Hospital financial assistance, often called charity care, is free or discounted care that hospitals provide to patients who cannot afford to pay. Every nonprofit hospital in the United States is required by federal tax law to have a written financial assistance policy, and many public and for-profit hospitals offer similar programs. Yet many eligible patients never apply, often because they do not know these programs exist or assume they will not qualify.
This guide explains how financial assistance works, who usually qualifies, and how to apply. It is general information, not legal or tax advice. Never delay emergency care because of cost: call 911 in an emergency.
The federal rules for nonprofit hospitals
Nonprofit hospitals are exempt from federal income tax under section 501(c)(3). Since the Affordable Care Act, section 501(r) of the Internal Revenue Code has added specific requirements, enforced by the IRS:
- A written financial assistance policy (FAP) that explains who qualifies, what discounts are available, how to apply and how the hospital calculates what patients owe
- Wide publicity: the policy, the application form and a plain language summary must be available on the hospital's website, on paper on request, and in the languages of significant local populations
- Limits on charges: patients who qualify for assistance cannot be charged more for emergency or other medically necessary care than the "amounts generally billed" to people with insurance
- Limits on collections: the hospital must make reasonable efforts to find out whether a patient qualifies before taking "extraordinary collection actions" such as reporting the debt to credit bureaus, filing a lawsuit or placing a lien
- A community health needs assessment at least every three years
The rules also include timelines. In general, a hospital must allow at least 240 days after the first post-discharge bill for a patient to apply, and must wait at least 120 days after that first bill before starting extraordinary collection actions, with written notice beforehand.
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Public and for-profit hospitals
Public hospitals, owned by counties, cities, states or hospital districts, often have their own programs for uninsured residents, sometimes funded by local taxes. For-profit hospitals are not covered by section 501(r), but many have discount or charity policies, and some states require all hospitals to offer assistance.
State laws
A number of states set their own charity care rules that go further than federal law. These can require hospitals to provide free care below a certain income level, cap what eligible patients can be charged, require screening for assistance, or limit interest and collection practices on medical debt. Your state attorney general or health department website usually explains the rules where you live.
Who usually qualifies
Eligibility is set by each hospital's policy and any state rules. Most policies use household income compared with the Federal Poverty Guidelines published each year by HHS. A typical structure looks like this:
| Household income | Typical assistance |
|---|---|
| Lower incomes, often up to around 200% of the poverty guidelines | Free care |
| Moderate incomes, often up to 300% to 400% of the poverty guidelines | Discounted care on a sliding scale |
| Higher incomes with very large bills | Some policies offer catastrophic or medical hardship discounts |
These are common patterns, not guarantees. Some hospitals are more generous and some less. Insured patients with large deductibles or coinsurance can often apply too, so do not assume insurance makes you ineligible.
How to apply
- Ask for the policy and the application. Look on the hospital's website for "financial assistance" or "charity care," or ask the billing office or a financial counselor.
- Apply early. You can often apply before a planned procedure, during your stay or after you receive a bill.
- Gather documents. Hospitals commonly ask for proof of income such as pay stubs or a tax return, household size, and sometimes information on assets.
- Submit and keep copies. Write down the date and the name of anyone you speak with.
- Ask that collections be paused. While your application is pending, ask the hospital to hold your account. Nonprofit hospitals must suspend extraordinary collection actions while a complete application is being processed.
- Appeal if denied. Ask for the reason in writing and whether you can provide more information.
If you already paid a bill and later qualify, nonprofit hospitals must generally refund amounts above what you owe under the policy.
Other programs to check
- Medicaid: hospitals often screen uninsured patients for Medicaid. Medicaid can cover medical bills from up to three months before the month you applied in many cases, although some states have changed this rule and recent federal legislation shortens the window for many enrollees in future years.
- Marketplace coverage: losing other coverage usually opens a special enrollment period on HealthCare.gov or your state's marketplace.
- Hill-Burton facilities: a small number of hospitals that received federal construction funds still have obligations to provide free or reduced-cost care. The Health Resources and Services Administration (HRSA) keeps a list.
- VA health care: veterans may be eligible for care at VA hospitals. See How VA Hospitals Work.
Good faith estimates for uninsured patients
Under the No Surprises Act, if you are uninsured or not using insurance, providers must give you a good faith estimate of expected charges for scheduled care. If the final bill is $400 or more above the estimate, you can use a federal patient-provider dispute process. See How to Read a Hospital Bill.
Medical debt and credit reports
The three national credit bureaus, Equifax, Experian and TransUnion, do not include paid medical collection debt on credit reports, do not report medical collection debt under $500, and wait a year before medical collection debt can appear. Applying for assistance quickly still helps keep a bill from reaching collections at all.