Chrystal McKay knew enough about medical care costs that she skipped the ambulance ride after a car accident. A friend drove her to the emergency room.

That saved her one bill, but she faces another for more than $20,000 after her ER visit. The 29-year-old Stockton, California, woman must balance paying her debt with getting care for a sprained shoulder that may need surgery: “I have to weigh the pros and cons. I’m already $20,000 in debt, and any more treatment will just put me more in debt.”

Uninsured at the time and facing a bill she doesn’t know how to handle, McKay finds herself in a position familiar to many in her generation. If she can’t cover the cost, her bill may wind up in collections.

No matter your age or insurance status, there are ways to make medical debt more manageable, whether you just got the bill or it’s already in collections.