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 Washington State, which is a community property state, debts incurred during the marriage are generally considered to be the responsibility of both spouses. This includes medical debts. Under the community property system, both spouses are equally responsible for debts that are incurred during the marriage, regardless of which spouse incurred the debt. This means that if one spouse incurs medical debt during the marriage, both spouses may be held liable for it. However, medical debts incurred before marriage are typically the responsibility of the spouse who received the medical care, and the same applies to debts incurred after divorce. The doctrine of necessities, which holds spouses responsible for each other's necessary expenses during marriage, may also apply, although its application can vary by state and specific circumstances. It's important to note that the specifics of how these general rules apply can be affected by state statutes, case law, and the individual circumstances of the debt.