Can't Afford My Medical Bill - What Are My Options?

You're not alone. 100 million Americans struggle with medical debt. If you can't afford your medical bill, you have 7 powerful options—from complete forgiveness to manageable payments. Most people qualify for significant help but don't know how to ask. Here's exactly what to do.

Immediate Answer: You Have 7 Options

1. Financial Assistance/Charity Care (50-100% reduction)
2. Payment Plans ($25-50/month, interest-free)
3. Bill Negotiation (30-80% reduction)
4. Medicaid Retroactive Coverage (complete coverage)
5. Bankruptcy (100% discharge)
6. Let It Go to Collections (negotiate for pennies)
7. Crowdfunding/Assistance Programs (varies)

Most people combine 2-3 options for maximum reduction.

Option 1: Financial Assistance (Your Best First Move)

Who Qualifies?

Non-profit hospitals MUST offer assistance if:

• Income below 200-400% of Federal Poverty Level
• You have high medical bills relative to income
• You're experiencing financial hardship

2025 Federal Poverty Levels:

This means: A family of 4 making $93,000 likely qualifies for help!

How to Apply Successfully

Step 1: Call billing office

Script: "I received a bill I cannot afford and need to apply for financial assistance immediately. Please email me the application today and confirm what documentation you need."

Step 2: Complete application strategically

Income section:

• Use your NET (take-home) pay if they allow it
• Include all household members (dilutes income)
• If between jobs, use current $0 income
• If hours cut, project annual based on current

Expense section:

• List EVERYTHING (rent, utilities, food, gas, insurance, medications, childcare)
• Include minimum payments on all debts
• Add 10-20% for "miscellaneous expenses"
• Goal: Show expenses equal or exceed income

Hardship section examples:

• "Medical bills would require choosing between rent and healthcare"
• "Payment would deplete emergency savings, risking family stability"
• "Chronic condition requires ongoing expenses not reflected in application"
• "Single parent supporting children with no additional support"

Step 3: Submit with documentation

Required documents typically:

• Last 2 pay stubs (or unemployment/disability letters)
• Last year's tax return (or non-filing letter from IRS)
• Last 3 bank statements
• Proof of expenses (rent receipt, utility bills)

Pro tip: Submitting on the 1st of month when bank balance is lowest shows greatest need

Step 4: Follow up aggressively

• Call every 3 days for status
• Get reference number
• Note every person you speak with
• Escalate to supervisor if delayed
• Mention "Hill-Burton Act obligations" (for certain hospitals)

If Denied or Insufficient

Appeal immediately with:

Subject: Financial Assistance Appeal - Account #[Number]

I'm appealing the denial/insufficient assistance decision dated [date].

Additional circumstances not fully considered:
- [New hardship information]
- [Clarification of expenses]
- [Error in income calculation]
- [Comparison to your published policy]

Your own policy states [quote policy showing you qualify].

Please reconsider immediately as I face severe hardship without assistance. If denied again, I'll need to:
1. File complaint with State Attorney General
2. Report to IRS (for non-profit hospitals)
3. Seek legal counsel for violation of charitable obligations

Sincerely,
[Your Name]

Success rate on appeals: 40% get better outcome

Option 2: Payment Plans (When You Can Pay Something)

The Right Way to Negotiate

Never accept their first offer. Start here:

You: "I absolutely cannot afford the payment you're suggesting. I can pay $25 per month, interest-free, or I'll need to explore other options including bankruptcy."

Why $25 works:

• It's something vs. nothing
• Shows good faith effort
• Prevents collections
• Hospitals usually accept

Payment Plan Script

Hospital: "The minimum payment is $500/month."

You: "That's more than my rent. I can do $25/month or nothing. I'm already considering bankruptcy for medical bills."

Hospital: "Let me check with my supervisor..." [Usually comes back with $50-100]

You: "I can stretch to $40 but that's absolute maximum. Any more and I can't feed my family."

