How to apply for hospital financial assistance (charity care)

What is hospital financial assistance?

Hospital financial assistance is help paying a hospital bill. It can mean a full write-off, which means you owe nothing, or a partial discount. Many people call it charity care. The Centers for Medicare and Medicaid Services, or CMS, says nonprofit hospitals must give financial assistance to eligible patients who cannot afford to pay. CMS also says the term charity care is sometimes used for the same thing.

Many people with no insurance never hear about it, because most hospitals do not offer it unless you ask. If you have a bill you cannot pay, this is one of the first things to try. This page is general information and not legal or medical advice. If you ever think you are having an emergency, call 911 or go to the nearest ER.

What the law requires

Under section 501(r) of the tax code, nonprofit hospitals must follow certain rules to keep their tax-exempt status. The IRS says each hospital must have a written financial assistance policy. The policy has to explain who qualifies and whether the help is free care or discounted care. It must also say how the discounts are figured, how to apply, and what papers you need.

The IRS also says people who qualify for help cannot be charged more than the amounts generally billed to people who have insurance. That means no more than what the hospital usually gets paid for the same care by insurance. The hospital must also tell the public about the policy. It has to post the policy and the form on its website and offer paper copies for free. It must also share a plain-language summary of the policy with patients. A hospital cannot turn you down for missing a paper that its own form did not ask for.

A hospital also has to treat emergencies without regard to whether you qualify for help. That ties to the federal emergency room law, which you can read about in our guide on the ER with no insurance.

Some states have their own charity care laws too, and they may be stronger than the federal rules. Ask the hospital or your state's health department what applies where you live.

How do I apply? A step-by-step checklist

The steps below work for most hospitals. Start by finding the written policy, because it tells you who qualifies and what the deadline is.

1. Search the hospital's name with the words "financial assistance" or "charity care." You can also call the billing office or ask for a copy at the hospital.
2. Read who qualifies by looking at the income limits, how the hospital counts your household, and the deadline.
3. Ask the billing office for the application. Some hospitals use an online form, and others use a paper form that you mail or drop off.
4. Gather your papers using the list in the next section.
5. Fill out the form completely. Answer every question, and write "none" or "0" where it applies instead of leaving it blank.
6. Send the form in and keep a copy. Note the date, how you sent it and who you spoke with.
7. Ask how long the decision will take, who can answer your questions, and what happens to your bill while they decide.
8. If you do not hear back, follow up in writing and ask for a status update.

Apply even if you are not sure that you qualify. Hospitals set their own income limits. Some are higher than people expect, and some hospitals give discounts at moderate incomes.

Which documents to gather

Every hospital is different, so check its form first. The CMS page says to follow the hospital's own instructions. In general, hospitals commonly ask for these items.

• A photo ID is usually needed to confirm who you are.
• Proof of income, such as recent pay stubs, a tax return or a letter from an employer, shows what you earn.
• If you have no income, a short signed letter can explain your situation.
• Other income, such as unemployment benefits, Social Security or child support, should also be shown.
• Bank statements are needed if the form asks for them.
• The bill itself and any letters from the hospital or a collection company should be included.
• Proof of how many people live in your home helps the hospital count your household.

If you cannot get a paper, tell the hospital. The IRS says a hospital may grant help based on a signed statement or other evidence, so ask what else they will take.

Timing and bills in collections

The IRS says a nonprofit hospital generally has to give you at least 240 days from your first bill to apply. That clock starts after you leave the hospital. The hospital must also wait at least 120 days after that first bill before it takes major collection steps. Those steps include reporting to a credit bureau, selling the debt, putting a lien on property or suing you. A lien is a legal claim on your home or car until the debt is paid.

The hospital also has to send a written notice at least 30 days before starting those actions. While a complete application is pending, those actions must be paused.

If your bill is already with a collector, tell the collector in writing that you are applying for financial assistance, and ask them to pause collection. The CMS page suggests this step. Our guide on help paying medical bills covers what else to do.

What if I am denied or only get a small discount?

If you are denied or only get a small discount, there are several things you can try next.

• Ask why you were denied, and ask for the reason in writing.
• Ask if there is an appeal process or a second review. The CMS page does not describe one, so ask the hospital directly.
• Check whether you missed a paper, and send it if you did.
• Ask to speak with a supervisor or a patient advocate at the hospital.
• Ask for a lower bill for paying on your own, or a payment plan with no interest.
• Read our guide on how to negotiate a medical bill.
• Tell any collector that you are disputing the bill.

You can also ask whether you qualify for Medicaid or a Marketplace plan, since some hospitals have staff who help with that. Having a regular doctor can reduce the chance of future bills, too. You can search for a cash-pay doctor or read our guide to care without insurance.