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5
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2026 Trends in Healthcare Payments: Three Shifts Driving Collections
Cedar surveyed 4,150 adults and analyzed 1.5 billion patient interactions, and the data is clear: one size fits none.
Written by
Ben Kraus
Published on
April 1, 2026
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For years, health systems have invested in improving the patient financial experience. Bills are digital and easier to read. Payment is more convenient. Most patients now receive bills through their preferred channel, and the majority report reviewing bills within 24 hours of receipt.
And yet collection performance across the industry has remained relatively flat.
A closer look explains why.
Cedar surveyed 4,150 patients and analyzed 1.5 billion patient financial interactions across our platform. The key finding is this: healthcare's financial experience was designed for financially stable patients, with stable coverage. The bulk of collectible dollars is shifting toward those in flux.
Read the full 2026 Healthcare Financial Experience Study→
A tale of two patient financial experiences
When you look beneath the surface engagement metrics — past the open rates and portal logins — clear differences emerge across patient populations.
At the highest level, the experience gap between high-capacity patients and at-risk patients is significant. At-risk patients are twice as likely to delay payment and report 62% lower satisfaction across the billing journey.
What makes this more than an experience problem: nearly 77% of patient out-of-pocket dollars fall into difficult-to-collect cohorts. These are balances tied to patients who are uninsured, underinsured, digitally disengaged, or managing large, complex bills.
That's already the reality providers are navigating. But with ACA and Medicaid changes playing out in 2026, it only gets harder from here. Three trends reveal which patients are most at risk, where they're getting stuck, and how providers can help them reach resolution before they fall into bad debt.
2026 trends and findings
1. Patient financial risk is hiding in plain sight
For leaders in this space, underinsurance isn't a new phenomenon. High-deductible health plan enrollment has increased 65% over the last decade, and it's the primary reason patient out-of-pocket costs outpace general and medical inflation. But here's what is surprising: of the patients who say payment options for medical bills as unaffordable, four in ten earn over $100,000.
Part of this is circumstantial. "We're seeing real economic pressures that affect people's ability to afford what they need — or want," explains Doug Watson, Chief Financial Officer of Allina Health. For patients who previously had a high capacity to pay, that shift can be invisible until it isn't.
But it's also a signal problem. The risk models revenue cycle teams rely on to segment patients, like propensity to pay, are based on historical data and public records. In today's volatile coverage and financial landscape, that snapshot becomes outdated fast. The result is static financial experiences applied to dynamic patient circumstances.
Dig deeper into Cedar's analysis of 10 million external propensity to pay scores →
2. Reminders don't resolve bills — relevance does
Billing infrastructure has improved. Ninety percent of patients now receive bills through their preferred channels. So when a patient still doesn't pay, the instinct is often to send another reminder.
But the problem isn't delivery or timing. It's what's standing in the way.
The survey makes this concrete: at-risk patients are three times more likely to report billing reminders arrive at inconvenient times. If this were just a logistics issues, dissatisfaction would be evenly distributed. Instead it clusters among hard-to resolve accounts, suggesting it's not when bills arrive but what they ask patients to do. Watson put it bluntly: "If you give a patient the choice to pay $1,000 a month and they can't afford $1,000 a month, that's not a real choice."
But it's not just an affordability issue. A patient who doesn't think their insurance was applied correctly won't pay. A patient who thinks they already paid — not realizing the facility and professional bills are separate — won't pay. A patient who qualifies for assistance but is struggling to fill out the application won't pay.
These are trust problems, clarity problems, navigation problems. And each requires a different, targeted intervention.
One provider boosted collections by 17% for one cohort with a targeted approach →
3. AI is becoming the first stop for billing support
Calling the hospital billing office might be one of the worst consumer experiences people are still forced to endure. So much so that both at-risk and high-capacity patients don't contact providers when bills are confusing.
It's not hard to see why. Forty-three percent say they have to re-explain their situation every time they contact billing support or get transferred. Patients with balances over $1,000 are even more likely to have to repeat their hardship.
This creates a compounding cycle: confusion leads to silence, silence leads to delay, and every unanswered question is a missed opportunity to intervene.
But patients aren't powerless. Half have already turned to AI tools like ChatGPT to interpret their medical bills and resolve billing issues. So the question isn't whether AI becomes part of the patient billing experience. The question is whether providers are part of it.
See which patient cohorts are using AI to bypass provider support channels →
One size fits none
The 2026 Healthcare Financial Experience Study is built on one core argument: the financial experience most health systems have invested in was designed for a specific kind of patient — financially stable, continuously insured, comfortable engaging with digital tools. That patient is still in your population. But a growing share of collectible dollars sits with patients who look nothing like them.
Meeting those patients where they are requires moving from a uniform experience to one that adapts — to their coverage, their capacity, their comprehension of the bill in front of them.
The data shows what happens when it does. And it shows the cost of the status quo when it doesn't.
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