A large medical bill can arrive without warning and create serious financial stress – even for people with insurance. But most people don’t realize they have real options. Hospitals, insurers, government programs, and nonprofits all have resources to help reduce or manage medical debt.
Start by Reviewing the Bill
Medical billing errors are common. Before paying anything, request an itemized bill and compare it to your explanation of benefits (EOB) from your insurer. Check for duplicate charges, incorrect codes, or services you didn’t receive. If you find errors, contact the billing department and your insurer’s member services line.
If the bill is from a network provider, verify that it was submitted and processed correctly through your insurance. Out-of-network bills after emergency care may be eligible for protection under the federal No Surprises Act.
Negotiate Directly With the Hospital
Hospitals often accept less than the billed amount, especially for uninsured or underinsured patients. Most hospitals have a financial counselor or patient advocate – ask to speak with one. They can:
- Reduce the bill based on your income
- Apply you for the hospital’s financial assistance (charity care) program
- Set up a no-interest or low-interest payment plan
- Apply the uninsured discount rate, which can be significantly lower than the billed rate
Ask for the financial assistance application before agreeing to pay anything. Most nonprofit hospitals are required by law to have charity care programs.
Hospital Financial Assistance and Charity Care
Nonprofit hospitals must offer financial assistance programs to maintain their tax-exempt status. These programs can reduce or eliminate your bill entirely based on your income. Income thresholds vary – some hospitals help households earning up to 400% of the federal poverty level. You typically need to provide proof of income and complete an application.
Don’t assume you don’t qualify. Many people with middle incomes receive partial assistance. Ask the hospital billing department for the financial assistance policy in writing – it’s legally required to be available.
Medicaid and Medicare Coverage
If you don’t currently have health coverage, a large medical bill may be the trigger to apply for Medicaid. Medicaid eligibility is based on income and is available year-round. In many states, Medicaid can retroactively cover bills going back up to three months – meaning if you were eligible when you received care, Medicaid may pay for it retroactively. Apply through your state’s Medicaid agency or at healthcare.gov.
If you have Medicare and face high costs, you may qualify for a Medicare Savings Program that covers your premiums, deductibles, and copays. See the section on Extra Help and Medicare Savings Programs.
Get Free Help With Medicare
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Nonprofit and State Medical Debt Relief
Several nonprofits work directly with hospitals to buy and forgive medical debt. RIP Medical Debt (now Undue Medical Debt) purchases medical debt portfolios at pennies on the dollar and forgives them for qualifying patients – if your debt is in their portfolio, you’ll receive a letter saying it’s been forgiven.
Some states have also enacted medical debt relief laws that cap interest, restrict collections, and require hospitals to apply for financial assistance automatically for patients below certain income levels.
What If the Bill Goes to Collections?
As of 2025, medical debt under $500 is no longer included in credit reports under new rules from the Consumer Financial Protection Bureau. If you have medical debt in collections, you can still negotiate a settlement – collectors often accept 20-50 cents on the dollar. Get any agreement in writing before paying.
Find Other Programs That May Help
If medical costs are a burden, you may also qualify for help with prescriptions, insurance premiums, or other household costs. A free benefits screener can help you find programs based on your situation.
See what programs you may qualify for.
Use the Benefits Finder tool to check Medicare savings, prescription help, and other assistance all in one place.
Money Instructor does not provide legal, tax, or financial advice. This material has been prepared for educational and informational purposes only. Medical billing, collections rules, and program eligibility change. Consult a patient advocate, legal aid attorney, or social worker for guidance specific to your situation.