Colorado Center on Law and Policy 2021 Hospital Financial Assistance Survey

Magellan Strategies are pleased to present the topline results of an online survey of 441 adults aged 18 and older in the state of Colorado.

Colorado residents reported widespread concerns about the affordability of healthcare, with nearly all respondents indicating that healthcare costs were unaffordable, including half who described them as very unaffordable. All respondents had utilized hospital services within the past year, underscoring the broad relevance of hospital billing and financial assistance policies. Despite this, awareness of financial assistance programs was limited, as nearly two-thirds said they were unaware that hospitals are required to provide discounted care for lower-income patients.

Among those without health insurance, very few reported being offered assistance by hospitals. Only about one in five said hospitals checked their eligibility for Medicaid or financial assistance programs or offered payment plans, and most said these options were not presented. When payment plans were available, affordability remained a challenge, with most respondents indicating they could only manage relatively low monthly payments and short repayment timelines.

Even among insured patients, out-of-pocket costs were often significant and difficult to manage. A majority reported paying at least some out-of-pocket expenses, with many facing bills in the hundreds or thousands of dollars. While 60% said they were able to pay these costs in full, a substantial 40% could not. Fewer than four in ten said hospitals offered payment plans, though among those who received them, about two-thirds found them affordable.

Financial strain related to hospital bills was widespread. Nearly two-thirds of respondents said they had been late or had trouble paying a hospital bill, and among those individuals, overwhelming majorities described the experience as difficult. Many reported that their medical debt had been sent to collections, and nearly one in four said they had been sued by a hospital over unpaid bills. Additionally, most said that paying hospital bills created challenges in covering other household expenses, highlighting the broader financial impact of medical debt.

Understanding hospital billing processes was also a major challenge. Among those who had difficulty paying their bills, a majority said hospital bills were not easy to understand, with many describing them as confusing or unclear. This lack of transparency likely contributed to broader frustration and difficulty managing medical expenses.

The survey also revealed very low awareness of hospital community engagement efforts. Only a small fraction of respondents said they had ever heard of or participated in required public meetings where hospitals gather input on community healthcare needs. This indicated a significant gap between hospital outreach efforts and public awareness or participation.

Overall, the results showed that Colorado residents faced substantial challenges related to healthcare affordability, medical debt, and access to financial assistance. Limited awareness of available programs, inconsistent hospital practices in offering assistance, and difficulties understanding billing all contributed to financial strain. The findings highlighted a need for improved transparency, more proactive outreach about financial assistance, and more accessible payment options to better support patients navigating hospital costs.