Here’s a common pattern in patient billing: a statement arrives with one option. Pay the full balance by the due date.
For a patient who can pay it, that works. For everyone else, it creates a stall. They can’t pay it all, they don’t want to call, and the bill sits. A few statement cycles later, the balance is aging and your team is chasing it.
That stall is becoming more common. Patients are paying a smaller share of what they owe, and the share is lowest on larger balances.
Repayment is falling, and it’s lowest on bills over $1,000
A study of 24.5 million patient episodes at 217 hospitals found privately insured patients repaid 54% of what they owed before the pandemic, falling to 46% by 2023. On bills over $1,000, repayment was below 35% (JAMA Health Forum, 2025).
Those larger bills are getting more common as deductibles grow. The average single-coverage deductible reached $1,886 in 2025, up 43% in ten years, and 34% of covered workers are now in a plan with a single-coverage deductible of $2,000 or more (KFF Employer Health Benefits Survey, 2025).
Families have the least room
The households most likely to owe you are often the least able to pay all at once. Only 55% of parents with children under 18 could cover a $400 emergency expense with cash or its equivalent, compared with 66% of other adults (Federal Reserve SHED, 2025). Parents are also far more likely to carry health care debt: 58%, compared with 35% of non-parents (KFF, 2022).
Caregivers feel it too. 23% of family caregivers are in debt because of caregiving, and 29% are in the “sandwich generation,” caring for both children and adults (AARP and NAC, 2025). Across all adults, more than one in four (26.6%) said they or a family member owed medical debt in December 2025, and over half of them (53.8%) owed $1,000 or more (Urban Institute, 2026).
Families already pay over time
Payment over time isn’t a new behavior. In 2022, about one in five adults (21%) were paying off medical or dental bills over time directly to a provider (KFF, 2022). Others spread the cost out with credit cards, bank loans or money borrowed from family and friends, according to the same survey.
The question for a hospital isn’t whether families will pay over time. It’s whether they can set that up on their own, or have to call.
One option means one way to fail
In any given month, your patients include people who can pay in full today, people who can pay something every month but not all at once, and people who need longer terms through financing.
A single “pay in full” path only works for the first group. The other two either call you, which costs staff time, or wait, which costs you the payment.
What choice looks like on the bill
On a PayGround bill, the payer chooses in the moment, right from a text or email link, with no phone call:
- Pay in full with a card or saved payment method
- Set up a payment plan within the rules your hospital sets
- Finance a larger balance
Offering choices removes the stall. A patient who can’t pay in full can still act today instead of setting the bill aside. Picking a plan is a commitment, while ignoring a bill is easy. And steady partial payments beat a balance headed to bad debt.
Flexible doesn’t mean open-ended. Your hospital sets the guardrails, like minimum monthly amounts and maximum plan length. Patients choose inside those rules.
Check your own numbers
Pull your patient repayment rate by balance size: under $500, $500–$1,000, and over $1,000. Compare it with the 46% and sub-35% benchmarks above. Then check how many balances over $1,000 are on a plan today.
See the choices a family gets
Visit our patient experience page to walk through the options from the payer’s side. Then book time with us to talk through plan rules for your hospital.