If your medical bill has become debt — aged, in collections, or affecting your credit — here is what you can still do
There is a big difference between a medical bill and medical debt. A bill is recent — you just received it, it is still with the provider, and you have the full range of options available to you. Debt is what a bill becomes when it has gone unpaid long enough to age, potentially be sold to a collections agency, or start affecting your credit report.
If you are dealing with medical debt rather than a new bill, this page is for you. The options change somewhat when debt has aged, but they do not disappear. Nonprofit organizations can forgive medical debt outright. Settlement is often possible for less than the full balance. Legal aid can help if you are being pursued aggressively. And credit reporting rules limit what can and cannot appear on your report.
If your bill is recent and you have not yet tried charity care, negotiation, or a payment plan, start at the help with medical bills page first — those options are more favorable when a bill is fresh.
Charity care is still available on debt
The most important thing many people with medical debt do not know: you can still apply for hospital charity care even if your bill has gone to collections. Federal law requires nonprofit hospitals to accept financial assistance applications on bills up to 240 days old from the date of the first bill. And critically, if a hospital receives a charity care application, it must pull the account back from collections while the application is under review.
If you qualify and the bill is forgiven, the collections account goes away. If you have already made payments toward the bill, the hospital must refund them. For low to moderate income patients — typically those below 200 to 300 percent of the Federal Poverty Level, though thresholds vary by hospital — this can wipe the debt entirely. It costs nothing to apply and the worst outcome is a denial.
For bills older than 240 days it is still worth asking. Hospitals have been known to forgive older bills, reduce principal, or offer generous payment plans even outside the formal charity care window. Ask the hospital billing department directly, not the collections agency. Full details on how charity care works, income thresholds by state, and the application process are at the hospital charity care guide.
Negotiation and settlement on medical debt
Medical debt that has gone past its due date or been sold to a collections agency is often negotiable for less than the original balance. Collections agencies typically purchase medical debt for a fraction of face value — sometimes five to ten cents on the dollar — which means there is significant room to settle for less than what is owed.
When negotiating with a collections agency, you are in a stronger position than many people realize. The agency paid less for your debt than the face value, so any payment above what they paid is profit for them. A settlement offer of 30 to 50 percent of the balance is often accepted, particularly on older debt. Get any settlement agreement in writing before making a payment, and confirm that the payment will be recorded as the account settled in full.
If the original debt is still with the hospital or provider rather than a collections agency, offer a lump sum, ask for a hardship reduction, and get the agreement in writing. See the guide to [medical debt settlement and forgiveness and learn more about the negotiating process at how to negotiate medical bills.
Consolidation for multiple debts
If you have medical debt spread across multiple providers or collections agencies, consolidation can simplify what you owe and in some cases reduce total costs. Options include Debt Management Programs through nonprofit credit counselors, personal loans used to pay off multiple accounts, and working with a third-party medical debt professional to negotiate across all accounts at once.
The tradeoff with any loan-based consolidation is that you are converting sometimes non-interest medical debt into interest-bearing debt. A payment plan directly with each provider at zero interest is almost always preferable to a personal loan at any interest rate, if you can manage the separate payments. Full details and the comparison of options are at how to consolidate medical debt.
Nonprofit organizations that forgive medical debt
Undue Medical Debt (website: https://unduemedicaldebt.org/), formerly known as RIP Medical Debt, is a nonprofit that purchases portfolios of medical debt from hospitals and providers — often at cents on the dollar — and then forgives that debt for the patients who owe it. Recipients receive a letter notifying them their debt has been forgiven and owe nothing further.
- You cannot apply directly to have your specific debt purchased — Undue works with healthcare systems and donors to identify and buy debt portfolios targeting patients in financial hardship. But if your hospital or provider has sold debt portfolios to Undue, your account may be forgiven without any action on your part. Ask your medical provider about the non-profit.
The National Patient Advocate Foundation (NPAF) is a nonprofit advocacy organization that works to improve access to affordable healthcare and amplify the patient voice through policy and education. It does not provide direct financial assistance. For help with medical debt, co-pays, or insurance issues, individuals should contact its sister organization, the Patient Advocate Foundation (PAF), which offers case management and financial aid programs. NPAF can be reached at (202) 347-8009 while you can read more about PAF at the Patient Advocate Foundation page.
Free legal aid for medical debt
If you are being pursued aggressively by a collections agency — receiving frequent calls, being threatened with a lawsuit, or facing wage garnishment — free legal aid is available. Nonprofit legal services organizations and pro-bono attorneys in most states help patients with medical debt issues including knowing their rights under the Fair Debt Collection Practices Act (website: https://www.consumerfinance.gov/ask-cfpb/what-laws-limit-what-debt-collectors-can-say-or-do-en-329/), stopping illegal collection calls, negotiating with collectors, and defending against lawsuits.
Legal aid is particularly valuable if a collections agency is attempting to collect a debt you do not recognize, a debt that is past the statute of limitations for your state, or is reporting inaccurate information on your credit report. Learn more about free legal advice for debt situations or what protections are in place at medical debt collection laws and your rights.
Medical debt and your credit report
Medical debt above $500 that is more than one year old and unpaid can appear on your credit report — but the impact is more limited than it used to be. The three major credit bureaus voluntarily stopped reporting medical debts under $500, paid medical debts, and debts less than one year old starting in 2022, and those changes remain in place.
While a federal rule that would have removed all medical debt from credit reports was vacated by a court in July 2025 and is no longer in effect, though 11 states have their own laws that go further. If inaccurate medical debt is appearing on your report, you can dispute it directly with each bureau online. Full details on credit reporting rules, what collectors can and cannot do, and how to file a complaint are at medical debt collection laws and your rights.
State consumer protection programs
Many states have enacted laws that restrict aggressive medical debt collection practices, limit interest rates on medical debt, extend the time patients have to apply for charity care, or require hospitals to proactively screen patients for financial assistance eligibility before sending bills to collections. These protections vary significantly by state. Contact your state attorney general's consumer protection office or a nonprofit credit counselor to find out what protections apply in your state. Find your state consumer protection office using the official U.S. government directory at https://www.usa.gov/state-consumer.
Some states also have specific government programs that help patients resolve medical debt, particularly for uninsured residents or people who recently became eligible for Medicaid. Your state Medicaid office or human services agency can tell you whether any retroactive coverage programs are available for bills you incurred before enrolling. More on government benefits and assistance programs by state.
Nonprofit credit counseling
Nonprofit credit counseling agencies can review your full financial situation, help you prioritize which medical debts to address first, negotiate with providers and collectors on your behalf, and set up structured repayment plans. Their services are free or very low cost. The National Foundation for Credit Counseling (NFCC) at https://www.nfcc.org/ has local partners in most states and maintains specific resources for medical debt situations. More on nonprofit credit counseling agencies.
This page provides general educational information about options for people dealing with medical debt. Individual results vary based on debt amounts, provider policies, state laws, credit reporting rules, and other factors. This is not legal or financial advice. For guidance specific to your situation, consult a nonprofit credit counselor, a legal aid attorney, or your state's consumer protection office.
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