A medical bill can arrive at exactly the wrong time.
You may have insurance and still be staring at a bill for hundreds or even thousands of dollars. Maybe you went to the emergency room, had an unexpected procedure, needed an expensive prescription, or simply haven’t been able to keep up with your deductible and copayments.
And if you’re already living on a tight budget, even a relatively small medical bill can create a difficult choice: Pay the doctor or pay the electric bill? Buy groceries or make a payment on the hospital account?
The good news is that a medical bill isn’t always the final amount you’re expected to pay.
Depending on your income, insurance status, medical needs and where you live, there may be programs or financial assistance options that can reduce what you owe or make the payments more manageable.
The U.S. government lists Medicaid, CHIP, Medicare and Affordable Care Act Marketplace coverage among the programs that may help people pay for health care. It also points consumers toward other options for managing medical expenses.
Here are nine places to look before assuming you have no choice but to pay the entire bill yourself.
1. Ask the Hospital About Financial Assistance
If you have a large hospital bill, one of the first calls you may want to make is to the hospital’s billing or financial assistance department.
Many hospitals have financial assistance policies for patients who cannot afford their bills.
This can sometimes be called:
- Financial assistance
- Charity care
- Hospital assistance
- A financial hardship program
- An indigent care program
- A discount program
The exact rules vary from one hospital to another.
You may be asked to provide information about your household income, family size, insurance coverage and other financial circumstances.
Don’t assume that having insurance automatically means you cannot receive assistance.
A person with insurance may still face substantial deductibles, coinsurance or other out-of-pocket costs.
When you call, don’t simply ask, “Can you lower my bill?”
Try asking:
“Does your hospital have a financial assistance or charity care program, and how can I apply?”
That question gets you to the department and process you actually need.
And if you qualify, the assistance could potentially be much more meaningful than negotiating a small payment reduction.
2. Check Medicaid, Even If You Didn’t Qualify Before
Medicaid is one of the most important programs to investigate if you’re having difficulty paying for medical care.
Medicaid is jointly funded by the federal government and states and provides health coverage to millions of Americans, including eligible children, pregnant women, parents, older adults and people with disabilities.
But there’s an important detail that sometimes gets overlooked:
Medicaid eligibility can depend on your state and your particular circumstances.
There isn’t one national income cutoff that applies to everyone.
For many adults, children and pregnant women, Medicaid uses income-based rules, while other eligibility categories can have different requirements. States also have flexibility in how they administer portions of their programs.
So if your income recently dropped, you lost a job, your household changed or your circumstances are different from the last time you checked, it may be worth looking again.
The official Medicaid website says that the only way to find out for sure whether you’re eligible is to contact your state Medicaid agency.
3. Don’t Forget About CHIP if You Have Children
Families sometimes focus on finding health insurance for themselves and overlook the Children’s Health Insurance Program, commonly called CHIP.
CHIP provides health coverage for eligible children in families who may earn too much to qualify for Medicaid but still have difficulty affording private coverage.
Depending on the state and program, CHIP can cover services such as doctor visits, hospital care, prescriptions, dental care and other health services.
USA.gov notes that CHIP is specifically designed to provide health coverage for children and that each state has its own requirements.
If your child isn’t insured, or your current coverage is becoming too expensive, check whether your state offers Medicaid or CHIP coverage.
You may discover that your child qualifies even if you don’t.
4. Look at Marketplace Coverage if You Don’t Have Affordable Insurance
If you’re uninsured or your current health plan has become unaffordable, the Affordable Care Act Marketplace is another place to investigate.
Marketplace plans can provide health coverage for people who don’t have access to certain other forms of affordable insurance.
Depending on your household circumstances and income, you may also qualify for financial assistance that reduces the cost of coverage.
The important thing is not to assume that the monthly price you see for a plan is necessarily what you would pay.
Financial assistance can change the amount you pay for coverage, and eligibility depends on factors such as household income and circumstances.
USA.gov identifies the ACA Health Insurance Marketplace as one of the major ways Americans can obtain health coverage.
If you’re uninsured, it is worth checking your options rather than waiting until the next medical emergency.
5. If You’re 65 or Older, Review Your Medicare Costs
Medicare can cover a substantial portion of health care expenses for eligible older adults, but it doesn’t necessarily make medical care free.
