As the cost-of-living increases, so does the grip of the US healthcare system on its users. I ask three experts to share their insights on how BNPL and instalment payment models are supporting or hindering citizens with their health insurance and what it means for North American society.
Kavelle Christie, CEO and Founder at Orion 360 Health
The rise of digital Buy Now, Pay Later (BNPL) models in US healthcare is a red flag, not a revolution. These platforms are gaining traction because too many people, including those in rural communities and across reproductive and maternal health, are being priced out of care altogether. When giving birth can cost over US$18,000 without complications, and families are asked to take on payment plans just to leave the hospital, that isn’t innovation. It’s a warning sign of a system collapsing under its own weight.
BNPL is often framed as a way to expand access. But let’s be honest: it’s deferred debt. It’s a sleight of hand that makes unaffordable care look within reach, while quietly shifting the financial burden from insurers and health systems to patients, who were already juggling medical bills, denied claims and steep deductibles. And because these platforms aren’t typically regulated as credit products, people are left without real recourse when terms turn predatory or when their personal health and financial data is reused without explicit consent to target ads, adjust credit scores, or share with third parties. In healthcare, that’s not just a privacy issue. It’s a risk to people’s safety, especially in states where some forms of reproductive healthcare are now criminalised.
As Founder and CEO of Orion 360 Health, a boutique public policy consulting firm, I’m in the process of launching the Center for Regulatory Policy and Health Innovation. This is a policy and advocacy initiative that monitors how healthcare regulations—or the absence of them—are reshaping access to care in real time. We’re focused on exposing harmful regulatory gaps, building forward-thinking solutions, and ensuring that complex policy developments are translated into accessible information that communities, advocates and decision-makers can act on.
If we’re serious about healthcare innovation, we have to stop mistaking FinTech workarounds for structural progress. We need to expand Medicaid and private insurance to cover essential services, like childbirth, abortion and postpartum care, without hidden fees or denials. We need to enforce regulatory guardrails that protect patients from predatory lending, data misuse and cost-shifting disguised as flexibility. We also need to make care more affordable by tackling hospital markups, opaque pricing, and the patchwork of state benefit design. Access to care should never depend on a financing app or a credit score. Neither should the future of healthcare shouldn’t be debt-driven; It should be guaranteed through public policy, accountability and justice.
Shalvi Singh, Founder of Healthengine.us and Senior Product Manager at Amazon AI
While digital Buy Now, Pay Later (BNPL) and installment plans are promoted as tools to enhance healthcare affordability, their increasing uptake highlights potential systemic risks that may worsen costs and inequities.
1. Masking prices, not fixing them
By allowing patients to make installment payments, BNPL transforms steep healthcare prices into something manageable—for example, a dental procedure costing US$6,000 sinks to US$100 monthly payments. This provides little real financial help because it perpetuates charted, unregulated care pathways and payment structures. In elective care sectors like cosmetic surgery or LASIK, BNPL enhances payment uptake but keeps pricing stagnant, which remains dissociated from the actual care value provided. This in turn creates an ominous feedback loop where payment plans facilitate pricing medians driven by profit instead of challenging them.
2. Debt cycles in disguise
Incorporating charging mechanisms masked by the term “interest-free” propagates modern forms of unmet, medical debt. Allowing plan revisions to remove grace periods and subject borrowers to credit score penalties due to missed payments places patients in unrecognised forms of medical debt. With many providers outsourcing payment plans to third-party platforms, patients confront consented opaque terms and undisclosed price risks. Vulnerable groups geographically located in low gentrification zip codes are further disadvantaged since approval algorithms used in socioeconomic gated communities replicate biases seen in other lending domains.
3. Eroding Healthcare Financial Solutions
The adoption of Buy Now Pay Later (BNPL) models supports the use of high-deductible health plans where patients have to pay upfront costs. The use of BNPL is strategically placed to complement deductible coverage, enabling greater shifting of financial responsibility to patients which eliminates catalysts for devising more comprehensive insurance systems or scaling coverage for vision, chronic care, and even dental services. The industry exploits this further by using BNPL as a marketing tool to sell excess procedures without prior assessment on whether the services rendered are treatment-worthy or reasonably priced.
