Help with hospital bills and charity care programs in Pennsylvania.
Hospital bills in Pennsylvania can often be reduced, and in some cases eliminated, when a patient applies for a hospital’s financial assistance program. Many hospitals call this charity care. The goal is to ensure patients can receive medically necessary care even when they cannot pay the full charges. The fastest way to get help is to request the hospital’s financial assistance application and submit it with proof of income and household size, before the balance is sent to collections. But there are other options as well and learn more below on how to get help with hospital bills in Pennsylvania.
Charity care programs and financial assistance policies in Pennsylvania
Nonprofit hospitals must publish a Financial Assistance Policy and follow federal rules that limit certain aggressive debt collection actions (for unpaid bills) until the hospital has made reasonable efforts to see if the patient qualifies for assistance, with the IRS policy (which also applies to PA) listed here. https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6.
- In Pennsylvania, large health systems and many community hospitals have their own written charity care or financial assistance policies. These policies usually cover emergency care and other medically necessary services. They often offer free care for households at lower income levels, people with no insurance and also offer partial discounts at higher income levels.
- The exact income limits and documentation rules vary by hospital, so the best approach is to make sure to ask. If the billing office or medical provider does not pro-actively bring it up - request it. Apply first and let the hospital determine eligibility using its own standards. A hospital can also reduce the bill through self-pay discounts and negotiated settlements even when the patient does not meet full charity care criteria.
The first step is to slow the billing process down and gather documents before agreeing to pay any hospital bill. Ask the billing office for an itemized statement and confirm that insurance was billed correctly. Learn how to find medical billing errors too. If the patient was uninsured, confirm that the account is coded as self-pay and ask whether the hospital automatically applies an uninsured discount.
- At the same time, ask for the hospital’s “Financial Assistance Policy” and “plain language summary,” and request the application. Many hospitals have financial counselors who help patients complete the paperwork. A common mistake is entering a payment plan too quickly, because once a plan is set up, some people stop pursuing charity care even though they may qualify for a much larger reduction.
Insurance, including Medical Assistance / Medicaid which can help with bills
Pennsylvania residents should treat Medical Assistance, which is the state’s version of Medicaid, as a second major path to reducing hospital bills, especially after an emergency room visit or inpatient stay. Medical Assistance can cover eligible people with low income, and it can sometimes cover bills from prior months if the person was eligible during that time. Pennsylvania’s retroactive eligibility rule states that the earliest possible date for retroactive Medical Assistance benefits can be the first day of the third month preceding the month of application, if the applicant was otherwise eligible in that month. It can also be combined with other government insurance programs in Pennsylvania.
This matters because a hospital stay in the last few months may be paid by Medical Assistance after the fact if the application is filed promptly and eligibility is confirmed. Pennsylvania also publishes eligibility resources for Medicaid and related programs through the Department of Human Services. https://www.pa.gov/agencies/dhs/resources/medicaid/medicaid-general-eligibility and has other information on paying past due bills.
For people who do not qualify for Medical Assistance, Pennie is Pennsylvania’s official health insurance marketplace and the only place to receive financial assistance for marketplace coverage. https://pennie.com/special-enrollment-periods/. Coverage will not automatically erase an old hospital bill, but it can prevent the next hospital visit from becoming another large balance. Pennie also has enrollment guidance along with a consumer call center number as 1-844-844-8040. The Pennsylvania Insurance Department also explains open enrollment timing and special enrollment events. https://www.pa.gov/agencies/insurance/consumer-help-center/learn-about-insurance/health-insurance.
Examples of hospitals and their charity care programs
Hospital charity care and financial assistance policies in Pennsylvania are commonly available online, and they typically explain how to apply, what proof is needed, and what services are covered. Some of the major hospitals in the state, with information on their programs, is below. These examples show the pattern across Pennsylvania: the help exists, but the patient must request it and complete the application.
When completing a hospital financial assistance application, include every supporting document the first time. Hospitals commonly request pay stubs, Social Security or disability award letters, proof of unemployment income, or a recent tax return. As an example of some of the more detailed steps by steps, see below.
- If income recently fell due to job loss, reduced hours, separation, illness, or caregiving, attach a brief written explanation and supporting documents.
- If the patient has no income, provide a written statement of how basic living costs are being met.
- If the patient lives with family and has shared expenses, clarify household size and financial responsibility, because household definitions can affect eligibility.
- If the patient is waiting on Medical Assistance, submit the hospital application anyway and attach proof that Medical Assistance is pending, because that can pause collections and may result in a full or partial write-off while coverage is determined.
Help with past due hospital bills - debt in PA
If the hospital denies charity care or approves only a small discount, the bill can often still be reduced by negotiating. A patient can request the “self-pay” rate or ask that charges be reduced to a rate closer to what insurers pay. If the hospital offers a settlement amount, request the settlement in writing, confirm the due date, and confirm the account will be treated as resolved in the hospital system. If a payment plan is the only option offered, keep the payment amount realistic and do not agree to terms that force the patient to skip rent, food, or utilities, because a failed payment plan can move the bill into collections faster.
If the bill is already in collections, the most effective step is to still contact the hospital - as if they can review it under its financial assistance policy. Patients can call the hospital billing office and ask for a financial assistance review even though the account has unpaid debt on it or even has been assigned to a collector.
- Some hospitals will recall the account if the patient appears likely to qualify for charity care or a major discount. At the same time, patients should keep records of all communication and request validation of the debt from the collector, then continue the charity care process with the hospital. Federal rules for nonprofit hospitals are designed to ensure patients have an opportunity to be considered for financial assistance before certain extraordinary collection actions are taken, which is why it is still worth applying even after the first bills arrive.
For Pennsylvania residents who need help navigating denials, coverage problems, or aggressive collection pressure, legal aid can be a practical tool. The Pennsylvania Health Law Project provides free legal services and education for eligible Pennsylvanians dealing with health coverage and access issues. https://www.phlp.org/.
In addition, statewide legal aid networks can help connect residents to local programs and look here for how to get free legal aid in PA. Legal help can be especially important when the patient is eligible for Medical Assistance but is stuck in application processing delays, when hospital financial assistance was denied without clear reason, or when the patient believes the hospital failed to follow its own policy.
Non-profit credit counseling can also help when medical debt is one part of a larger need. A counselor can help build a budget, prioritize critical bills, help negotiate unpaid costs, and communicate with creditors in a structured way. A national nonprofit starting point is to look here for debt and credit counseling in Pennsylvania. Credit counseling does not guarantee that a hospital bill will be forgiven, but it can prevent a person from falling behind on other bills in an attempt to keep up with an unrealistic medical debt payment plan.
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