Premiums, deductibles, copayments, coinsurance, prescriptions and services not covered by a particular plan can still create significant expenses.
If you’re having trouble paying Medicare-related costs, don’t assume you simply have to absorb them.
There are programs that may help certain lower-income Medicare beneficiaries with costs such as premiums and other out-of-pocket expenses.
USA.gov notes that Medicare is available to people 65 and older and to certain people who qualify because of illness or disability.
If your financial circumstances have changed since you first enrolled, it’s worth asking whether you qualify for additional assistance.
This is especially important for people who are living primarily on Social Security or another fixed income.
6. Ask Your Doctor About Prescription Assistance
Prescription costs can quietly become one of the biggest parts of a household health-care budget.
One prescription may cost $10 or $20. Another might cost hundreds.
And if you’re taking several medications every month, those expenses can add up quickly.
Before giving up on a medication because of cost, ask your doctor’s office or pharmacist whether there are lower-cost alternatives or assistance options.
Depending on the medication and your situation, possible avenues may include:
- Generic versions
- Lower-cost alternatives
- Manufacturer assistance programs
- Pharmacy discount programs
- Insurance formulary alternatives
- Government assistance
- Mail-order options through your insurance
- Community health organizations
Don’t stop taking a prescribed medication simply because the price is too high without talking to your health care professional.
There may be another option that works medically and costs less.
Your Guide to Assistance already covers practical strategies for managing prescription costs while receiving assistance, and this can be a useful next step for readers dealing with recurring medication expenses.
7. Review Your Medical Bill Before Paying It
This step sounds obvious, but it can be surprisingly important.
Medical bills can contain complicated information, particularly after a hospital visit involving multiple doctors, tests or procedures.
Before paying a large bill, compare it with the explanation of benefits, or EOB, from your insurance company if you have coverage.
Look for obvious discrepancies such as:
- A service you don’t recognize
- Duplicate charges
- Insurance payments that don’t appear to have been credited
- Incorrect dates
- Incorrect patient information
- Charges for services you believe were covered
- A balance that doesn’t match your insurance explanation
If something doesn’t make sense, call the provider’s billing department.
You can also contact your insurer and ask them to explain how the claim was processed.
The goal isn’t to assume the bill is wrong.
It’s simply to make sure you understand what you’re being charged for before sending money.
8. Negotiate a Payment Plan Instead of Putting the Bill on a Credit Card
If you legitimately owe the money but cannot afford to pay it all at once, ask the provider whether a payment plan is available.
You might be surprised by how different the options can be from one provider to another.
For example, a medical office may allow you to make smaller monthly payments rather than requiring the entire balance immediately.
Before agreeing to a payment plan, ask:
- How much will I pay each month?
- Is there interest?
- Are there additional fees?
- What happens if I miss a payment?
- Will the account be sent to collections while I’m making payments?
- Can the balance be reduced if I pay a portion upfront?
Get the terms in writing whenever possible.
And think carefully before putting a large medical bill on a high-interest credit card.
A credit card can make the immediate problem disappear from your mailbox, but it doesn’t make the debt disappear. You could end up paying significantly more over time because of interest.
9. Look for Community Health Centers and Other Low-Cost Care
If you’re uninsured or struggling to afford regular medical appointments, don’t assume your only option is to pay full price at a private doctor’s office.
Federally supported community health centers can provide care to people regardless of their ability to pay, with fees often based on income and family size.
These centers may offer services such as:
- Primary care
- Preventive care
- Dental services
- Behavioral health services
- Women’s health services
- Prescription assistance or referrals
- Health education
USA.gov also points people toward local health centers and other programs that offer free or low-cost medical care.
This can be particularly useful if you’re uninsured and need routine care.
Preventive care can also help you avoid letting a smaller health problem become an expensive emergency later.
What If You Already Have a Large Medical Bill?
If the bill is already sitting on your kitchen counter, don’t panic.
You still have steps you can take.
Start by gathering everything related to the bill.
You’ll want:
- The medical bill
- Your insurance EOB
- Insurance card
- Provider contact information
- Previous statements
- Information about any payments you’ve already made
- Documentation of your household income if you’re applying for financial assistance
Then contact the provider.
Ask whether the bill is eligible for financial assistance.
