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Financial assistance for medical bills: what to do, step by step

The short answer

Before you pay a big medical bill, ask for an itemized bill and check it for errors. Then see if insurance or Medicaid can still pay. Next, apply for the hospital's financial assistance. Nonprofit hospitals must accept applications for at least 240 days (law.cornell.edu) after the first bill they send once you leave.

By Last reviewed Sources

Constantino Lardi, FreedInsure's licensed agent, is licensed in 42 jurisdictions. He owns FreedInsure, the private agency that publishes this guide, and insurers may pay FreedInsure when people enroll with its help.

Got a big bill? Do these 7 things in order

Each step can lower the bill or wipe it out. Work from the top. The early steps cost you nothing but a phone call or a form.

Before you pay: ask about financial assistance first. The CFPB warns that once a hospital bill is on a credit card, it may be harder to get help from the hospital (CFPB (consumerfinance.gov)).

  1. Get an itemized bill and check it. Ask the hospital or the collector for a bill that lists each charge and code, what insurance paid and what you owe. Look for care you never got, wrong dates, medicines or procedures, and bills that you, your insurer or a charity care program already paid (CFPB (consumerfinance.gov)).
  2. Make sure your insurance was billed. If you had coverage on the day of care, compare the bill with your insurer's statement for that visit. Give the billing office your insurance details if they are missing.
  3. See if Medicaid can pay it. If you would have qualified for Medicaid when you got care, Medicaid can pay covered bills from up to 3 months before the month you apply (42 CFR 435.915 (law.cornell.edu)). That window gets shorter for applications made on or after January 1, 2027 (see the deadline table). Some states have federal permission (a waiver) to change the look-back for some groups (MACPAC (macpac.gov)), so ask your state Medicaid agency what applies to you. You can apply any time of year through your state or HealthCare.gov.
  4. Apply for the hospital's financial assistance. This is also called charity care. Nonprofit hospitals must have a written financial assistance policy. They must take applications for at least 240 days after the first bill they send once you leave (26 CFR 1.501(r)-1 (law.cornell.edu)). Our guide to hospital charity care explains the rules.
  5. Use your surprise-bill and estimate rights. If you have insurance, federal law protects you from most surprise out-of-network bills for emergency care, for out-of-network care tied to a visit at an in-network hospital or surgery center, and for air ambulance rides. If you had no insurance or chose not to use it, you may be able to dispute a bill that is at least $400 more than the written estimate you got (CMS (cms.gov)).
  6. Appeal if your insurer said no. You have 180 days from the denial notice to ask your insurer to look again (HealthCare.gov).
  7. Set up a payment plan for what is left. Ask the billing office for a plan with little or no interest. Be careful with medical credit cards that have "deferred interest." If you don't pay the full amount before the promotion ends, interest is charged on the whole amount you put on the card (CFPB (consumerfinance.gov)).

Your options, cheapest first

Coverage you had, or Medicaid that looks back

Who qualifies
People who had insurance on the day of care, and people who would have qualified for Medicaid then.
What it costs
Your normal share under your plan. Medicaid costs little or nothing for people who qualify.
How to get it
Send your insurance details to the billing office. For Medicaid, apply through your state's official site or HealthCare.gov, then tell the hospital you applied.

Hospital financial assistance (charity care)

Who qualifies
People who meet the hospital's own rules on income and household size. Each hospital sets its own limits.
What it costs
Free or discounted care, based on the policy. If you qualify, a nonprofit hospital can't charge more for emergency or other needed care than it generally bills people who have insurance (IRS (irs.gov)).
How to get it
Ask the billing office for the policy and the application, or find them on the hospital's website.

Hill-Burton care at a small number of facilities

Who qualifies
People with low income at a facility that still owes this care because it got federal building money long ago. It does not cover care that insurance or a public program pays for. It covers only the facility's own charges, not separate doctors' bills (HRSA (hrsa.gov)).
What it costs
Care is free if your income is at or below the federal poverty guideline. Some facilities also give free or reduced-cost care up to twice the guideline, or three times for nursing home care (42 CFR 124.505 (law.cornell.edu)).
How to get it
Check HRSA's list of facilities (hrsa.gov) that still owe this care. The list, dated December 12, 2024, has 126 of them. If yours is on it, apply at its admissions or business office. You can apply before or after your care, even after the bill goes to collections (HRSA (hrsa.gov)). Each facility only has to give a set amount of this care each year (42 CFR 124.501 (law.cornell.edu)), so ask early.

Fix errors and dispute the bill

Who qualifies
Anyone with a wrong charge. A formal federal dispute is for people who had no insurance or chose not to use it, when a bill is at least $400 over their estimate.
What it costs
Checking the bill costs nothing. The federal dispute has a $25 fee. If the dispute goes your way, the $25 comes off what you owe the provider (CMS (cms.gov)).
How to get it
Call the billing office with your itemized bill. For the federal dispute, start from CMS's dispute page.

