Legal Requirements
Under the Affordable Care Act, nonprofit hospitals (about 60% of U.S. hospitals) must have written financial assistance policies, publicize them widely, and screen patients for eligibility before pursuing extraordinary collection actions. This is not optional -- it is federal law. Many hospitals fail to adequately publicize their programs, which is why millions of eligible patients never apply.
What Charity Care Covers
Charity care can cover: emergency room visits, inpatient stays, outpatient procedures, laboratory tests, imaging, and sometimes prescriptions. Coverage levels vary: some hospitals forgive 100% for patients below 200% of the federal poverty level and offer sliding scale discounts up to 400% FPL. A family of 4 earning up to $124,800 (400% FPL) may qualify for some reduction.
How to Apply
Ask the hospital billing department for a financial assistance application. You can apply before or after treatment, and even after the bill goes to collections. Provide: proof of income (pay stubs, tax return, benefit letter), ID, proof of household size, and proof of expenses. Processing takes 2-4 weeks. While the application is pending, the hospital should not pursue collection.
If the Hospital Denies Your Application
Appeal the denial with additional documentation. Contact your state's hospital licensing agency if the hospital is not following its own financial assistance policy. File a complaint with the IRS (Form 13909) if a nonprofit hospital is not meeting ACA requirements. Consider legal aid assistance -- some organizations specialize in hospital billing disputes.
Frequently Asked Questions
Can I apply for charity care after my bill went to collections?
Yes. Many hospitals will still process charity care applications even after referring the debt to a collector. Under the ACA, nonprofit hospitals must make reasonable efforts to screen for charity care eligibility before sending bills to collections.
Does charity care apply to for-profit hospitals?
For-profit hospitals are not required to offer charity care under the ACA, but many have voluntary financial assistance programs. Always ask -- the worst they can say is no.
Will charity care affect my credit?
No. Receiving charity care has no negative credit impact. If the bill was already reported to credit bureaus, the hospital should update the reporting once charity care is applied.
Check your bankruptcy discharge eligibility with our free screening tool.
Free Discharge Screener