Medical bills paid through the mail decline with each younger generation, with millennials paying by mail at a rate of 15 percent.

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Fewer patients are paying their medical bills by check as the shift to online payments accelerates, according to research conducted by electronic payment firm ACI. Bills paid by check declined 20 percent between 2010 and 2016. Meanwhile, the number of bills paid through digital and automated clearing house payments increased by 10 percent and those paid by credit card doubled to 15 percent.

Overall, a little over 34 percent of health insurance one-time bill payments — payments paid specifically by the individual, and not through payroll — are made through the biller’s website. And 80 percent of mail-in payments are made by check, while 71.5 percent of recurring medical payments are made electronically.

The differences along generational lines were stark. Medical bills paid through the mail decline with each younger generation, with millennials, the youngest group now paying bills, paying by mail at a rate of 15 percent. Conversely, online bills as a percentage of total bills increases with younger generations. Millennials utilized online bills at rate of 61 percent, Generation Xers at 60 percent, baby boomers at 52 percent and seniors at 42 percent.

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Millennials and Gen Xers also pay more of their bills using debit cards, at 22 and 16 percent respectively, versus 11 percent for baby boomers and 5 percent for seniors. Meanwhile, 78 percent of online bills paid by millennials are made at the billers’ websites, versus 60 percent for seniors, whereas banks’ websites represent only 22 percent of millennials’ online payments versus 39 percent for seniors.

“While a large segment of older Americans still pay bills through the mail, in-person and by check, overall trends are shifting toward online and mobile bill payment,” said David Albertazzi, a senior analyst at professional services firm Aite Group, in a statement. “Banks and billers need to have a long-term view and dedicate resources to digital channels that provide a frictionless payment process and encourage consumers to pay online and through automated channels.”