FHA Guidelines on Medical Collections and Charged-Offs
Mortgage Loan

FHA Guidelines on Medical Collections and Charged-Offs

Purchasing a home is a milestone that many Americans aspire to achieve, yet it often comes with its fair share of challenges. One such hurdle that prospective homeowners may encounter is the impact of medical collections and charged-offs on their ability to secure financing. Medical collections and charged-offs can emerge unexpectedly, casting a shadow of doubt on an individual’s creditworthiness. The worst thing is that even responsible borrowers may find themselves at the mercy of mounting medical bills, leading to concerns about their eligibility for a home loan. Fortunately, the FHA, an agency under the United States Department of Housing and Urban Development (HUD), recognizes the unique circumstances surrounding individuals with medical debts and has established guidelines to address this specific financial challenge. And since understanding these guidelines can provide much-needed clarity and pave the way to homeownership for those who have experienced medical debt-related setbacks, we will tell you everything you need to know about them in this article.

The Role of FHA in Mortgage Lending

First, we need to understand the FHA’s role in mortgage lending. Put simply, the FHA (Federal Housing Administration) provides mortgage insurance on home loans issued by approved lenders. Since its establishment in 1934, the FHA’s primary objective is to facilitate homeownership for individuals who may have difficulty qualifying for conventional loans for various reasons, such as limited down payment funds, lower credit scores, or a higher debt-to-income ratio. With that said, what are some of the advantages of FHA-insured loans?

  • Lower down payment – One of the significant advantages of FHA-insured loans is the ability to obtain financing with a lower down payment. While conventional loans often require a minimum down payment of 20% on the home’s purchase price, FHA loans typically require a down payment as low as 3.5%. This lower down payment requirement makes homeownership more accessible for individuals who may not have substantial savings for a large down payment.
  • Flexible credit requirements – FHA loans are also known for their more lenient credit requirements compared to conventional loans. Borrowers with less-than-perfect credit scores or limited credit history may still be eligible for FHA-insured financing, as lenders consider factors beyond credit scores, such as the borrower’s payment history and ability to repay the loan, providing greater flexibility for those with imperfect credit. So, even with medical collections and charge-offs on your credit history, you can still be considered for these loans.
  • Higher debt-to-income ratio – these loans also allow for a higher debt-to-income (DTI) ratio, which measures a borrower’s monthly debt payments relative to their gross monthly income. FHA guidelines typically permit a higher DTI ratio, allowing borrowers with higher levels of debt to still qualify for a loan, provided they can demonstrate their ability to afford the mortgage payments.
  • Mortgage insurance – FHA-insured loans require mortgage insurance premiums (MIP). And while this adds cost to the monthly mortgage payment, it enables borrowers to secure financing with a lower down payment and lenient credit requirements. In addition, the FHA’s mortgage insurance program protects lenders against losses in the event of borrower default, making lenders more willing to offer loans to borrowers with less traditional credit profiles.
  • Streamlined refinancing – lastly, these loans offer a streamlined refinancing option, known as an FHA streamline refinance, which allows borrowers with existing FHA loans to refinance their mortgages quickly and with reduced documentation. Streamlined refinancing can enable borrowers to secure a lower interest rate and monthly payments, or even switch from an adjustable-rate-mortgage to a fixed-rate mortgage.

These are the most common benefits of FHA, and of course, they vary from lender to lender.

What are medical collections and charged-offs?

Simply put, medical collections refer to outstanding medical bills handed over to a collection agency or a third-party collector for payment recovery. When an individual cannot pay their medical bills on time, healthcare providers often transfer the debt to a collection agency. These agencies then pursue the collection of unpaid medical bills on behalf of the original healthcare provider. On the other hand, charge-offs occur when a creditor, after a significant period of non-payment, determines that a debt is unlikely to be collected and writes it off as a loss. Financial institutions and lenders typically follow this accounting practice to remove the debt from their books and claim a tax deduction for the uncollectible amount. So, when medical bills remain unpaid for long, the creditor writes them off from their books. And while the lender charges off the debt, it does not mean the borrower is no longer responsible for the outstanding balance.

This type of debt is usually treated differently from other debts by many lenders, and it’s for two different reasons; first, medical collections arise from unpaid medical expenses incurred for necessary healthcare services, whereas other types of debt usually result from consumer spending or borrowing for non-medical purposes. Secondly, the debts are often the result of unforeseen circumstances, such as unexpected medical emergencies or inadequate insurance coverage. Conversely, other types of debt may stem from discretionary spending or poor financial management.

