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According to a Kaiser Family Foundation survey, 20 percent of people 65 and older struggle to pay medical bills. Almost half of Americans surveyed said they'd have trouble paying an unexpected medical bill of $500.

A 2015 nationally representative Consumer ­Reports survey of 2,200 adults found that 30 percent of privately insured Americans had received a medical bill where insurance covered less than they expected, leaving them on the hook for the rest.

When dealing with a daunting medical bill, such as an unexpected tab from a hospital stay, one approach many people overlook is negotiating a lower price. Whether your bills are the result of a high deductible, an out-of-network charge, a procedure that's not covered or lack of insurance, experts say the following could help cut them up to half. (Regulations limit discounts that can be offered under traditional Medicare, but providers have freer rein with Medicare Advantage and other health plans.)

1. Be proactive. For planned surgery, make sure your insurer covers both the procedure and the facility where it is being done. Tiering (where consumers pay more for certain facilities) is on the rise. Ask your doctor whether everyone ­involved takes your insurance, and ­request a written response; that might help if you later learn an out-­of-­network provider was used.

If you'll be paying out of pocket, ask beforehand for a rate in line with what insurance companies pay. "When you deal with things that aren't covered by insurance, there is a tremendous opportunity to discuss the fee and negotiate a discount off the posted charge," says ­Abbie Leibowitz, chief medical officer of Health Advocate Solutions, an advocacy and health assistance company.

2. Do your research. Whether you're negotiating in advance or after you get a bill, websites such as Fair Health and Healthcare Bluebook can help you determine what insurers pay in your area. "Say, 'I know this is the reasonable and customary charge; can we come down a little bit?' " suggests Adria Gross, chief executive of MedWise Insurance Advocacy.

3. Talk to the right person. If you get a bill, check it to make sure it's correct. Then ask your ­insurer whether some or all will be covered. If not, call the provider who sent the bill. Start with someone in the billing department or the patient financial counseling office. "The first response will be 'No, I can't do anything,' " Leibowitz says. Keep asking for the manager of the person you're talking to, until you get to someone with the authority to make a deal.

4. Offer to pay cash. If you can pay most of a bill, offer to do so immediately. Medical advocates say they can often get a 15 to 20 percent "prompt pay" discount this way. "Appeal to their sense of a good business decision," says James Napoli, chief executive of Medliminal, which works with consumers and companies to reduce medical costs.

5. Explain why you can't pay. "If you are in retirement on a set income, that will play into it," Napoli says. The possibility of not getting paid gives health-care providers a reason to offer a discount or payment plan. (Ask that it be interest-free.) Some states, such as California, require hospitals to provide free or reduced-fee care to consumers within certain income limits. Ask whether yours does.

6. Enlist help. Many hospitals have patient advocates who can help you understand billing codes and pinpoint errors. Hiring a medical advocate is another option, but it can be expensive. Some take a flat fee, and others charge a percentage of what they save you. (Twenty-five percent is typical.) When considering advocates, ask for their track record and make sure they have experience with complicated medical billing codes.

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