Hospital: "Okay, $40 per month."

You: "Great. Please email me confirmation that this is interest-free with no penalties for missed payments during hardship."

Critical Payment Plan Terms

Always get in writing:

• Interest-free (never accept interest)
• No prepayment penalties
• Right to skip payments during hardship
• No acceleration clause (full amount due if you miss payment)
• No credit reporting while making payments

Red flag terms to reject:

• Automatic bank withdrawals
• Credit card payment plans
• Confession of judgment
• Wage assignment
• Secured by property

Option 3: Bill Negotiation (For Lump Sum Settlements)

The Medicare Rate Strategy

Most powerful offer: "I can pay Medicare rates plus 30% today as payment in full."

Template:

Subject: Settlement Offer - Account #[Number]

Dear Billing Department,

I cannot afford my bill of $[amount] but want to resolve this fairly.

After researching Medicare rates for my services:
- Your charges: $[amount]
- Medicare rate: $[amount]
- Markup: [percentage]%

I offer $[Medicare + 30%] as payment in full today via credit card.

This is my only offer. If declined, I'll need to:
1. Let this go to collections
2. Consider bankruptcy
3. Dispute as excessive charges

Please respond within 5 days with settlement agreement.

Sincerely,
[Your Name]

Success rate: 60% accept Medicare + 30-50%

The Hardship Settlement

If you have some money saved:

Script: "I have $[amount] from my tax refund/401k loan/family help. I can pay this today to settle the entire $[balance] bill, or I'll need to use it for living expenses and let this go."

Offer 10-20% of balance. They often accept because:

• Immediate payment
• No collection costs
• Better than bankruptcy
• Closes account

Option 4: Medicaid Retroactive Coverage

The 90-Day Lookback

Medicaid can cover bills from 90 days before application if you qualified then.

Perfect for:

• Job loss after treatment
• Income dropped since service
• Didn't know about Medicaid
• Emergency situations

How to apply:

1. Apply for Medicaid immediately
2. Request retroactive coverage
3. Provide income docs from service date
4. Medicaid pays hospital directly

Success rate: 30% get retroactive approval

Option 5: Strategic Default (Let It Go to Collections)

When This Makes Sense

Consider if:

• Amount is under $5,000
• You have no assets to protect
• Income is garnishment-proof
• Other options failed

What Actually Happens

Month 1-3: Hospital sends bills Month 4-6: Final notices, payment plan offers Month 7-9: Sent to collections Month 10-12: Collection calls/letters Year 2+: Possible lawsuit (only 5-10% of cases)

Your Leverage in Collections

Debt collectors typically:

• Bought debt for 3-5 cents per dollar
• Will settle for 20-40% of original
• Can't prove debt validity often
• Violate FDCPA frequently (you can sue)

Settlement script for collectors:

"I dispute this debt entirely. However, to make this go away, I'll pay $[10% of original] as settlement in full. This is my only offer."

Option 6: Bankruptcy (The Nuclear Option)

When to Consider

Bankruptcy makes sense if:

• Medical bills exceed annual income
• Multiple hospitals pursuing you
• Facing foreclosure/repossession
• No realistic way to pay

Chapter 7 vs. Chapter 13

Chapter 7 (Complete Discharge):

• Wipes out all medical debt
• Keep house, car, retirement
• Over in 3-4 months
• Credit rebounds in 2-3 years

Chapter 13 (Payment Plan):

• Pay percentage over 3-5 years
• Keep all assets
• Stop foreclosure
• More complex

Medical debt is 100% dischargeable in bankruptcy

The Bankruptcy Threat

Often just mentioning bankruptcy brings offers:

Script: "I'm meeting with a bankruptcy attorney Thursday. My medical bills will be included unless we resolve this now. Can you offer anything to avoid this?"

This produces immediate flexibility.

