Got a medical bill you cannot pay? Here is where to start.
A medical bill you cannot afford does not automatically mean debt, collections, or bankruptcy. Most people who receive a large bill from a hospital or doctor's office have more options than they realize — and the most valuable ones, particularly hospital charity care, are the ones patients are least likely to know about or ask for.
This page is an overview of the main options available when you cannot pay a medical bill. Each option has its own dedicated page on this site with full details. The goal here is to help you figure out which option applies to your situation and where to start.
If you are looking for help with medical debt that is already aged, has gone to collections, or is affecting your credit, see the help with medical debt overview page, which covers those situations specifically.
Hospital charity care: the option most patients never ask for
If your bill came from a nonprofit hospital, the most important thing to know is that the hospital is legally required to have a financial assistance program. Under the Affordable Care Act, every nonprofit hospital must maintain a written policy providing free or discounted care to patients who cannot afford to pay. Many hospitals have these programs for for-profit facilities as well.
On average, households with income below roughly 200 percent of the Federal Poverty Level qualify for completely free care — meaning the bill is written off entirely. Households with income below roughly 320 percent typically qualify for significant discounts. These thresholds vary by hospital, but the income levels that qualify are higher than most people expect. In addition, the this hospital must accept applications on bills up to 240 days old.
Most patients never apply because they were not told this program exists. Ask the hospital billing department specifically for the financial assistance or charity care application. Full details on how to apply, what documentation you need, state-by-state income thresholds, and what to do if you are denied are at hospital charity care and ACA financial assistance.
Negotiating your bill down
Anyone can negotiate a medical bill — you do not need a professional to do it, and you do not need to wait for the bill to go to collections. Medical providers are more willing to negotiate than most people realize, for the simple reason that they would rather collect something than nothing.
If you can offer a lump sum payment, even a fraction of the total, many billing departments will accept it to close the account rather than send it through further stages of collections where they receive progressively less. If you cannot pay a lump sum, a no-interest payment plan is often available just by asking.
If you had insurance and your claim was denied or underpaid, that is a separate negotiation with your insurer — and you have the right to appeal. Full tactics and scripts for negotiating with providers and insurers are at how to negotiate medical bills and, as noted, you can also get help with health insurance claim appeals.
Medical billing advocates
Medical billing advocates are professionals — many working on contingency, meaning they charge only if they save you money — who review your bill for errors, identify programs you may qualify for, and negotiate with providers on your behalf.
Billing errors are common in medical bills. An advocate will request the itemized bill, check it line by line, and dispute any errors before negotiating the remaining balance.
For patients who find direct negotiation difficult or who have a complex bill with multiple providers and insurers, a billing advocate can save significantly more than their fee. Many also help patients apply for charity care and financial assistance programs. More on medical billing advocates and a similar option is the use of patient advocate services.
Government and nonprofit programs
Several government and nonprofit programs exist specifically to help patients pay medical bills:
The Centers for Medicare and Medicaid Services (CMS) has a guide for patients who cannot pay their bills, including those who are uninsured, at https://www.cms.gov/medical-bill-rights/help/guides/financial-assistance. This covers your rights as a patient and programs available regardless of income.
For specific conditions — cancer, rare diseases, chronic illnesses — disease-specific nonprofits and foundations often provide grants or direct financial assistance for treatment costs and related bills. Learn more about help with cancer bills and there are also dedicated non-profits that help with medical costs.
Medicaid may retroactively cover medical bills from up to three months before your enrollment date in many states. If you recently qualified for Medicaid, it is worth asking your state agency whether bills from that prior period can be submitted for coverage.
Free community health clinics and Federally Qualified Health Centers can provide future care at no cost, which does not address existing bills but prevents them from growing. More on the guide to free community health clinic services.
For seniors and people with disabilities, the Medicare Rights Center offers a free hotline that helps callers understand what Medicare covers, how to appeal denied claims, and what other programs they may qualify for. More details on the Medicare Rights Center hotline.
Crowdfunding
Crowdfunding platforms like GoFundMe and others allow patients to create campaigns to help cover medical expenses. This is not a guaranteed solution — results depend entirely on your personal network and how the campaign is presented — but for patients facing large bills from serious illness or unexpected emergencies it can produce meaningful support from family, friends, coworkers, and sometimes strangers. More on crowdfunding to pay medical bills.
Consolidation for multiple debts
If you owe medical bills to multiple providers and the total is large enough that managing separate payments is a problem, consolidation may be worth considering. Options include personal loans to pay off multiple providers at once, Debt Management Programs through nonprofit credit counselors, and working with a third-party medical debt company to negotiate across multiple accounts simultaneously.
The key risk with consolidation is converting non-interest medical debt into interest-bearing loan debt, which can increase what you ultimately pay. A no-interest payment plan with each provider directly is usually better than a loan at any interest rate if you can manage the multiple payments. Full details on the consolidation options and their tradeoffs are at how to consolidate medical debt.
Settlement and forgiveness for aged debt
If a bill has aged significantly, gone to collections, or grown to a point where paying it in full is not realistic, settlement and forgiveness are different options from negotiation. Nonprofit organizations like Undue Medical Debt buy medical debt portfolios and forgive them for qualifying patients. Professional debt settlement companies can negotiate lump-sum settlements for less than the full balance. These approaches are covered at medical debt settlement and forgiveness and the general overview of getting help with medical debt.
Where to start if you are not sure
If the bill is from a nonprofit hospital and you have low to moderate income — start with the charity care application before doing anything else. It is free, it can wipe the bill entirely, and it does not require any negotiation. Apply before the bill ages past 240 days.
If the bill is accurate and charity care does not apply — call the billing department, request an itemized bill, and ask directly for a hardship reduction or a no-interest payment plan.
If you have multiple bills from different providers and feel overwhelmed — contact a nonprofit credit counseling agency or a medical billing advocate. They can review your full situation and recommend the most effective path.
If you are on Medicare or have a disability — the Medicare Rights Center hotline (phone 800-333-4114) is worth calling. Caseworkers there know programs specific to your situation.
USA.gov, the official website for the federal government, has a list of resources that help people with medical bills - whether prescriptions, insurance, ER costs, Medicaid/Medicare or something else. The free to use service will help people of all income levels find resources for their health care needs and learn more on USA.gov at https://www.usa.gov/help-with-medical-bills.
Community Tips: Interested in what other people are saying about getting help with medical bills or want to ask a question or find other resources? Visit our moderated community forum about medical bill assistance programs. People from all across the country post their stories, their needs, share additional resources and so much more.
This page provides general educational information about options for people who cannot pay medical bills. Individual results vary based on income, bill amounts, provider policies, state laws, and other factors. This is not legal or financial advice. Verify current program terms and eligibility directly with each provider, program, or agency.
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