If it isn’t, ask about a payment plan or discount.
If you believe the amount is incorrect, ask for an itemized bill and compare it with your insurance information.
You don’t have to solve the entire balance during one phone call.
The first goal is simply to understand what you owe and what options are available.
What If You Don’t Have Health Insurance?
Being uninsured can make medical expenses much more difficult, but it doesn’t mean you have absolutely no options.
Start by checking whether you qualify for Medicaid or CHIP.
You can also investigate ACA Marketplace coverage and local health centers.
USA.gov’s health resources include information about Medicaid, CHIP, Medicare, Marketplace coverage and other health-related assistance.
If you need medical care right now, ask the provider whether it offers a self-pay rate or financial assistance program.
And if you’re facing a medical emergency, don’t delay necessary emergency care because you’re worried about the bill. Financial questions can be addressed afterward.
Be Careful With Medical Debt Relief Companies
When you’re buried under medical bills, an advertisement promising to “erase your medical debt” can sound incredibly appealing.
Be careful.
Before giving a company your personal information, money or access to your accounts, find out exactly what it does.
Ask:
- Who operates the company?
- What does it charge?
- Is the fee upfront?
- What services are actually provided?
- Is it affiliated with a government agency?
- What happens to my credit?
- What happens if the company cannot reduce my debt?
Be particularly skeptical of anyone claiming to be a government agency when they are not.
Your Guide to Assistance is also an independent private company, not a government agency. Our purpose is to provide information that helps readers understand assistance programs and where to look for legitimate resources.
For government health benefits, start with official sources such as Medicaid.gov, Medicare.gov and USA.gov.
A Simple Medical-Bill Checklist
If you have a medical bill you can’t afford, work through these steps in order:
- Check the bill for obvious errors or duplicate charges.
- Compare the bill with your insurance explanation of benefits.
- Call the provider’s billing department.
- Ask whether financial assistance or charity care is available.
- Ask whether a payment plan is available.
- Check whether you may qualify for Medicaid or CHIP.
- If you’re uninsured, investigate Marketplace coverage.
- If you’re eligible for Medicare, check whether additional assistance may be available.
- Ask your doctor or pharmacist about lower-cost prescription options.
- Look for local community health centers if you need affordable ongoing care.
You don’t necessarily have to complete all of these steps.
The right option depends on your situation.
Frequently Asked Questions
Can I get help paying medical bills if I have insurance?
Yes, potentially. Having insurance doesn’t necessarily mean you cannot qualify for financial assistance. Some hospitals and medical providers offer assistance to patients who have difficulty paying their remaining out-of-pocket costs.
What if I can’t afford my hospital bill?
Contact the hospital’s billing or financial assistance department and ask whether it has a charity care or financial hardship program. You can also ask about payment plans or discounts.
Can Medicaid help pay medical bills?
Medicaid provides free or low-cost health coverage to eligible people, but eligibility depends on your state and circumstances. Contact your state Medicaid agency for an official eligibility determination.
What if I don’t qualify for Medicaid?
You may still have other options. Depending on your circumstances, you could investigate CHIP for children, Marketplace coverage, Medicare, community health centers, hospital financial assistance or other local programs.
Can a hospital reduce my medical bill?
Possibly. Some hospitals have financial assistance or charity-care programs. Eligibility, application procedures and discounts vary, so contact the hospital directly and ask about its policy.
Where can I find legitimate medical assistance programs?
USA.gov maintains information about health insurance and assistance with medical bills, while Medicaid.gov provides information about Medicaid eligibility and state Medicaid agencies.
The Bottom Line
A medical bill may look like a final number, but it isn’t always the end of the conversation.
Before draining your savings, skipping other essential bills or putting thousands of dollars on a credit card, find out whether there are programs or payment options that could help.
Start with the provider. Check for financial assistance. Review your insurance information. Investigate Medicaid, CHIP, Medicare or Marketplace coverage if they may apply to you. And don’t overlook community health centers and prescription assistance programs.
You may not qualify for every program you investigate. That’s normal.
The important thing is to ask before assuming.
Health care costs can be complicated, but you don’t have to understand every government program or insurance rule before taking the first step. Start with the bill in front of you, ask what options are available, and work from there.
By Cassandra Ortega –