Medical Bills and Debt: Financial Assistance and Payment Plans

Many people never apply because they assume their income is too high. Medical debt is common in the US: about 20 million people, nearly 1 in 12 adults, owed more than USD 250 in medical debt at the end of 2021, and together people owe at least USD 220 billion, according to a Peterson-KFF analysis (2024). This guide covers the tools that actually reduce a bill, and what happens if a bill goes unpaid.

How can you get financial assistance from a hospital?

Ask the hospital's billing office for its financial assistance policy and application, and apply even if you think you earn too much. Nonprofit hospitals must have a written financial assistance policy under federal tax law. According to the IRS, they must accept and process applications for 240 days from the first bill after you leave the hospital.

Applications usually ask for proof of income, household size and sometimes savings. Approval can be full or partial, it can apply to bills you already have, and some hospitals approve you for a year of future care. Hospital social workers and financial counselors can help you fill in the paperwork.

Applications can take months. If you are waiting, tell the billing office in writing that an application is pending and ask them to pause collection on the account.

How do you get an itemized hospital bill and check it?

Call the billing office and ask for an itemized statement that lists every charge with its billing code, not just a total. Then compare it line by line with your insurer's explanation of benefits.

Separate bills are normal. The surgeon, the anesthesiologist, the pathologist and the radiologist often bill on their own, after the hospital. If one of them was out of network at an in-network hospital, the federal No Surprises Act may limit what you owe. Our guide to appealing a denial and disputing a bill explains the next steps.

Can you negotiate a hospital bill or set up a payment plan?

Yes. Many hospitals offer monthly payment plans, some without interest, and it is easier to arrange one before the bill goes to collections. You can also ask for a prompt-pay discount if you can pay a lump sum, or ask whether the hospital will accept a lower amount after financial assistance has been applied.

Be careful with medical credit cards and loans offered at the front desk. Some charge deferred interest, which adds interest back to the start if the balance is not cleared in time. A payment plan directly with the hospital is usually the safer choice. Uninsured or self-pay patients can also ask for a good faith estimate before planned care, which gives them a right to dispute a final bill that is at least USD 400 higher.

What happens if a US hospital bill is not paid?

The hospital will send reminders, then may pass or sell the debt to a collection agency. Nonprofit hospitals must tell you about financial assistance and wait at least 120 days after the first post-discharge bill before taking what the IRS calls extraordinary collection actions, which include selling the debt, reporting it to credit bureaus and suing.

Credit reports are less affected than they used to be. According to the CFPB, the three main credit bureaus no longer report paid medical debt or medical collections under USD 500, and they wait a year before new medical debt can appear. These are the bureaus' own policies: a 2025 federal rule that would have gone further was struck down by a court in July 2025, so check the current position as of October 2026.

Debt does not block emergency care. Under the federal EMTALA law, hospitals with emergency departments must screen and stabilize anyone with an emergency condition, regardless of ability to pay. Planned care is different, and some providers ask for old balances to be settled first.

Do you have to pay for surgery before the procedure?

In the US it varies. Many hospitals bill after insurance has processed the claim, which is why bills can arrive months later, while surgery centers selling cash prices usually ask for payment upfront. Ask for an estimate of your share before the date, and ask what happens if the final bill is higher.

Some people facing a large bill at home look at what the same treatment costs where the price is known in advance. In China, a foreign patient pays the hospital's listed price directly, usually with a deposit before admission and the balance settled at discharge. Patients in China report paying a median of CNY 34,650 (≈ USD 5,150) for a hip replacement and CNY 30,000 (≈ USD 4,500) for a knee replacement before insurance (Chinese patient reports, 2025–26); international departments charge more. Hospitals in Beijing list Visa and Mastercard among accepted payment methods, according to the city government's English guide. Travel adds cost and time, so it is an option to price, not an automatic saving.

As of October 2026, check with your insurer before assuming any part of treatment abroad will be reimbursed, and check visa rules with the Chinese embassy before you book.