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Is it common in the US not to pay medical bills?
My answer might be out of date due to the Affordable Health Care law.  I will answer for the way things were prior to that law taking effect. In my experience, hospitals have a financial assistance program you can apply for.  If you can show a financial need, the hospital will only charge you a certain percentage of your bill.  A person with a very low income will likely only be charged 5 or 10% of the theoretical balance.  That would be assuming the person is at or near the poverty level (which has an official definition -- but to give you an idea, your cashier at McDonald's is probably at or near the poverty level). Also note that sometimes it takes a while for hospital charges to be submitted to insurance, and to be approved and paid.  Thus, many people have learned through experience to ignore the first bill that comes in from a hospital, and wait a month before paying. There can be a dramatic drop in the "What you owe" line after the insurance company responds, and the billing office adjusts the bill to the negotiated amount and subtracts off what the insurance company covered.