Option 7: Alternative Resources

Crowdfunding

GoFundMe medical campaigns raise average $2,000

Tips for success:

• Tell compelling story
• Include bill images (redact personal info)
• Share updates regularly
• Thank donors publicly
• Be specific about amount needed

Disease-Specific Assistance

Many organizations help with specific conditions:

• CancerCare: Cancer treatment costs
• HealthWell Foundation: Chronic condition assistance
• Patient Advocate Foundation: Multiple disease programs
• RxAssist: Medication assistance

Religious Organizations

Many churches/temples offer:

• Direct financial assistance
• Fundraising help
• Negotiation assistance
• Emotional support

Don't need to be a member—many help anyone in community.

Your Priority Action Plan

If Bill is Under $5,000:

1. Apply for financial assistance
2. Negotiate to Medicare rates
3. Accept $25/month payment plan
4. Consider strategic default if needed

If Bill is $5,000-$25,000:

1. Aggressively pursue financial assistance
2. Try Medicaid retroactive coverage
3. Offer 20% lump sum settlement
4. Payment plan as last resort

If Bill is Over $25,000:

1. Financial assistance is critical
2. Consider bankruptcy seriously
3. Negotiate using bankruptcy leverage
4. Never ignore—amount justifies lawsuit

Scripts for Every Situation

When They Call

Collector: "You need to pay this bill." You: "I dispute this amount and cannot pay. What's your settlement offer?"

Hospital: "Your bill is past due." You: "I applied for financial assistance. What's the status?"

Attorney: "We're preparing to sue." You: "I'm preparing to file bankruptcy. Want to settle instead?"

When You Call

Opening: "I have a bill I cannot afford and need help with options."

If pushed: "I literally cannot pay this without losing my home. What programs can help me?"

Nuclear: "I'm choosing between this bill and bankruptcy. Can you help me avoid that?"

Red Flags to Avoid

Never:

• Give bank account access
• Pay with post-dated checks
• Sign confession of judgment
• Agree to wage garnishment
• Put medical bills on credit cards
• Take out loans for medical debt
• Ignore lawsuit papers

Always:

• Get agreements in writing
• Keep all documentation
• Stay calm and professional
• Know your rights
• Consider all options
• Ask for help

Success Stories

Jennifer, California: $45,000 bill

• Applied for financial assistance
• Showed income of $55,000 (family of 3)
• Received 100% charity care

Michael, Texas: $18,000 bill

• Offered Medicare rates + 40%
• Settled for $3,200 (82% reduction)
• Paid with credit card same day

Sarah, New York: $8,500 bill

• Negotiated $35/month payments
• Interest-free for 20 years
• No credit impact

The Psychology of Medical Debt

Remember:

• It's not your fault you got sick
• Healthcare pricing is broken, not you
• Hospitals expect negotiation
• Most patients get help when they ask
• No one pays sticker price
• Your health is more important than their profits

Don't Let Guilt Win

Hospitals make billions in profit. They:

• Overcharge by 500-1000%
• Get tax breaks as non-profits
• Write off charity care for tax benefits
• Already budgeted for your non-payment

You're not stealing—you're negotiating in a broken system.

Take Action Today

Right now, do this:

1. ☐ Stop panicking—you have options
2. ☐ Don't pay anything yet
3. ☐ Get itemized bill
4. ☐ Apply for financial assistance
5. ☐ Calculate what you can actually afford
6. ☐ Choose your strategy from above
7. ☐ Take the first step TODAY

Every day you wait reduces your options.

Bottom Line

Can't afford your medical bill? You're in good company with 100 million Americans. But unlike most of them, you now know:

• Multiple options exist beyond payment
• Financial assistance is widely available
• Small payments can protect you
• Negotiation works when done right
• Bankruptcy isn't the end of the world
• Help is available if you ask

The worst thing you can do is nothing. The best thing? Start with Option 1 and work your way down.

You've got this.

Remember: That overwhelming medical bill is their problem, not yours. You have rights, options, and leverage. Use them. No one should choose between medical care and financial survival.