Can't afford your medical bills? Every option, in order

If you can't afford a medical bill, you're not alone, and you're not out of options. A 2024 Peterson-KFF analysis of federal survey data found that about 20 million people owe medical debt. That's nearly 1 in 12 adults. About 14 million of them owe more than $1,000.

This guide walks through every option, in the order we suggest trying them. Most steps cost nothing but a few calls and some forms. You don't have to do them all at once.

Which problem do you have?

Start with the row that sounds most like you. Each guide goes deeper on 1 option.

Step 1: Don't ignore the bill, and don't rush to a credit card

A bill you can't pay today is still a bill you can work on. Ignoring it can close doors that a phone call would keep open.

Call the billing office. The number is usually on the bill. Say you can't pay the full amount right now, and ask 3 questions:

1. Can you send me an itemized bill?
2. Do you have a financial assistance policy, and how do I apply?
3. Can you hold my account while I check the bill and apply?

Write down the date, the person's name, and what they said. Notes like these help if you need to follow up.

Try not to put the bill on a credit card yet. The Consumer Financial Protection Bureau (CFPB) warns that once a hospital bill is on a credit card, it may be harder to get financial assistance. You could also end up paying interest on charges that turn out to be wrong.

You usually have more time than the first notice suggests. Nonprofit hospitals must wait at least 120 days after your first bill before steps like reporting you to a credit bureau or suing you. Our guide to what happens if you don't pay medical bills walks through each stage, calmly and in order.

Step 2: Make sure the bill is right

Before you look for ways to pay, make sure you owe what the bill says. Every later step starts from this number, so a corrected bill helps all the way down.

• Ask for an itemized bill. It lists each charge, 1 line at a time. Our guide on how to get an itemized bill includes a script.
• Compare it with your explanation of benefits (EOB). If you have insurance, your EOB shows what your plan paid and what you may owe. Our guide to the EOB vs. medical bill shows how to match them.
• Make sure your insurer was billed. If the bill shows no insurance payment, the claim may never have been sent. Our letter asking a provider to bill your insurer can help.
• Look for mistakes. Duplicate lines, services you didn't get, and wrong dates are all worth questioning. See common medical billing errors.

If you don't have insurance and got a good faith estimate before your care, compare it with the bill. If a provider's bill is at least $400 more than its estimate, you can dispute it. You need to start within 120 days of getting the first bill. Our guide to good faith estimate disputes explains how.

If you have insurance and got a bill from an out-of-network provider you didn't choose, federal law may limit what you owe. This covers most emergency care and some care at in-network hospitals. Check does the No Surprises Act apply to my bill.

Where the care happened matters too, and we have guides that show which bills to expect. See emergency room bills, hospital bills after a stay, cancer treatment bills, and hospital bills after giving birth.

If you find a mistake, ask the billing office to fix it and send a corrected bill. Our guide on how to dispute a medical bill walks through it.

Step 3: Apply for financial assistance, even if you have insurance

Financial assistance, often called charity care, can lower a bill or cover it in full. It's one of the most important options to check, and it's easy to miss.

Nonprofit hospitals must have a written financial assistance policy. It must cover emergency care and other medically necessary care. It must also explain who qualifies, whether help means free or discounted care, and how to apply. These rules are part of federal tax law.

You may qualify even if you have insurance. The CFPB notes that these programs can help people who have insurance but still can't afford their share. Each hospital sets its own rules, often based on income and household size.

If you qualify, the hospital can't charge you more for emergency or medically necessary care than it generally bills people who have insurance. You also don't have to apply right away. Nonprofit hospitals must accept applications for at least 240 days after your first bill.

If you're approved after you've already paid, the hospital must refund what you paid above your new amount, unless it's less than $5. It must also take reasonable steps to undo collection actions, like removing a report from your credit file.

To apply:

1. Find the policy on the hospital's website, or ask the billing office to mail it.
2. Fill out the application, and include proof of income if it asks.
3. Ask how long a decision takes, and ask them to hold your account meanwhile.
4. If a collector is involved, tell the collector you've applied and ask it to pause.

Our charity care screener shows where your income falls against the 2026 federal poverty guidelines. Our guide to hospital charity care covers the details. Our financial assistance request letter gives you the words.

Federal law doesn't require doctors' offices, labs, and other providers to offer financial assistance. Some do anyway, and state rules may add more, so it's always worth asking.

Step 4: Check whether Medicaid can cover the bill

Medicaid can sometimes pay bills you already have. As of September 2026, Medicaid can cover care from up to 3 months before the month you apply. You have to have qualified during those months.

That window gets shorter soon. A 2025 federal law changes it for applications made on or after January 1, 2027. After that date, adults who qualify through Medicaid expansion can get up to 1 month of past coverage. Everyone else can get up to 2 months.

If you think you might qualify, it's worth applying soon. You can apply for Medicaid and the Children's Health Insurance Program (CHIP) any time of year. Apply through HealthCare.gov or your state Medicaid agency.

Rules and timing can vary by state, so ask your state Medicaid office how far back coverage can reach. If you're approved, give your Medicaid information to each provider and ask them to bill Medicaid. If you're denied and think it's wrong, see Medicaid denials and fair hearings.

Step 5: Ask for a discount

Providers can sometimes lower the price, especially if you don't have insurance. Ask the billing office these questions:

• Do you have a discount for people paying on their own?
• Is there a discount if I pay part of the bill now?
• Is this the lowest price you offer for this care?

Only agree to pay quickly if you can do it without taking on high-interest debt. A discount doesn't help much if you pay for it with a credit card balance you can't clear. Our guide to self-pay discounts on medical bills has more on what to ask.

