Hospital charity care: nonprofit hospitals must forgive or discount your bill if you earn under these limits (2026)
Almost 60% of U.S. hospitals are nonprofits, and federal law requires every one of them to have a financial assistance policy. Most write off 100% of the bill for households under 200–300% of the poverty line and give sliding discounts up to 400%. It applies retroactively, even after collections, and you can apply with or without insurance. Income limits for 2026, how to apply, and the letter that gets it approved.
- Nonprofit hospitals (most hospitals: check the name in the IRS Tax Exempt Organization Search, or just ask) must have a written Financial Assistance Policy (FAP) under IRS section 501(r), publish it, tell patients about it, and screen you before sending you to collections or suing.
- Typical thresholds: free care under 200% of the Federal Poverty Level, sliding discounts up to 300–400%. For 2026 that's roughly $32,000 for one person / $66,000 for a family of four for free care, and up to about $132,000 for a family of four for a discount. Some states set higher minimums by law (California, Washington, Oregon, Illinois, New Jersey, Maryland, Colorado, New York…).
- You can apply after the bill, after collections, and often up to 240 days after the first statement or longer; approval wipes or reduces the balance retroactively and the hospital must refund payments made in the meantime and recall the collection.
- Having insurance doesn't disqualify you: assistance applies to what insurance left you owing.
- Apply in writing with proof of income; if the hospital ignores you or won't give you the policy, that's a 501(r) violation you can report.
Do you qualify? (2026 numbers)
2026 Federal Poverty Guidelines (48 states): 1 person $15,960; 2: $21,640; 3: $27,320; 4: $33,000; add about $5,680 per extra person (Alaska and Hawaii are higher).
Swipe the table sideways to see every column.
| Household | 200% FPL (free care at most hospitals) | 300% FPL | 400% FPL (common discount cutoff) |
|---|---|---|---|
| 1 | $31,920 | $47,880 | $63,840 |
| 2 | $43,280 | $64,920 | $86,560 |
| 3 | $54,640 | $81,960 | $109,280 |
| 4 | $66,000 | $99,000 | $132,000 |
Hospitals may also count assets, and many have a catastrophic clause: if the bill exceeds a percentage of your annual income (often 20–30%), you get a discount regardless of income. State laws set floors: e.g., California requires free or discounted care up to 400% FPL at all hospitals; Washington requires free care up to 300% FPL at larger systems; Illinois, Oregon, New Jersey, Maryland, Colorado and others have their own mandatory scales. Always read the specific hospital's FAP: it's on their website under "financial assistance" or "billing help".
How to apply
- Find the policy: search "[hospital name] financial assistance policy". Federal law requires a plain-language summary and the application form on the website and on request.
- Fill out the application: household size, income (pay stubs, tax return, benefits letters, or a signed statement if you have no income), and the account numbers. Some hospitals also require you to apply for Medicaid first; do it, a denial letter is enough.
- Send it with a cover letter (template: financial assistance request letter) asking for a written decision, a hold on collections, and, if you've already paid, a refund of amounts above the assistance rate.
- Deadline: most hospitals accept applications for at least 240 days after the first post-discharge bill (the 501(r) minimum); many accept later. Apply anyway if you're past it: they can still approve.
- Decision: usually 30–60 days. If approved, ask for the written confirmation and, if the debt was in collections, proof the collector was told to close it.
- Denied? Ask for the reason and the appeal process. Errors in counting household size or income are common. Re-apply with corrected documents.
Your rights under 501(r) (nonprofit hospitals)
- The hospital must publicize the policy, offer paper copies free, and include a notice on bills about financial assistance.
- It cannot charge assistance-eligible patients more than the amounts generally billed to insured patients (so no chargemaster prices for you).
- It must make reasonable efforts to determine eligibility before any "extraordinary collection action": selling the debt, reporting to credit bureaus, lawsuits, liens, wage garnishment. That includes a 120-day wait after the first bill and written notice 30 days before any such action.
- Violations can be reported to the IRS (Form 13909) and your state attorney general; hospitals take these complaints seriously because tax-exempt status is at stake.
For-profit hospitals are not bound by 501(r), but many have similar policies and several states require assistance from all hospitals.
Free help applying
Dollar For is a nonprofit that checks your eligibility and helps you apply at no cost; hospital financial counselors and patient advocates also help. Avoid anyone charging a fee to "get your bill forgiven".
FAQ
I have insurance and a $4,000 deductible bill
Apply. Financial assistance covers patient responsibility after insurance at most hospitals.
The bill is from the ER doctor's group, not the hospital
Physician groups often have their own policies, and some states extend assistance to them. Ask the group and check state law; also see surprise bills.
They already sued me / garnished wages
If you were eligible and never screened, that's a 501(r) problem. Apply now, tell the court and the hospital's counsel, and file complaints with the IRS and AG. Consumer attorneys handle these.
Will assistance affect my taxes or immigration status?
No. It's not income and it's not a public benefit.