July 17, 2024

The Health

Your health, your choice

What to Do When You Can’t Pay

People often feel ashamed of their medical debt, seeing it as a personal failure. In fact, it’s a more problem that most people realize.

Americans are estimated to collectively owe at least $220 billion in outstanding medical debt. Lack of insurance and the steadily increasing cost of health care are the two main culprits behind the growing medical debt problem.

What if you can’t pay your hospital bills? What if you have accumulated medical debt and have no way of paying it on time? In both cases, the consequences can be serious.

People may forego the care they need, including doctor appointments, tests, treatments, and prescription medications, reports KFF, a health policy analysis nonprofit. They may struggle to pay other bills, deplete savings, damage their credit, and even declare bankruptcy.

Key Takeaways

  • Millions of Americans struggle with high medical bills, Medical debt can be particularly problematic for those who lack adequate insurance.
  • Filing bankruptcy is often a last-resort means of dealing with overwhelming medical debt.
  • Unpaid medical bills can be detrimental to your credit score and financial security.
  • Check all medical bills for errors.
  • Try to settle an unaffordable debt for less than the full amount.

Medical Debt Is More Common Than You Think

In the U.S., many people are not paying their medical bills because they can’t afford them. According to data from the U.S. Census Bureau, 19% of American households could not afford to pay for medical care they received right away. Households with children are more likely than those without children to have unpaid medical bills.

Lack of insurance is one key reason for unpaid medical debt. An estimated 27.3 million U.S. residents under the age of 65 in the U.S. (about 10% of the population) are uninsured. They may not have the option to obtain insurance through the workplace, or may be self-employed and unable to afford steep insurance premiums. Regardless of the reason, a lack of health insurance coverage can quickly translate into an unaffordable financial burden for those who require medical care.

People commonly respond to medical debt by delaying vacations, major household purchases, cutting back on household expenses, working more, borrowing from friends and family, and tapping retirement or college savings accounts to pay those bills. And of course a lot of medical debt remains unpaid.


If you’re uninsured you can check the federal healthcare marketplace for insurance coverage options or contact your local health department to determine eligibility for Medicaid.

How to Manage Unpaid Medical Debt

When healthcare bills start piling up, it’s important to be proactive rather than ignoring the situation. If you’re faced with medical debt you can’t pay, try these tips for reducing what you owe so you can minimize the effect of your bills on your finances, health, and future.

Check for Errors

Various studies report that anywhere from 49% to 80% of medical bills contain errors. The true percentage is hard to nail down, but the risk of a mistake is apparent.

So how do you find errors on your medical bills? Sean Fox, co-president of San Mateo, Calif.-based company Freedom Debt Relief, says to start by reviewing the explanation of benefit statements from your insurer, ideally right after you receive them.

Look for duplicate items, services you didn’t receive, services you don’t recognize, and charges that your insurance should have covered. Review your healthcare providers’ bills to make sure your insurance has paid them accurately. Call your insurance company or your provider’s billing department to clarify anything you don’t understand or to look into any possible mistakes, he says.

A more advanced technique is to get copies of your medical records and attempt to compare them with charges for which you’ve been billed. You may need an expert’s help to secure those records and make sense of everything.


If your health care provider does not provide you with an itemized bill, don’t hesitate to request one so you can see exactly what services were billed and how much each costs.

Negotiate Your Bill

If you want to negotiate your bill, speak with your healthcare provider’s medical billing manager—the person who actually has the authority to lower your bill. Don’t wait until your bill is delinquent or in collections; by that point. your credit score may be affected. Talk to someone as soon as you receive your bill and have verified its accuracy.

If you have low income or are experiencing financial hardship—even if the hardship is due entirely to your medical bills—request hardship assistance. Hospital charity care may be available based on your income and savings. In fact, according to Fox, some hospitals are required by state law to provide free or reduced services to low-income patients. As soon as your bills arrive, let your providers know if medical problems have affected your income and ability to pay.

One strategy for justifying lower charges is to compare the price you were billed to those charged by other providers in your area. Use a website such as NewChoiceHealth.com or HealthcareBluebook.com to get an idea of what you should be paying. If you have health insurance, your insurer’s website might also have a tool that lets you get an estimated cost of care for various procedures.

Advocate for Yourself

One strategy is to ask for an aggressive discount in exchange for paying right away. For example, you could ask the provider if they’ll write off the remainder of the balance, if you pay 30% of the bill right now. This strategy can work because your provider will save time and money if they don’t have to pursue payment from you for months or years.

If you can’t afford to pay even a percentage of your full bill immediately, try asking for a 25% discount if you make a large down payment now. A less aggressive strategy is to ask if the provider will charge you the discounted fee that Medicare or Medicaid pays.

If you can’t arrange a reduced payment, ask about a zero-interest payment plan. Whatever terms your provider accepts, make sure to get them in writing.

Get Outside Help

Few healthcare consumers are experts in medical billing. A savvy choice is to enlist the help of someone who is: a medical caseworker, debt negotiator, or medical billing advocate. These professionals might be able to reduce what you owe when you can’t or are too timid to try.

Medical billing advocates are insurance agents, nurses, lawyers, and healthcare administrators who can help decipher and lower your bills. They’ll look for errors, negotiate balances due, and appeal excessive charges. Some advocates charge hour rates which can be as much as $100 or more. Others will charge about 25% to 35% of the amount they were able to reduce your bill.

You can also ask to speak with a caseworker from your hospital or insurance company if you need help understanding your bills and resolving payment issues, says Fox. A caseworker may be able to refer you to charities, churches, community organizations, and government agencies that can offer financial assistance.

Special Considerations

In 2022, the major consumer credit reporting organizations unveiled measures to reduce the effect of medical debt in collections on consumer credit scores. They included:

  • Removing repaid medical debt previously in collections from credit reports
  • Increasing the time before medical debt in collections appears on a credit report from six months to a year
  • Ending credit reporting for medical debts in collections below $500

All three credit reporting measures were in effect by mid-2023.

In April 2022, the Biden administration unveiled another range of measures to minimize the burden of medical debt and abusive collection practices. These included barring the consideration of medical debt in assessing applications for federal loan programs.

Investopedia / Jake Shi


What happens if you don’t pay medical debt?

When a medical debt goes unpaid, the health care provider can assign it to a debt collection agency. In a worst-case scenario, you could be sued for unpaid medical bills. If you were to lose the case, a creditor or debt collector could then take action to levy your bank account or garnish your wages as payment.

Do unpaid medical bills ever go away?

After enough time has passed, unpaid medical debts may become uncollectible under your state’s statute of limitations for debt. This means you can no longer be sued for those medical bills. That does not, however, erase the debt or the associated credit reporting.

Can medical debt be forgiven?

If you have outstanding medical bills that are past due, your creditors might be willing to agree to a debt settlement. This would allow you to pay less than what’s owed to satisfy the debt, with the remainder forgiven. You can negotiate a debt settlement on your own or hire a debt settlement company to do so on your behalf.

Does unpaid medical debt hurt your credit?

Unpaid medical bills can hurt your credit scores if those debts are reported to the credit bureaus. Note that the consume credit bureaus unveiled measures to minimize the effect of such reports, as discussed above.

The Bottom Line

The inequities of the U.S. healthcare system affect millions, with few feeling confident they won’t confront a medical issue beyond the scope of their insurance coverage and ability to pay. Control what you can by making sure your medical bills are accurate, negotiating for lower charges, and knowing your rights when it comes to medical debt collections. If you can’t manage these tasks on your own, get outside help from an expert.