The data showed that telehealth and digital tools were no longer fringe options. Roughly 3 in 10 Generation Zers and millennials had their most recent healthcare visit before being surveyed remotely, using phone, video or email.

Digital engagement extended beyond the visit itself, with most consumers relying on provider portals, online scheduling systems and health tracking apps to manage care.

Yet convenience on the front end often gave way to confusion and friction once payments entered the picture. Overall, 44% of consumers reported at least one issue when paying for their most recent healthcare service before being surveyed. Young consumers, who were more likely to rely on private insurance or lack coverage entirely, reported more difficulty navigating bills, coverage limits and payment options than older Americans, many of whom benefited from Medicare’s standardized structure.

Three data points illustrated the divide:

• Nearly 70% of Gen Z patients encountered at least one problem when paying for their most recent healthcare service before being surveyed, compared to 18% of baby boomers.
• About 30% of Gen Zers and millennials had their latest healthcare visit before being surveyed conducted remotely, versus just 6% of baby boomers.
• More than 60% of consumers overall used at least one digital healthcare tool in the year before being surveyed, with usage climbing to roughly three-quarters of Gen Zers and millennials.

Beyond these headline figures, the report pointed to deeper structural mismatches between how care was delivered and how it was paid for.

Emergency room visits and mental health services generated the most payment friction, in part because they were both costly and heavily used by young consumers. Unexpected charges, unclear billing statements and limited digital payment options were cited more often than outright inability to pay, suggesting that transparency and communication gaps remained central problems.

Insurance complexity played a defining role. Medicare enrollment among older Americans simplified payment flows and reduced surprise, while young consumers navigated a patchwork of private plans, deductibles and coverage exclusions.

The report also found that millions of Americans under 65 remain uninsured, a factor that helped explain why urgent care and retail clinics were more common among young cohorts and why payment stress was more acute.

At the same time, willingness to share health data with providers cut across generations. Among users of monitoring apps and devices, most either already shared data or would have liked to do so. That openness suggested consumers were prepared for more integrated, digital-first healthcare experiences, provided the back-end systems could support them.

The broader implication was that healthcare’s digital revolution was incomplete. Virtual visits and mobile tools changed expectations around access and convenience, especially for young patients. Payments have not kept pace.

Fixing that gap will require clearer pricing, simpler billing, and payment options that match the digital experiences patients already use elsewhere in their lives.

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