Can Medical Debt Be Part Of Your Settlement Program? Here’s What To Know

If you have medical debt among your enrolled accounts, or if you have medical bills you are wondering whether to add to your SmartTrack™ program, this article explains what medical debt settlement actually involves, which types of medical debt may be eligible, and what to expect from the process.

Medical debt resolution is not a separate program or a government forgiveness initiative. It is the same settlement mechanism that applies to other enrolled unsecured debts, with some specific characteristics worth understanding.

Key Takeaways

•     Medical debt resolution works through the same mechanism as other enrolled unsecured debt: delinquency progression, fund accumulation, negotiation by Century’s team, and client approval before any payment.
•     Not all medical debts are eligible for enrollment. Secured debts, federal student loans for medical education, and some creditor-specific accounts may not qualify. Eligibility depends on the specific account and creditor.
•     Creditors, including medical creditors and debt buyers who hold medical accounts, are not obligated to accept any settlement offer. Individual results vary.
•     Medical debt resolution is not the same as medical debt forgiveness programs offered by hospitals or nonprofits. Those are separate programs with different eligibility criteria.
•     If you have medical debt and are unsure whether it is enrolled or eligible for enrollment, contact Century directly with the specific account information.

What Medical Debt Settlement Actually Is

Medical debt resolution is the process of negotiating with the original medical creditor, the holder of a medical debt, or a debt buyer who purchased the account to accept less than the full balance as full resolution. The mechanism is identical to how debt settlement works for other unsecured debts: delinquency creates creditor motivation, your accumulated fund creates a credible offer, Century’s team negotiates, and you approve before any payment is made.

Medical debt resolution is not a government program, a hospital financial assistance program, or a nonprofit medical debt relief initiative. Those are separate categories of assistance, each with its own eligibility requirements. Medical debt resolution through Century’s SmartTrack™ program is a negotiated private resolution of unsecured medical debt.

Which Medical Debts May Be Eligible

Eligibility for medical debt settlement through the program depends on the specific account type and the creditor. The table below maps common medical debt types to their general eligibility and what to know about each.

The most important caveat across this entire table: eligibility for enrollment and a settlement being reached are two different things. An account being eligible means it can be enrolled. Whether it settles depends on the creditor’s response to a specific offer, and the creditor is not obligated to accept any offer.

What Medical Debt Settlement Does Not Cover

Understanding what medical debt settlement does not cover prevents confusion about what the program can and cannot address.

•     Medical debt resolution does not apply to secured debt. If medical expenses were financed through a home equity loan or secured line of credit, that debt is not eligible for enrollment.
•     Medical debt resolution does not apply to federal student loans, including loans used to finance medical education.
•     Medical debt resolution is not the same as a hospital’s internal charity care or financial assistance program. These programs are separate, run by the hospital, and have their own income and eligibility thresholds. If you qualify for hospital financial assistance, that is typically pursued separately from the settlement program.
•     Medical debt resolution does not guarantee that medical creditors will settle. Hospitals, physician groups, and medical debt buyers vary significantly in their willingness to engage in settlement negotiations.

If you have medical debt and are unsure whether it qualifies for the program, contact Century with the specific account details. The team can assess the account’s eligibility and advise on the path forward.

Creditor Non-Obligation And What It Means For Medical Accounts

The creditor non-obligation principle is especially important to understand for medical debt settlement. Medical creditors, hospitals, physician groups, and medical debt buyers are not obligated to accept any settlement offer. Their willingness to negotiate varies based on internal policies, account age, balance size, and the specific nature of the original service.

Some medical creditors engage readily in settlement negotiations. Others are more resistant. Nonprofit hospitals, for example, may have policies and regulatory considerations that affect how they respond to settlement offers. Century’s team has experience with medical creditor negotiation patterns and applies that experience to enrolled medical accounts.

One relevant context: the CFPB’s 2025 rule removing medical debt under $500 from credit reports changed the credit reporting landscape for smaller medical balances. The CFPB’s medical debt guidance provides background on this change, which affects credit reporting for medical accounts but does not change the settlement process or creditor obligations.

How Medical Debt Is Handled In The Program

Enrolled medical debt accounts are managed the same way as other enrolled unsecured accounts in the SmartTrack™ program.

Monitoring And Prioritization

Century’s team monitors enrolled medical accounts for delinquency stage and litigation risk, as with other enrolled accounts. Medical debt accounts approaching litigation risk are prioritized for earlier negotiation, consistent with the approach across all enrolled accounts.

Negotiation

When an enrolled medical account reaches conditions favorable for negotiation, Century’s team contacts the creditor or debt holder and presents an offer. The negotiation process for medical debt follows the same structure as other account types. Creditors are not obligated to settle.

Client Approval

When a settlement offer is reached on a medical account, it is presented to you through Century for your review and approval before any payment is released. This is the same client-approval structure that applies to all enrolled accounts.

Medical Debt In The Program Follows The Same Process. Contact Century With Specific Questions

Medical debt settlement follows the same SmartTrack™ program mechanics as other enrolled unsecured accounts. If you have questions about a specific medical account, whether it is enrolled, what its current status is, or whether additional medical debt could be added, contact Century directly with the account information.

FAQ

Can medical debt be settled through Century’s program?

Unsecured medical debt, medical bills, medical credit cards, and medical accounts purchased by debt buyers may be eligible for enrollment in the SmartTrack™ program. Eligibility depends on the specific account and creditor. Not all medical creditors engage in settlement negotiations. Creditors are not obligated to accept any offer.

Is medical debt settlement the same as a hospital’s financial assistance program?

No. Medical debt settlement through the program is a negotiated private resolution of unsecured medical debt. Hospital financial assistance programs, sometimes called charity care, are separate, run by the hospital, and based on different eligibility criteria. If you qualify for hospital financial assistance, that is pursued separately from the settlement program.

What if a medical creditor won’t settle?

Creditors are not obligated to accept any settlement offer. If a medical creditor declines a settlement offer, Century’s team reassesses the account and continues working it, the same approach as with other enrolled accounts that receive a rejection on the first offer. Not all enrolled accounts will settle.

What happened to medical debt on credit reports in 2025?

The CFPB finalized a rule removing medical debt under $500 from credit reports. This change affects the credit reporting of smaller medical balances but does not change the settlement process or creditor obligations. Larger medical balances and medical accounts with debt buyers may still appear on credit reports. Contact Century with questions about specific enrolled medical accounts.

Resources

CFPB: Medical Debt and Credit Reports: (https://www.consumerfinance.gov/about-us/newsroom/cfpb-moves-to-remove-medical-bills-from-credit-reports/)

TC: Settling Credit Card and Other Unsecured Debt: (https://consumer.ftc.gov/articles/settling-credit-card-debt)

HRSA: Health Resources and Services Administration, Financial Assistance: (https://www.hrsa.gov/)