FHA Guidelines on Medical Collections and Charge-offs

The FHA has recognized the unique circumstances surrounding medical debt and has implemented specific guidelines to address the impact of medical collections on loan approvals. One thing to remember is that the FHA distinguishes between medical collections and non-medical collections when assessing a borrower’s creditworthiness. Unlike non-medical collections that are considered in the overall credit evaluation, the FHA does not include medical collections in the borrower’s credit score calculation. This distinction acknowledges that medical debt often arises unexpectedly and may not reflect a borrower’s ability to manage their finances responsibly. With that said, the FHA guidelines aim to provide borrowers with a fair opportunity to obtain FHA-insured financing, even if they have experienced medical-related financial setbacks. Some of these guidelines include the following:

  • Exclusion of medical collections – FHA guidelines allow borrowers to exclude medical debt from their debt-to-income (DTI) ratio calculation if the collections’ total outstanding balance is less than $2,000. This means that even if Medical Collections are on your credit report, they won’t directly impact your eligibility for an FHA loan as long as the total outstanding balance meets the threshold.
  • Verification of medical collections – If the total outstanding balance of all medical debt is equal to or greater than $2,000, lenders can verify and document that the borrower has made satisfactory payment arrangements with the collection agency or that the collections are on hold during the mortgage application process. The verification process seeks to establish whether the borrower has taken steps to address the medical collections and is actively working to resolve them.
  • Disputed medical collections – If a borrower disputes a medical collection account, the lender must include a payment in the borrower’s DTI calculation based on either 5% of the outstanding balance or the documented monthly payments, whichever is greater. Therefore, even if the borrower disputes a medical collection, the lender will still factor in a payment obligation when determining the borrower’s DTI ratio.
  • Manual underwriting – In some cases, lenders may require manual underwriting for borrowers with outstanding medical collections, even after excluding them from the DTI ratio calculation. Essentially, manual underwriting involves a more thorough evaluation of the borrower’s credit history and financial situation by a human underwriter instead of relying solely on automated underwriting systems. So, the lender may want to impose additional requirements or restrictions during this process to assess the individual’s creditworthiness and ability to repay the loan. All this means that lenders can evaluate the borrower’s overall creditworthiness, considering factors beyond the credit score, such as the borrower’s payment history, financial stability, and compensating factors.

Regarding the charged-off medical collection accounts, FHA ignores them and considers them as zero balances. However, you can’t have any credit disputes, especially about charging off accounts. So, any credit disputes on these accounts must be retracted when applying for an FHA mortgage.

Remember that these guidelines are always subject to change, so it is essential to work closely with a mortgage professional who can provide the most up-to-date information and guide you through the FHA loan application process.

Overcoming Medical Collections and Charged-Offs

Suppose you have had a medical collection or charge-off and probably have gone beyond the threshold. In that case, there is something that you can do to improve your current situation and hence improve your chances of qualifying for an FHA mortgage. It includes the following:

  • Establish a positive payment history – first of all, even with the medical collection or charge-off on your credit history, it would really help if you could prove to the lender that you have turned things around and can manage your financial obligations responsibly. A positive payment history demonstrates your ability to make timely payments and meet your financial commitments. It also reflects your reliability as a borrower and indicates to lenders that you will likely repay your debts as agreed.
  • Credit score improvement – late payments, defaults, or collections can harm your credit score. So establishing a positive payment history is crucial if you are to have success in your loan application. Also, payment history is a significant factor in calculating credit scores. You gradually rebuild your credit and raise your credit score by consistently making on-time payments. And like other mortgage options, a higher credit score enhances your creditworthiness and increases the likelihood of loan approval.
  • Debt reduction – high levels of outstanding debt can negatively affect your creditworthiness, so you have to do something to reduce them. Lenders consider your debt-to-income ratio (DTI), which compares your monthly debt obligations to your income. Lowering your outstanding debt brings down your DTI, making you appear less risky to lenders, and it also demonstrates your ability to manage your financial responsibilities and frees up more of your income for future loan payments.
  • Provide a letter of explanation – When applying for an FHA mortgage, especially when you have medical collections or charged-off accounts, providing a detailed and persuasive explanation letter to the lender can be beneficial. In this letter, you can explain the extenuating circumstances that contributed to the collections or charge-offs. Additionally, the letter provides context, demonstrates your understanding of the situation, and highlights the steps you have taken to address and rectify the issue. A well-crafted letter of explanation can help lenders better understand your financial history and may positively influence their decision-making process.
  • Building trust with lenders – A detailed letter of explanation shows transparency and a willingness to take responsibility for past financial difficulties. It can help build trust with lenders and convey that you are committed to improving your financial situation. By addressing the concerns and providing a clear plan for moving forward, you demonstrate your creditworthiness beyond the negative marks on your credit report.

Alternatives for Borrowers with Significant Medical Collections

Other than FHA loans, there are other alternative loan options that you can check out if you have significant medical collections. They include the following:

  • VA loans – for starters, these loans are only available to eligible veterans, active-duty service members, and their surviving spouses. The loans generally have more flexible credit requirements, and medical collections may be considered less impactful. However, since individual lenders may still have their requirements, discussing your situation with a VA-approved lender is essential.
  • USDA loans – these are loans that the United States Department of Agriculture (USDA) offers to rural and suburban property buyers with low to moderate incomes. USDA loans have flexible credit guidelines and may be more forgiving regarding medical collections. However, just like other loan options, consulting with a USDA-approved lender is advisable to understand their specific requirements.
  • State and local programs – some states and localities offer homebuyer assistance programs that provide loans or down payment assistance to individuals or families with medical collections or other credit challenges. These programs, however, vary by location and may have specific eligibility criteria, so it’s worth exploring the options available in your area.
  • Non-traditional lenders – Non-traditional lenders, such as online lenders or community development financial institutions (CDFIs), may consider borrowers with medical collections. These lenders often take a more holistic approach to underwriting, considering factors beyond credit history. However, it’s essential to research and carefully evaluate the terms and conditions, including interest rates and fees, before choosing a non-traditional lender.

