Hospital charity care: do you qualify and how to apply

A hospital bill can be more than you can pay, even after insurance. Hospital charity care can help. It's free or discounted care for people who qualify, and you usually have to ask for it. This guide explains who qualifies, what rules protect you, and how to apply. It's part of our guide on how to lower medical bills.

Before you apply, make sure the bill is right. Our guide on how to get an itemized bill shows how to see every charge. Then apply for help before you negotiate a hospital bill.

What is hospital charity care?

Charity care is what many people call a hospital's financial assistance program. It can mean free care, or a discount on your bill. The Consumer Financial Protection Bureau (CFPB) says these programs serve people without insurance and people whose insurance doesn't cover enough.

Each hospital writes its own rules. They're in a document called a financial assistance policy. It says who qualifies, how much help you get, and how to apply.

Which hospitals have to offer it?

Nonprofit hospitals must have a written financial assistance policy. That's a condition of their federal tax exemption. The rules are in section 501(r) of the tax code, and the Internal Revenue Service (IRS) enforces them.

The policy must apply to all emergency and other medically necessary care the hospital provides. It must also say:

• Who qualifies, and whether help means free or discounted care
• How the hospital figures what you're charged
• How to apply
• What the hospital may do if you don't pay
• Which doctors and other providers working in the hospital it covers, and which it doesn't

Other hospitals may have financial assistance programs too, but federal tax rules don't require them to. Some states set their own charity care rules, and those can apply to more hospitals. State rules may add more protections than the ones below.

Do you qualify?

It depends on the hospital. Most policies look at household income and size. Many set limits as a percent of the federal poverty guidelines. For example, a policy might give free care below 1 limit and a discount below a higher one.

Here are the 2026 poverty guidelines from the U.S. Department of Health and Human Services, as of September 2026. They apply in the 48 contiguous states and Washington, D.C.

For each person over 6, add $5,680. Alaska and Hawaii have higher guidelines. In Alaska, it's $19,950 for 1 person plus $7,100 for each added person. In Hawaii, it's $18,360 plus $6,530.

To find your percent, divide your yearly household income by the guideline for your household size. Then multiply by 100. Our charity care screener does the math for you.

Some policies may also ask about other things, like savings or where you live. Read the eligibility section closely.

What rules protect you at a nonprofit hospital?

If you're treated at a nonprofit hospital, federal tax rules give you these protections.

"Serious collection steps" is our plain term for what the rules call extraordinary collection actions. They include selling your debt and reporting you to a credit bureau. They include suing you, placing a lien, or garnishing wages. They also include delaying or refusing medically necessary care because of an unpaid bill.

The hospital also can't require you to pay before it treats an emergency. Its emergency care policy must cover people whether or not they qualify for financial assistance.

Step 1: Find the hospital's policy

Look for 3 documents: the full financial assistance policy, the application form, and a plain-language summary. The summary should tell you who qualifies, how to apply, and who to call for help.

Here's where to look:

• The hospital's website. Search the hospital's name plus "financial assistance."
• Your bill. Nonprofit hospitals must include a notice with a phone number.
• The emergency room or admissions area, where nonprofit hospitals must have free paper copies
• The billing office. Ask for free paper copies by mail.

If you speak a language other than English, ask for a translation. Nonprofit hospitals must translate these documents for large language groups in their community.

Step 2: Read the rules that matter for you

You don't need to read every word. Find these parts:

1. Income limits. Find the cutoffs for free care and for each discount.
2. What counts as income and household. Some policies count only certain people.
3. Which providers are covered. Check the list of doctors and groups.
4. Deadlines. Note the last day to apply.
5. Documents. See what proof they want.

If you're close to a limit, apply anyway. Our charity care screener shows where your income falls.

Step 3: Gather your documents

Most applications ask for proof of income, like recent pay stubs or last year's tax return. Some ask about your expenses and household size. Send copies, not originals.

If your income changed recently, say so. A recent job loss, for example, may matter more than last year's tax return.

Step 4: Apply and ask for a hold

Fill out the application and send it the way the hospital asks. Keep a copy and a record of when you sent it. If you mail it, use a method you can track.

Then call the billing office. Say you've applied for financial assistance, and ask them to hold your account. If a collector has the bill, tell it too. Ask it to pause while you wait.

Our financial assistance request letter can help you ask in writing.

Step 5: Follow up and check the decision

Ask how long the review takes, then follow up if you don't hear back. If your application is missing something, a nonprofit hospital must tell you in writing what it needs. It must also give you a reasonable chance to send it.

Some hospitals decide you qualify without a full application, based on other information or an earlier decision. If they give you less than the most help available, they must tell you how to apply for more.

If the hospital thinks you may qualify for Medicaid, it may wait for that decision first. Medicaid could cover the bill.

When you get the decision, check the math. Make sure the discount was applied to every bill from that hospital for the care.

Say Andre, his partner, and their son make $50,000 a year. Andre has insurance through work. After a hospital stay, his share is $3,000. He had already paid $1,500 of it.

The hospital's policy, in this example, gives:

• Free care up to 150% of the poverty guidelines
• A 60% discount from 150% to 250%

For a household of 3, the 2026 guideline is $27,320.

Step	Math	Result
His income percent	$50,000 ÷ $27,320 × 100	About 183%
150% cutoff	$27,320 × 1.5	$40,980
250% cutoff	$27,320 × 2.5	$68,300
His discount	60% of $3,000	$1,800 off
What he owes	$3,000 − $1,800	$1,200
His refund	$1,500 paid − $1,200 owed	$300

Andre falls in the discount range, so he owes $1,200. He had paid $1,500, so the hospital refunds $300.

Every hospital's limits are different. Check the real policy before you count on a result.

If you don't qualify

A "no" from financial assistance isn't the end. Ask what other help the hospital offers.

• Ask for a self-pay or prompt-pay discount. See self-pay discounts on a medical bill.
• Negotiate what's left. Our guide on how to negotiate a hospital bill has scripts.
• Ask for a payment plan with no interest. See interest-free medical payment plans.
• Ask about Medicaid. If your income is low, you may qualify.

If this doesn't work

If the hospital won't give you a policy, won't take your application, or moves to collections while you wait, try these steps:

1. Ask for a supervisor or the hospital's patient advocate. Name the rule you think applies.
2. Put it in writing. Send a letter with a copy of your application and the date you sent it.
3. Report it. You can report a nonprofit hospital to the IRS if you think it isn't following these rules. The IRS keeps your identity private, but it won't send you updates.
4. Check your state's rules. Your state attorney general or health department may oversee charity care where you live.

If the bill is in collections, see medical bill in collections for your rights.

When to get help

You can often apply on your own in an hour. It's worth getting help when:

• The application is long, or you're not sure how to count income.
• The bill is in collections, or you've been sued.
• You're applying for a parent or someone you care for.
• The hospital denied you, and you think its math is wrong.

A financial counselor at the hospital can explain the policy and help you apply. Dollar For, a nonprofit, helps people apply for charity care for free. Your state's consumer assistance program, if it has one, can help with insurance questions. A medical bill advocate can also take on the paperwork and calls. If you've been sued, talk to an attorney.