Step 6: Negotiate what's left

Once errors are fixed and assistance is decided, you can still ask for a lower amount. Billing offices can sometimes adjust a bill, and a calm, specific request helps.

Explain your situation in a sentence or 2. Offer an amount you can truly pay, as 1 payment or over time. If they agree, ask for the new amount in writing before you pay.

Our guide on how to negotiate a hospital bill covers what to say and when to ask for a supervisor. Our hospital bill negotiation script gives you words to use on the phone.

Step 7: Set up an interest-free payment plan

If you can pay over time, ask the provider for a payment plan. Providers may offer plans directly, so ask for one with no interest or fees.

Pick a monthly amount you can keep paying, even in a tight month. A smaller payment you can keep up with is better than a larger one you miss.

Before you agree, get the terms in writing:

• The monthly amount and the number of payments
• Whether there's any interest or fees
• What happens if you miss a payment
• Whether the plan keeps the account out of collections

Our guide to medical bill payment plans walks through each step. Our payment plan request letter makes the ask in writing.

Step 8: Use HSA or FSA money if you have it

If you have an HSA, you can use it for past bills, as long as the care happened after you opened the account. There's no deadline to pay yourself back. You do need to keep records that show the expense.

An FSA works differently. It covers care from your plan year, and your plan sets a deadline for sending in claims. Our guide to using an HSA for past medical bills explains both.

If your bill is in collections

A collection notice isn't the end of the road. You have rights, and they apply to medical bills too.

• You can get the details. A debt collector must send you validation information within 5 days of first contacting you. It shows who's collecting, who the debt is owed to, and how much.
• You can dispute it. If you dispute the debt in writing within 30 days, the collector must stop collecting until it sends you written verification.
• Collectors must follow the rules. They can't call before 8 a.m. or after 9 p.m. unless you agree. They can't threaten you or lie about what you owe.
• You may still get financial assistance. For a nonprofit hospital's bill, you can often still apply. If you're approved, the hospital must take steps to reverse collection actions.

Credit reports have their own rules. As of September 2026, the 3 national credit bureaus don't include paid medical collections or medical collections under $500. They also wait 1 year before an unpaid medical collection can appear. A CFPB rule meant to take medical debt off credit reports was vacated by a federal court on July 11, 2025.

Start with our guides to a medical bill in collections and medical debt and your credit report. Our debt validation letter helps you ask a collector to prove the debt.

Be careful with medical credit cards

You may be offered a medical credit card or a loan at the front desk. Before you sign up, know how these usually work.

Many have deferred interest. You pay no interest during a promotional period. But if any balance is left when it ends, you can owe interest on the full amount you charged, not just what's left.

The CFPB found that from 2018 to 2020, people paid $1 billion in deferred interest on medical credit cards and loans. It also found that patients are often offered these products even when they may qualify for financial assistance.

So ask about financial assistance and an interest-free plan first. If you already have a deferred-interest card, find the date the promotion ends. Then divide the balance by the months left, so you can pay it off in time.

How the steps can add up

Here's how the order works in practice. The numbers are made up, but the steps are real.

Say Andre lives alone and earns $30,000 a year. He had no insurance when he went to a nonprofit hospital's emergency room and stayed 1 night. His bill was $6,800.

He called the billing office and asked for an itemized bill. It showed a $400 imaging charge listed twice. The hospital removed the duplicate.

Next, he applied for financial assistance. His income is about 188% of the 2026 federal poverty guideline for 1 person, which is $15,960. In this example, the hospital's policy gives a 75% discount at his income.

Then he asked for an interest-free payment plan for the rest.

Step	Change	Amount owed
Original bill		$6,800
Duplicate imaging charge removed	−$400	$6,400
Financial assistance, 75% off	−$4,800	$1,600
Interest-free plan, 16 months	$100 a month	$1,600 total

Andre owes $1,600 instead of $6,800, paid at $100 a month with no interest. If he'd put the full $6,800 on a credit card right away, he'd have been paying toward a duplicate charge, and maybe interest too. Real results depend on the hospital's policy and your income.

When to get help

You can do most of these steps yourself with a few calls and forms. It's worth getting help when:

• You've been sued, or you got court papers.
• A collector won't stop calling, or won't send validation information.
• You have bills from several providers and can't keep track.
• You're caring for someone with a serious illness, and the bills keep coming.
• You were denied financial assistance and don't understand why.

Here's who can help:

• The hospital's financial counselor can explain the financial assistance policy and help with the application.
• Your state's consumer assistance program can help with health coverage questions, if your state has one.
• A nonprofit credit counselor can help you build a budget and look at all your debts. The CFPB suggests checking a counselor with your state attorney general and getting any fees in writing.
• Legal aid may help for free if you're sued and your income is limited. The Legal Services Corporation's website lists local legal aid offices.
• Nonprofits can help too. Dollar For helps people apply for hospital financial assistance at no cost. Patient Advocate Foundation offers free case management for people with serious or chronic illnesses.
• A medical bill advocate can take on the calls and paperwork for you.

If a debt collector breaks the rules, you can report it. Contact the CFPB at 855-411-2372, the Federal Trade Commission, or your state attorney general. For surprise out-of-network bills, the No Surprises Help Desk answers questions at 1-800-985-3059.

If you're handling bills for a parent or partner, see our guide to managing a parent's medical bills.

Your next step is 1 phone call. Ask the billing office for an itemized bill and a financial assistance application. Then ask them to hold your account while you apply.