4. Policies Gaps, Inequitable Access
There is minimal legislations regarding BRNPL which places it in a neutral political space. Unlike traditional medical debt which comes with some level of consumer protection, non-medical debt incurred using fintech services entails other harsh penalties of late payment, and other abuses to patients. There is also the risk of creating a discriminatory system for consumer health services where patients with dependent children are strategically advantaged over those without through lopsided approval rates across systems.
My path forward…
There is a need to reconsider the linking of BNPL in healthcare services and financialisaton, and retain policies the system’s stakeholders must:
- Foster information control: Stop leading to abuse of discretion on disclosure of terms in considering contracts related to BNPL.
- Monitor price control: Restrict onboarding other providers to those actively looking to slash costs first before using BNPL arrangements.
- Recreate policies: Resolve deductibles and underexplored areas of coverage that make BNPL “necessary.”
BNPL is harmless per se, but the way it is integrated into the US healthcare system is profit-driven without any intention to transform the system. If left unchecked, these models could become yet another sign—not a solution—to the policy’s crisis of affordability.
Tannon Krumpelman, Partner, and Matthew Cornish, Managing Director at Solomon Partners
Given the proliferation of high-deductible health insurance plans, material co-insurance contributions, and limited coverage for numerous mainstream elective procedures, many Americans are struggling to receive desired medical care due to unaffordable levels of out-of-pocket (OOP) medical expenses. According to Bankrate’s 2025 Annual Emergency Savings Report, which surveyed more than 1,000 US adults about their ability to handle a surprise bill, 59% of Americans do not have enough savings to cover an unexpected US$1,000+ emergency expense.
In response to these financial challenges, digital ‘buy now, pay later’ (BNPL) and other installment payment models have emerged as viable solutions for medical care—adapting the pay-over-time framework that is commonplace for purchases of lower-cost discretionary goods, such as electronics, clothing and accessories.
These models significantly open the aperture for consumers who would not otherwise pursue certain medically necessary or elective procedures, given a lack of insurance coverage and/or high OOP costs.
Overall healthcare costs continue to rise significantly faster than inflation, driven by underlying health factors (e.g., ageing population, prevalence of chronic disease), treatment innovations (e.g., drug development, technological advancements, mental health awareness) as well as administrative costs given structural and delivery complexities of the US healthcare system. Forecast analysts estimate that the medical loans market will continue growing at a compound annual growth rate (CAGR) of 11.2% to an impressive US$291 billion by 2028. In this environment, digital BNPL and similar installment payment models offer a practical way to increase access and fill the coverage gap.
Today, BNPL options are offered by FinTechs, financial institutions and even some medical providers themselves. By offering flexible payment options, healthcare providers can attract a broader patient base, including those who might have deferred necessary treatments due to financial constraints. This increased patient and treatment volume can lead to higher overall collections and potentially lower costs for procedures due to economies of scale. The BNPL models will improve with added usage as more underlying data is used to train the underwriting algorithms.
However, several factors may prevent BNPL from rapidly gaining wider adoption or lowering costs. Historically, BNPL was primarily used for lower ticket hard goods versus either higher dollar items or care/services.
Additionally, the CFPB’s January 2025 final rule bans the inclusion of medical bills on credit reports used by lenders to determine creditworthiness; consumers may prioritise other types of bills and may still struggle to manage debt loads or installment payment plans. Lastly, the US healthcare and insurance ecosystems, including medical care lenders, are generally for-profit entities and potential savings from programmes such as BNPL do not necessarily trickle down to the consumer.
While BNPL and similar installment payment models offer promising solutions to potentially increase access to both necessary and elective medical care, it is unclear whether they will have a significant impact on overall costs and patient debt. As the medical loans market continues to grow, stakeholders must ensure alignment, such that these financial innovations truly benefit the patients they are designed to help.
