How to manage debt with a finite amount and some qualifiers.

Put your money wherever the highest interest rate is.

a scary total of $400 a month out of your paycheck Pay now, or pay a lot more later. Those are your choices. You can only juggle for so long. Eventually you'll drop the ball.

As saeculorum mentions, you should check with your 401(k) provider but in general in my experience a loan against a 401(k) is automatically deducted from any rollover at termination (whether or nor voluntary) along with tax and penalty, so there's no out-of-pocket requirement. As someone who has been an idiot with money in the past, I would recommend paying off the credit card debt and keeping only one card, with a limit that would cover you in an emergency, and closing the others. I know that $400 out of each paycheck sounds awful, but if you never get it, you won't be tempted to spend it on things other than your debt. Sometimes idiots like us have to handcuff ourselves into creating good habits and getting out of debt.

by juggling, i think you mean kicking the can down the road. you take the $200 that you don't have to spend to pay off your debt in a more efficient way on whatever else you want to buy. you should make a budget assuming you would have to pay whatever the monthly payment in your 401k loan would be, assuming it could fully cover your credit card debt. if that's something you think you could realistically do, then pull the trigger, and have faith that in the future you will stick to your budget when you have an outside influence forcing you to make the hard decisions. if you can't make the budget work out, then either take the high interest yet liquid on the scale of a few months credit card debt, or start talking to a bankruptcy lawyer about if it would be beneficial to you to declare bankruptcy.

Intellectually I understand that paying off the cards is the way to go. But there's a nagging part that hates that fixed bite coming out of the paycheck instead of JUGGLING the card debt, as I currently do. If you juggle, you might drop the ball, even if you are the most diligent, careful and organized person in the world, because credit card companies often move the goalposts on you. If you juggle, you will never be able to stop juggling, because you have balances that are not being paid off. If you juggle, therefore, you are no longer suffering because you had medical bills that are outside your control: you are now (and in an endless future) suffering because you're making the poor choice to juggle. Plus: the $400 burden may feel high, but that's only $200 more than you're stuck with anyway, so it's really only a $200 extra burden...and it's one that, if you can keep the now-paid-off credit cards stashed away, leaves you with better credit (so you can borrow money cheaper in the future if another medical emergency arises.) So stop being cheap. Sign up for the $400 a month, pay it off, and be better off from day one because of what it will mean for your credit rating and your ability to stop juggling and focus on more important things.