Working with a knowledgeable mortgage professional can help you navigate all these loan options and find the most suitable solution for your situation. You may also consider working with non-profit credit counseling about your medical debt. It can be pretty beneficial, with some of the benefits including the following:

  • Financial education and guidance – these agencies often provide financial education and counseling services to enable individuals better comprehend their financial situation and make informed decisions. They can offer guidance on budgeting, debt management, and strategies for improving overall financial health, and they do also empower individuals with knowledge and skills to promote long-term financial stability.
  • Debt management – the counseling agency may also offer debt management programs (DMPs) as a potential solution for managing medical debt. With a DMP, the agency negotiates with creditors on behalf of the borrower to potentially secure reduced interest rates, waived fees, and more manageable monthly payments. This way, individuals with medical debt can create a structured repayment plan and avoid falling further behind.
  • Mediation with creditors – Dealing with medical debt often involves interacting with medical providers, hospitals, or collection agencies. Non-profit credit counseling agencies can act as intermediaries, working with these entities on your behalf, where they can help negotiate payment arrangements, explore options for settling the debt, or establish more favorable terms to make repayment more feasible.
  • Debt consolidation options – depending on your specific circumstances, the agency may also help you explore debt consolidation options. It involves combining several debts into a single loan or payment, simplifying repayment, and potentially reducing overall interest costs. It will also help streamline repayment strategies, which is crucial when applying for a loan.
  • Reduced stress and emotional support – undoubtedly, medical debt can be emotionally challenging and cause significant stress. And in many cases, they drive many families into poverty, which triggers depression and low quality of life. But that’s where a Non-profit credit counseling agency would come in. They understand the emotional toll it can take on individuals and aim to provide support during the process, which means they can offer a compassionate and non-judgmental environment, helping individuals navigate their financial difficulties and develop strategies to alleviate their debt-related stress.
  • Trustworthy and objective advice – these agencies operate with the best interests of individuals in mind, as they are driven by their mission to serve the community. They adhere to ethical standards and regulations, ensuring that their advice and assistance are trustworthy and objective. In addition, the organizations prioritize the financial well-being of individuals, helping them make informed decisions about their medical debt and overall financial situation.

Seek help from FHA loan experts.

Consulting with experts who specialize in FHA lending and can offer personalized advice is crucial for several reasons:

  • In-depth knowledge of FHA guidelines – these experts understand the guidelines and requirements set forth by the Federal Housing Administration. They stay updated on any changes or updates to these guidelines, which can be complex and subject to revision. Therefore, consulting with these experts can ensure you receive accurate and current information tailored to their circumstances.
  • Individualized assessment – you will receive a personalized evaluation of your financial situation, credit history, and goals. They can review documentation, such as income, credit reports, and other relevant factors, to determine the feasibility of obtaining an FHA loan. By conducting this comprehensive analysis, experts can offer advice specific to your unique situation, helping you understand your eligibility and any potential challenges you may face.
  • Guidance on loan options and programs – You can also receive advice on the various loan options and programs available through the FHA. They can explain the requirements and benefits of each program, helping you determine the most suitable choice for your specific needs. It includes programs tailored for borrowers with medical collections, charged-off accounts, or other specific financial circumstances.
  • Assistance with the application process – the FHA loan application process can be complex, requiring careful attention to detail and adherence to specific requirements. FHA lending experts can assist borrowers in navigating this process, helping them gather the necessary documentation, complete the application accurately, and meet all the deadlines. Their expertise can minimize the risk of errors or omissions that could lead to delays or application rejections.
  • Access to lender networks – since the experts usually have established relationships with lenders specializing in FHA loans, they can leverage these connections to connect you with reputable lenders offering favorable terms and competitive rates. Doing this will save you a lot of time and effort in searching for the right lender and increase your chances of securing an FHA loan.
  • Clarification of FHA guidelines – lastly, remember the guidelines we highlighted above? They can sometimes be open to interpretation or subject to different lender overlays. But an FHA expert can clarify specific procedures, policies, and any lender-specific requirements that borrowers need to be aware of. This way, you will have a comprehensive understanding of the FHA loan process and can make informed decisions.


As we conclude, navigating the FHA guidelines regarding medical collections and charged-offs is crucial for potential homebuyers seeking an FHA-insured loan. By understanding these guidelines and implementing strategies to improve creditworthiness, you can increase your chances of getting approved for a loan. Remember, seeking professional assistance can provide invaluable guidance and support throughout the mortgage application process, so don’t overlook this step!

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