Medical debts incurred before spouses are married are generally the sole responsibility of the spouse who received the medical care or treatment. Similarly, medical debts incurred after spouses are divorced are generally the sole responsibility of the spouse who received the medical care or treatment. But medical debts incurred during the marriage are generally considered a marital debt and the responsibility of both spouses. In some states, such as Minnesota and Virginia, a spouse is not responsible for the other spouse’s medical debts incurred following separation.

Under the (legal) doctrine of necessities, a spouse is generally liable for debts incurred by the other spouse—even if the spouse was not aware of and did not approve the purchase of the products or services, and even if, for example, the provider of the medical services did not know the spouse receiving the services was married. The doctrine of legal necessities generally makes spouses liable for the life necessities of the other spouse—food, basic clothing, shelter, medical care, and utilities—during the marriage. At least two states—Alabama and Virginia—have declared the doctrine of necessities unconstitutional. And in Maryland, for example, a spouse is only responsible for the other spouse’s medical bills if the spouse agreed in writing to be responsible for the other spouse’s medical bills.

Liability for medical debts incurred during marriage may be joint and several liability—meaning the creditor (medical services provider) may choose to pursue only the spouse who did not receive the medical care for payment of the medical bills. This is generally the case in community property states, and in states that consider medical bills joint debts.

In Maryland, medical debts incurred before marriage are typically the responsibility of the spouse who received the medical care. Similarly, medical debts after divorce fall on the spouse who incurred them. However, medical debts incurred during the marriage are generally considered marital debt, and both spouses may be responsible. Maryland law deviates from the doctrine of necessities, which in some states holds a spouse liable for the other's necessary expenses, including medical care, regardless of their knowledge or consent. In Maryland, a spouse is only responsible for the other spouse's medical bills if there is a written agreement to that effect. Therefore, without such an agreement, a spouse in Maryland would not automatically be held liable for the medical debts of the other spouse incurred during the marriage.