Hospital financial assistance (charity care): do you qualify?
Nonprofit hospitals are required by federal law (IRS Section 501(r)) to have a written financial-assistance policy and to limit what they charge eligible patients to "amounts generally billed." Many cover patients well into middle incomes — sometimes even with insurance. Ask for the policy, apply, and ask them to pause collections while your application is pending.
Charity care is one of the most underused tools in medical billing. A lot of people who would qualify never apply — often because no one tells them it exists.
For nonprofit hospitals, it is not a favor; it is a condition of their tax-exempt status.
Who has to offer it
Nonprofit (501(c)(3)) hospitals — which is most hospitals in the US — must comply with IRS Section 501(r).
For-profit hospitals are not bound by Section 501(r), though many still offer assistance and some states require it. Always ask, regardless of the hospital type.
What the law requires of nonprofit hospitals
A written Financial Assistance Policy (FAP) describing who qualifies and how to apply.
Charges to FAP-eligible patients for emergency and medically necessary care limited to the "amounts generally billed" to insured patients — not the inflated list price.
Reasonable efforts to determine whether you qualify before taking "extraordinary collection actions" (like sending you to collections or suing).
You may qualify even with insurance or a normal income
Thresholds vary by hospital, but many cover patients up to 200–400% of the federal poverty level, and some go higher.
Having insurance does not automatically disqualify you — ask about the income limits and apply.
Step by step
Ask for the FAP and the application
Call billing and request the written Financial Assistance Policy, the plain-language summary, and the application form.
Gather your income documents
Typically recent pay stubs, tax returns, or proof of benefits. Ask exactly what they require.
Apply — and ask them to pause collections
Submit the application and request that collection activity be paused while it is pending.
If denied, ask why and appeal
Request the specific reason in writing and ask about an appeal or reconsideration.
Negotiate whatever is left
Combine assistance with a prompt-pay discount or a settlement offer on any remaining balance.
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FAQ
Can I get financial assistance if I have insurance?
Often, yes. Many nonprofit hospitals’ policies cover insured patients up to income thresholds. Ask for the limits and apply.
What if it’s a for-profit hospital?
Section 501(r) doesn’t apply to for-profit hospitals, but many still offer assistance and some states require it. Ask anyway, and negotiate the bill directly.
I already paid — can I still apply?
Ask. Some hospitals will apply assistance retroactively and refund the difference if you qualified at the time of service. Policies vary, so request it in writing.
- IRS — Requirements for 501(c)(3) hospitals (Section 501(r))
- CFPB — What to do if you can't pay a medical bill
This guide is general information and a starting point, not legal advice.