Last issue, we offered our thoughts on the top healthcare payments trends of 2026. One of these is the increased use of credit card surcharging by healthcare providers. This issue, we offer some additional thoughts on the surcharging topic/ controversy, along with the latest deal news.
We'll be in the Washington DC area for HFMA from June 8-10. We expect to be getting a group together for networking over beers and cocktails during the conference. Email us here if you'd like to meet up.
If you haven't yet, download our Demystifying Healthcare Payments white paper. And reach out here to schedule time if you'd like to take a deeper dive.
PNC Healthcare offers a fully integrated suite of tools, solutions, and advisory services to help the healthcare ecosystem maximize working capital, streamline administrative processes, mitigate financial risk, and access capital for investment and growth. Learn more here.
FEATURE ARTICLE
The Acceleration of Surcharging: A New Reality for Healthcare Payments
Credit card surcharging is the practice of adding a small fee - typically 1-4% - when a customer pays with a credit card, to offset the interchange merchants pay networks like Visa and Mastercard. Once banned by card brand rules, surcharging became broadly permissible after a 2013 antitrust settlement and is now legal in 47 states; only Connecticut, Massachusetts, and Puerto Rico still prohibit it. It's important to note that surcharging applies only to credit cards - federal law forbids it on debit and prepaid transactions, though many small merchants do it anyway due to thin enforcement.
From rare to routine
Surcharging is accelerating. J.D. Power finds 35% of U.S. small businesses now surcharge credit cards. Healthcare is moving faster: our 2026 ProviderPay survey shows 45% of independent medical and dental practices already surcharge, with veterinary clinics at 55%. Counting office managers who say they may surcharge in the future, the trajectory points to 85–90% of independent healthcare providers passing along card fees. The drivers are familiar - flat payer reimbursement, interchange of 1.5–3.5% per swipe, and patient responsibility now 20-30%+ of practice revenue. Absorbing those fees is hard to sustain for practices.
Controversy
Not surprisingly, there is pushback on surcharging - including in healthcare. Patients facing record out-of-pocket costs especially those on high-deductible plans may view a 3% fee on a $400 visit as making healthcare that much more unaffordable – and one more point eroding trust in the system. Under the last administration, the CFPB, HHS, and Treasury opened inquiries into medical payment practices. Consumers vote with their wallets: J.D. Power reports 81% of cardholders who encountered a surcharge later switched payment methods to avoid it. Providers counter that interchange has quietly become one of their largest operating costs after labor and rent, and that a transparent surcharge is more honest than burying it in higher prices.
What's next
For one, regulation. Colorado has capped surcharges at 2%, New York requires they match actual processing cost, and Illinois’ Interchange Fee Prohibition Act - the first of its kind - takes effect July 1, 2026 unless legal challenges cause a delay. Walmart and major retail groups are challenging the proposed $200B Visa-Mastercard settlement, demanding deeper interchange reform. Stax Payments data shows 22% of credit transactions migrate to debit or ACH once a surcharge appears, threatening bank card revenue while giving acquirers reason to encourage the practice.
For healthcare, three forces will dominate: tighter state disclosure rules, patient migration to debit and ACH, and bank-led merchant education. And adoption is uneven. While vet practices currently surcharge more often than dental and medical practices (55% vs. 45%, see here), we expect dental offices to catch up fast. Like it or not, surcharging is taking its place as part of the new economics of healthcare payments.
PAYMENT TRENDS
Patient share of healthcare bill continues to rise
Kodiak's 2026 "State of the healthcare revenue cycle" report includes data covering patient responsibility trends. The authors note that insured patients owed 7.3% of their healthcare bills in 2025, compared to 6.8% in 2024. Unfortunately for providers, the Kodiak data also shows patients paid only 42.4% of the value of their healthcare bills, a decrease of 2.7 percentage points from 45.1% in 2024 (see chart).
One way that providers have been trying to solve the patient collection problem is asking patients to pay their portion of the bill sooner. The good news is that in 2025, the median provider reported they were collecting 16.4% of patient responsibility upfront (termed "POS cash collections" by Kodiak). This is up from 13.8% in 2024. The bad news is that despite collecting more dollars earlier, providers still said they collected a lower overall percentage from patients in 2025.
We recently featured Inbox Health in our CEO Chat. We met Blake Walker through our friends at Ten Coves Capital. Patient payment has long been the most stubborn receivable in healthcare - frustrating for providers, operationally complex for the billing companies that manage revenue cycle on their behalf, and confusing for the patients receiving the bill. Inbox Health addresses this problem, automating and improving collections in this difficult A/R category.
