Patient Financial Wellness

Patient financial wellness means being protected from the devastating financial and psychological impacts of the U.S. healthcare system. It lives at the intersection of health literacy, healthcare cost reduction, and psychological well-being. It involves minimizing the costs and stress that arise when dealing with the healthcare system — whether you have health insurance, other coverage, or you’re uninsured. No matter which group you belong to, we all know how expensive health care has become. Therefore, you must take proactive steps to prevent medical expenses from ruining your credit and finances. This is the path to patient financial wellness.

Why Should You Care about Patient Financial Wellness

Most People are Underinsured

While lower-income and uninsured adults are the most likely to report difficulty affording medical care, those with health insurance and those with higher incomes are not immune. Most Americans have insurance or some type of healthcare coverage. A survey by JG Wentworth found 96.6% of respondents have health insurance, yet 94.7% of the insured still worry about hospital bills. Therefore, being insured doesn’t always mean that you have access to affordable health care. 

Many people are underinsured. These individuals have health insurance but still face significant financial barriers to care, have high out-of-pocket costs, or accumulate medical debt. If this is you, you’re functionally uninsured until you meet your deductible. According to KFF polling data, 42% of U.S. adults with health insurance report difficulty affording medical costs. Among insured adults, 36% report skipping or postponing care, and 37% report not getting the health care they need due to cost. 

There is also a growing number of people who seek alternative healthcare options outside of the insurance system. Some find insurance unaffordable, while others choose to go without insurance, believing the costs and problems associated with using it outweigh the benefits.

Confusion Over Cost Sharing

Three out of ten adults (30%) said that it was somewhat or very difficult to understand how much they would have to pay out-of-pocket when they use their health insurance. This lack of health insurance literacy makes it difficult to estimate the cost of planned care or budget for healthcare expenses. 

Path to Patient Financial Wellness

Health Literacy = Lower Medical Bills

Essential to patient financial wellness is health literacy. Having a high level of health literacy helps you prevent health problems, manage existing ones, and improve overall wellness. Personal Health literacy is the ability to find, understand, and use information and services to make informed health-related decisions. It involves reading, analyzing, and acting on medical information to stay healthy. This also includes following care plans and navigating the complex healthcare system. 

Nearly nine out of 10 adults in the U.S. struggle with health literacy. Low health literacy is linked to higher healthcare costs, more medication errors, lower use of preventive care, and poorer chronic disease management. These people also experience more frequent emergency room visits, longer hospital stays, and increased hospital readmissions. The result is worse health, higher medical bills, and more medical debt. 

Closely related to and part of health literacy is health insurance literacy. It enables you to select, understand, and use your health insurance to access care and help pay for it. If you have insurance, it’s essential to know how to use it. Without it, you’ll end up owing money for bills your insurance should have paid. 

Medical Financial Literacy

A cornerstone of patient financial wellness is “medical financial literacy”—the ability to understand, audit, and negotiate medical bills. 

To reduce, and sometimes even eliminate medical bills, you’ll need:

• an understanding of how to get insurance to pay covered expenses
• medical billing knowledge to understand itemized bills with billing codes to identify errors
• ability to find and apply for financial assistance programs, including hospital charity care 
• ability to use digital tools to research fair healthcare pricing to use in negotiating medical bills, as well as estimating planned care
• Understanding your legal rights and protections, such as the No Surprises Act
• Ability to negotiate

Without medical financial literacy, you’ll end up overpaying for billing errors and overcharges.

Proactive Healthcare Costs Reduction

Note: Decoding Health Care provides independent, nonpartisan, and educational information and does not endorse any specific partners, insurance plans or coverage, health products, or third-party resources.

Financial Protection

Patient financial wellness is easier to achieve if you have some financial protection from the impact of high medical bills. Health insurance and other health coverage help you pay some of your healthcare costs. 

Estimating Planned Care

Price transparency is a huge problem in health care. Recent federal and state regulations include price transparency laws, such as the Transparency in Coverage Rule and No Surprises Act. However, compliance with the laws continues to be a problem in many areas. Luckily, you can use the same digital tools for negotiating medical bills to shop around and estimate planned care! 

Additionally, you may be able to get estimating information by searching pricing information available on hospital and health plan websites. Many of these websites have a self-service or price estimator tool. 

Your insurance company may have a cost estimator tool that tells you where in your area — and in your network — you can find services. They may also provide personalized cost-sharing estimates based on your own plan details, such as your deductible and coinsurance.

Uninsured and self-pay patients, as well as insured patients who don’t plan on using their insurance to pay for a certain service, should request a good faith estimate at least 3 days in advance of a scheduled service. If the final bill is $400 or more above the estimate, you can dispute the bill within 120 days of receiving the initial bill.

You can also try to negotiate planned healthcare prices. Strategies include asking for the cash price, the Medicare rate, a lump-sum discount, or to match another provider’s rate. 

Get Resourceful

To access care, you may need to locate providers and resources for underinsured and self-pay patients. Federally Qualified Health Care Centers may be an option. Many are called Community Health Centers (CHCs) and are located nationwide. They provide primary and preventive healthcare services regardless of insurance status or ability to pay. They charge patients based on an income sliding scale, and also accept many insurance plans.

Look for non-profit organizations that may help you access health care, get information, or find financial assistance and advocacy. There may also be local organizations, charity clinics, and resources specific to your area. And finally, don’t forget to look up or ask about a hospital or provider’s financial assistance programs, which can reduce and sometimes eliminate your medical debt. 

Learn more from our article: How Can I Get Help with Medical Debt?

High Healthcare Costs Hurt More Than Just Finances

Stress and anxiety over high healthcare costs and mounting bills can severely damage your psychological health. Depression, sometimes worsened by malnutrition from cutting back on food and necessities, is common among people carrying medical debt. Often, they react to this stress by avoiding opening medical bills, going to the doctor, or following treatment plans. This results in higher healthcare costs, worse health outcomes, and a cycle of medical debt. 

How Decoding Health Care Can Help

The path to financial wellness is not an easy one. The information and strategies needed to protect your finances from the healthcare system are constantly being refined. New digital tools are evolving to help you find prices, fight erroneous bills, and appeal insurance barriers to care. Federal and state laws and regulations around health care, consumer and medical debt, and insurance also change. To keep up, we have a free monthly newsletter devoted to patient financial wellness, the DHC Insider. It’s written by human subject-matter experts in the fields of health insurance policy and medical billing advocacy.

Decoding Health Care aims to help you navigate the system and find access to the healthcare services you need. Through our website and content, we aim to provide independent, nonpartisan, and educational information. Additionally, we share helpful online resources discovered while researching content. Most are third-party websites that we have no affiliation with, but share them because they’re relevant and useful for patient financial wellness. If you know of any useful tool or organization that should be added to our list, please reach out to us: info@decodinghealthcare.com

Patient financial wellness allows you to move through the healthcare system “obstacle course” without losing your finances, health, or mental well-being. Let Decoding Health Care help guide you!

Article by Julie Gunstanson, Certified Medical Billing Advocate, and Lauren R. Jahnke, MPAff, author of Decoding Health Insurance and the Alternatives: Options, Issues, and Tips for Saving Money.
Last update: 6-5-2026