Most nonprofit hospitals are required to reduce or forgive your bill if you cannot afford it — here is how to apply
If you received care at a nonprofit hospital and cannot pay the bill, you may qualify to have it reduced significantly or eliminated entirely — not through a negotiation, not through a charity organization, but through the hospital's own financial assistance program, which the hospital is legally required to have.
Under the Affordable Care Act, every nonprofit hospital in the country must maintain a written financial assistance policy — commonly called charity care — as a condition of keeping its nonprofit tax status. This is a federal requirement, not a voluntary gesture. For patients who meet the income criteria, the hospital writes off the bill. You are not taking money from anyone else. The hospital reports the forgiven amount to the IRS as part of its community benefit obligation.
This page covers who qualifies, how to apply, what documentation you need, what happens with bills already in collections, and what to do if you are denied. We also have a page dedicated to medical bill assistance programs that include other options as well.
Who qualifies
Charity care eligibility is based primarily on household income compared to the federal poverty level. Dollar For — a nonprofit that maintains a national database of hospital financial assistance policies — reports that households with income below an average of about 204 percent of the Federal Poverty Level often qualify for completely free care, and households below an average of about 322 percent qualify for discounted care.
These are national averages. Individual hospitals set their own thresholds and some are considerably more generous. Examples from specific states give a sense of the range:
- In Colorado, patients earning up to 250 percent of the poverty level qualify for free care.
- In Washington state, hospitals must cover all costs for patients earning below 300 percent and provide discounts up to 400 percent.
- In Oregon, free care is available up to 200 percent and discounts up to 400 percent.
- In Illinois, free care is available up to 200 percent of the poverty level and discounts extend to patients earning up to 600 percent.
- In New Jersey, free care is available up to 200 percent and discounted care up to 300 percent for both insured and uninsured patients.
In most cases a patient's financial assets are not the primary consideration — eligibility is based on income. Some hospitals also consider whether the patient has insurance, and some limit charity care to uninsured patients while others extend it to insured patients whose out-of-pocket costs are high relative to their income. The specific terms are in the hospital's written financial assistance policy, which must be publicly available.
You do not need to be on Medicaid, Medicare, or any specific insurance plan to qualify. You do not need to be uninsured. Patients with insurance who cannot afford their copays, deductibles, or the portion of the bill not covered by their plan can also apply.
What the hospital is required to do
Federal law under the ACA imposes specific obligations on nonprofit hospitals regarding financial assistance. The hospital must have a written financial assistance policy and make it publicly available — on its website, posted in the hospital, and referenced on billing statements. The policy must apply to all emergency and medically necessary care.
The hospital must give patients at least 240 days from the date of the first bill to submit a financial assistance application. It cannot send a bill to a collections agency without first making a reasonable effort to determine whether the patient qualifies for assistance. If a patient submits an application, the hospital must pause any collections activity while the application is under review.
If a patient is approved for charity care after the bill has already been sent to collections, the hospital must pull the account back from the collections agency. And if the patient has already made payments toward a bill that is later forgiven through charity care, the hospital is required to issue a refund of those payments.
For-profit hospitals are not subject to the same federal requirements, but many have voluntarily established financial assistance programs. State laws in many states extend financial assistance requirements to for-profit hospitals as well. It is always worth asking regardless of the hospital's tax status.
How to apply
The application process varies by hospital but the steps are similar everywhere.
- Find the hospital's financial assistance policy. Look on the hospital's website under a name like "financial assistance," "charity care," or "patient assistance." Federal law requires this information to be posted online, displayed in the hospital, and included on billing statements. If you cannot find it, call the hospital billing department and ask specifically for the financial assistance application.
- Gather your income documentation. You will typically need recent pay stubs, your most recent federal tax return, Social Security award letters if applicable, or documentation of unemployment or other income sources. If you receive SNAP, Medicaid, or SSI, bring documentation of that enrollment — many hospitals treat participation in means-tested programs as presumptive eligibility for charity care and the application process is simpler.
- Submit the application as soon as possible. Do not wait. You have up to 240 days from the first bill, but applying early gives the hospital more time to process your application before the account ages further. If you were not given an application during your hospital stay or at discharge, contact the billing department immediately.
- What happens next. Applications typically take two to six weeks to review. You will be notified by letter of the decision. If you are approved, the bill is reduced or written off. If you are denied, the letter must explain the reason and tell you how to appeal and how long you have to do so.
- If the bill has already gone to collections. Call the hospital billing department directly — not the collections agency — and tell them you are submitting a financial assistance application. The hospital must pull the account back from collections while your application is reviewed. Notifying the collections agency that an application is pending may also pause collection calls.
- If your bill is older than 240 days. The formal federal window has closed but hospitals often still consider applications and may forgive or reduce the balance, reduce interest, or offer a generous payment plan. It is always worth asking. Hospitals have been known to forgive bills several years old.
Getting help with the application
You do not have to navigate this process alone. Several types of people can help:
- Hospital social workers and financial counselors are employed by most hospitals specifically to help patients access financial assistance programs. Ask at the billing department or patient services office.
- Medical billing advocates — many of whom work on contingency and charge only if they save you money — can identify programs you qualify for and handle the application on your behalf. Learn more about what medical billing advocates do.
- Dollar For is a nonprofit that helps patients apply for hospital financial assistance at no cost. They handle the paperwork and advocate on your behalf through the hospital's process. See https://dollarfor.org/.
- Nonprofit credit counseling agencies can also assist patients with financial assistance applications, particularly those dealing with multiple bills simultaneously. More on what nonprofit credit counseling agencies do.
What charity care does and does not cover
Charity care applies to the hospital's own charges for emergency and medically necessary care. This typically covers the hospital facility fee — the room, nursing care, procedures performed by hospital-employed staff, and related hospital services.
It may not automatically cover bills from physicians, surgeons, anesthesiologists, radiologists, or other providers who treated you at the hospital but are not employed by the hospital. These providers bill separately and have their own billing policies. Ask each provider separately whether they have a financial assistance program, or ask the hospital whether its charity care policy extends to affiliated providers.
Dental providers affiliated with hospital systems are often covered. Specialist referrals to out-of-network providers are generally not.
If you are denied
If your application is denied, you have the right to appeal. The denial letter must explain the reason and the appeal process. Common grounds for appeal include a change in financial circumstances since the application was submitted, documentation that was missing and can now be provided, or a belief that the hospital did not correctly assess your income or household size.
Submit a written letter of appeal along with any additional documentation. Include a clear explanation of your financial situation. Ask to speak with a billing supervisor or the hospital's financial assistance coordinator. If the hospital is not responsive, contact your state hospital association or your state attorney general's consumer protection office.
If you do not qualify under the hospital's standard income thresholds, many hospitals also have a hardship or catastrophic assistance category for patients whose medical bills exceed a certain percentage of their annual income regardless of income level. Ask specifically about this category.
If the hospital does not have a charity care program or you do not qualify
If charity care does not resolve the bill, the next steps are direct negotiation, a payment plan, or working with a professional. Learn about negotiating medical bills. As part of this approach, in some instances it is possible to get medical debt settled.
This page provides general educational information about hospital charity care and financial assistance programs. Income thresholds, eligibility criteria, and application processes vary by hospital and state and change over time. This is not legal or financial advice. Verify the specific terms of your hospital's financial assistance policy directly with the hospital's billing department before relying on any eligibility information described here.
Related Content From Needhelppayingbills.com
|
Need help navigating programs?