Click here for Blake's thoughts on what problem Inbox Health is solving for providers, and what it has in store for the next 12 months.
DEAL NEWS
Health iPASS and Sunbit strategic partnership
Nashville, TN-based Health iPASS, a leading cloud-based patient engagement platform, has announced that it will be integrating Sunbit's patient financing offerings directly into Health iPASS payment workflows. Sunbit is one of the fastest growing patient financing companies in the dental and medical markets (it covers other verticals as well - see this CEO Chat with Sunbit). The company has been adding to its balance sheet, and is estimated to have over $1.5 billion in total funding capacity based on its latest debt deal (an asset backed securitization, or ABS) in August 2025 led by Citi.
UHG/ Optum acquiring Alegeus for HSA infrastructure
UnitedHealth Group (NYSE: UNH) announced in its Q1 2026 earnings that it plans to acquire Boston-based Alegeus, a leading provider of benefits administration infrastructure. No purchase price was disclosed. UHG's Optum Bank already competes in the HSA administration business with HealthEquity, Fidelity, Webster's HSA Bank, and others. Now this deal brings more of the HSA value system in-house for Optum. As a benefits infrastructure player, Alegeus competes with WEX Health, Inspira (formerly Millennium Trust and Payflex), and newer entrants such as Boston-based Lynx (see our CEO Chat with Lynx's Matt Renfro).
IKS signs definitive agreement to acquire TruBridge
We reported in April that Mumbai, India-based IKS Healthcare was considering buying Mobile, AL-based TruBridge (formerly CPSI). The companies announced on April 23 that they have entered a definitive agreement for IKS to acquire TruBridge (NASDAQ: TBRG). TruBridge's largest shareholders are Pinetree Capital, L6 Holdings, and Ocho Investments.
This combination continues a trend of India-based technology companies expanding further into the U.S. revenue cycle market. TruBridge offers EHR, practice management, revenue cycle and related software primarily to community and rural hospitals. The deal would enable IKS to scale automation and AI-driven RCM solutions within the relatively fragmented small hospital market.
The companies claim the combined organization will bring revenue cycle management, predictive analytics, and EHR capabilities to 2,000+ healthcare organizations and 150,000+ clinicians.
The Evolution of the Payment Card from Transaction Tool to Trust Anchor. Mobile wallets, super apps, embedded finance, and Instant Payment are used by more and more consumers. And yet, in 2026, the debit and credit card remains one of the most widely used and most trusted financial instruments in the world. (The Financial Brand)
HISTalk interviews Scott MacKenzie, CEO, RevSpring. Scott MacKenzie has led rapid growth at this patient engagement company, which has a heavy focus on payments. The interview covers the company's strategy, changes in propensity to pay, acquisition of Kyruus and TrustCommerce, who owns the digital front door, and plans for the future. (HISTalk)
What Makes Judy Faulkner Run? Faulkner is a healthcare heavyweight with Epic managing electronic medical records for hundreds of millions of people, and one of the most successful female entrepreneurs in history. Stephen Dubner travels to Verona, WI to explore the Faulknerverse. (Freakonomics Radio podcast; full transcript available on website). Note, click here to read the HISTalk blog summary of the interview.
We'd love to say hello! Click here to schedule time to meet with us in Chicago May 4-6 and at the HFMA conference June 8-10, National Harbor, MD.
Conference List. Rolling twelve month look ahead at conferences and other events covering healthcare payments, revenue cycle, fintech and related areas. Updated through November 2026.
FMP Blog. Thoughts from healthcare payments CEOs and investors on their right to win and goals for the year ahead, as well as data and perspectives on healthcare payments.
Newsletter Archive. News, trends, and insights from the healthcare payments industry compiled in our bi-weekly newsletter. Last six months of newsletters.
Epic MyChart. Excel sheet with full listing of all Epic MyChart instances as of May 2024, categorized by state, provider type and specialty.
All of these resources can also be accessed at the FinMed Partners Insights page.
Thank you for reading! If you enjoyed this newsletter, please forward to a friend or colleague.
FinMed Partners is a management consulting and advisory business focusing at the intersection of payments/ fintech and healthcare. Our founders have developed deep expertise from decades of experience with health IT companies, healthcare providers and many players within the payments ecosystem. Investors, boards and executive teams work with us to maximize business value through strategic input and tactical execution.
FinMed Partners LLC, 34 Long Avenue, Belmont, MA 02478, United States
