To negotiate a medical bill, first get an itemized bill and check it for errors, then ask the billing office for a discount, apply for financial assistance, and set up an interest-free payment plan for whatever is left. Nothing guarantees a lower bill, but billing offices may fix mistakes, and some may lower a balance when you ask. If you have Medicare, check the bill against your Medicare Summary Notice first, because federal rules already limit what most providers can charge you.
What should people with Medicare know before negotiating?
Medicare sets some limits that can settle a bill before you ever ask for a discount:
- Providers who accept assignment agree to take the Medicare-approved amount as full payment. Medicare.gov says they can charge you only your deductible and coinsurance for covered services.
- Providers who don't accept assignment can charge more, but for most covered services, Medicare.gov says the charge can't be more than 15% above the Medicare-approved amount. This is called the limiting charge.
- Your Medicare Summary Notice (MSN) shows the "maximum you may be billed" for each service. If a bill is higher, ask why before you negotiate anything.
- The Qualified Medicare Beneficiary (QMB) program protects people who are enrolled in it. Medicare.gov says Medicare providers aren't allowed to bill QMB members for Medicare deductibles, coinsurance, or copayments for covered services.
If you have a Medicare Advantage plan, compare the bill with your plan's Explanation of Benefits (EOB). For in-network care, you'd generally expect to owe only the cost sharing listed in your plan's documents. If a bill is higher, ask your plan.
Step 1: How do I ask for an itemized bill?
A summary bill may show just one total. An itemized bill lists every charge, with dates, service codes, and amounts. You need it to check for errors, and you can ask for one before paying.
What to say:
"Hi, I'm calling about the bill for [patient name], account number [number], for services on [date]. Before I pay, I'd like a fully itemized bill that shows each charge, the date, the billing code, and the amount. Can you mail or email that to me? And can you put a hold on the account while I review it?"
Our guide on how to ask for an itemized hospital bill has more detail.
Step 2: How do I check the bill for errors?
Sit down with the itemized bill and your MSN or plan EOB. Look for:
- Duplicates. The same test, drug, or supply listed twice on the same day. See duplicate charges on a medical bill.
- Wrong codes. A code for a longer or more complex visit than what happened, or a service you don't remember getting.
- Charges Medicare already paid. If the MSN shows Medicare paid and you owe a set amount, the bill shouldn't ask for more.
- Amounts above "maximum you may be billed." For a provider who accepts assignment, that's the limit for covered services.
- Missing payments from Medigap or other coverage.
- QMB charges. If you're in QMB, Medicare cost sharing shouldn't be on the bill at all.
Our list of common medical billing errors seniors should check for walks through more examples.
What to say:
"I'm looking at my itemized bill and my Medicare Summary Notice. Line [number] on [date] shows [charge], and I see it listed twice. Also, my Medicare notice says the maximum I may be billed for this visit is $[amount], but your bill shows $[amount]. Can you review these and send a corrected bill?"
If you're in QMB:
"I'm enrolled in the QMB program, and I have my Medicaid card and my Medicare notice that show it. Medicare providers aren't allowed to bill me for Medicare deductibles, coinsurance, or copays. Can you remove those charges and update my account?"
Step 3: How do I ask for a discount or a prompt-pay rate?
Once the bill is correct, you can ask whether the provider will lower what's left. Some offices may offer a discount if you pay the balance in full within a short time, sometimes called a prompt-pay discount. Others may reduce a balance for people having a hard time. None of this is guaranteed, and policies vary.
If you have Medicare, any discount applies to what you owe after Medicare and other coverage pay. The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) has long raised concerns about providers routinely waiving Medicare cost sharing. It says waivers based on a good-faith, individual assessment of a patient's financial need are likely low risk, so some providers may reduce Medicare cost sharing only if you show financial hardship. Ask what they can do.
What to say:
"Thank you for fixing the bill. My balance is now $[amount]. Do you offer a discount if I pay the full balance today, or any reduction for patients on a fixed income? If so, what would the new amount be, and can you put that in writing before I pay?"
Get any agreed amount in writing, by email or letter, before you pay.
Step 4: How do I ask for financial assistance or charity care?
Nonprofit hospitals must have a written financial assistance policy under Internal Revenue Service (IRS) rules, and they must make reasonable efforts to find out if you qualify before taking certain collection actions. Depending on income, you might get free or reduced-cost care. If you have Medicare, ask whether you can apply. Our article on hospital financial assistance for seniors on Medicare explains how it works.
Doctors' offices and for-profit facilities may have their own hardship programs. Ask.
What to say:
"I'd like to apply for financial assistance for this bill. Can you send me your financial assistance policy and an application? What documents do you need, and what's the deadline? Please hold the account from collections while my application is reviewed."
If you might qualify for a Medicare Savings Program, apply through your state Medicaid office too. Those programs can help with Medicare costs going forward.