A payment plan for the rest

Who qualifies
Most people can ask. The terms are up to the hospital or doctor.
What it costs
What you still owe after the steps above, plus any interest or fees in the plan.
How to get it
Ask the billing office for the terms in writing before you agree.

Medical bill deadlines to know

Most help comes with a clock. These are the federal time limits. Your state may give you more time.

Federal time limits for medical bill help (checked October 19, 2026)
SituationTime limitWhat it means for youSource
Applying for financial assistance at a nonprofit hospital.At least 240 days after the first bill sent once you leave the hospital.You can apply even if the bill is months old. If you qualify, the hospital must refund what you paid above your new amount, unless the extra is under $5.26 CFR 1.501(r)-1 (law.cornell.edu), 1.501(r)-6 (law.cornell.edu).
A nonprofit hospital moving to collections.Not for at least 120 days after that first bill. The hospital must also send written notice at least 30 days before it starts.Reporting you to credit bureaus, selling the debt or suing must wait. An application sent within the window, even one that is missing papers, puts these on hold.26 CFR 1.501(r)-6 (law.cornell.edu).
Medicaid paying past bills, for applications made before January 1, 2027.Up to 3 months before the month you apply.Care from up to about 3 months back may still be paid if you qualified then.42 CFR 435.915 (law.cornell.edu).
Medicaid paying past bills, for applications made on or after January 1, 2027.1 month before the month you apply for adults in the Medicaid expansion group. 2 months for everyone else.For expansion adults, apply by the end of the month after the month of your care.CMS summary of Public Law 119-21 (medicaid.gov).
No insurance (or you chose not to use it), and the bill is at least $400 over your estimate.Start a dispute within 120 calendar days of the date on the first bill.There is a $25 fee. If the dispute goes your way, the $25 comes off what you owe.CMS (cms.gov).
Your insurer denied a claim.File an internal appeal within 180 days of the denial notice.The insurer has 60 days to decide on care you already got.HealthCare.gov.
Your insurer said no again.Ask for an outside review within 4 months after you get the insurer's final decision.It costs nothing in the federal process. Other processes can charge up to $25.HealthCare.gov.
A debt collector contacts you.Dispute in writing within 30 days. The collector's notice gives the end date.The collector must pause on the amount you dispute until it answers you.CFPB (consumerfinance.gov).

Source: 26 CFR 1.501(r)-6, Billing and collection (Cornell LII). Verified October 19, 2026.

Table compiled by FreeHealthInsurance.com (FreedInsure LLC); free to reuse under CC BY 4.0 with credit.

What this means: of the ways to get a bill paid or forgiven, the Medicaid look-back has the shortest clock, so check it first. For example, if an expansion adult gets care in March 2027, they need to apply by the end of April 2027 for Medicaid to cover it. The hospital's window is much longer. It runs at least 240 days from the first bill after you leave, so you can still apply on a bill that came three months ago.

Credit reports work on a different track. In 2023, the CFPB said the three national credit bureaus wait one year before an unpaid medical collection shows up, and leave off paid ones and ones under $500 (CFPB (consumerfinance.gov)). These are company policies, not a law. A 2025 federal rule that would have gone further was thrown out by a federal court in July 2025 (CFPB (consumerfinance.gov)). You can check your reports for free each week at AnnualCreditReport.com (CFPB (consumerfinance.gov)).

Who qualifies for hospital financial assistance

There is no single national income limit. Each nonprofit hospital writes its own financial assistance policy. The policy must say who qualifies, whether help means free or discounted care, how the hospital figures what you owe and how to apply (IRS (irs.gov)). These federal rules cover hospitals that are tax-exempt charities (IRS (irs.gov)). The CFPB notes that some private hospitals must also give free or reduced-fee care (CFPB (consumerfinance.gov)).

A policy may set its limits as a share of the federal poverty guideline (FPL). That is a yearly income amount that HHS sets for each household size.

Worked example. Say a hospital's policy gives free care to households with income up to 200% of the poverty guideline. In 2026, the guideline for a household of three is $27,320 everywhere except Alaska and Hawaii (HHS (aspe.hhs.gov)). So a family of three earning up to $54,640 a year would meet that policy's income limit for free care. Another hospital may use a lower or higher limit, so read each policy.

You don't have to guess. Hospitals must post the policy, the application and a plain-language summary on their website. They must also give you paper copies at no charge when you ask (IRS (irs.gov)).

How to ask for help with a hospital bill

  1. Find the hospital's financial assistance policy on its website, or call the billing office and ask for it.
  2. Fill out the application. Send it with copies, not originals, of the papers it asks for.
  3. Keep a record of each call: the date, the name of the person you spoke to and what they said.
  4. If something is missing, the hospital must tell you in writing what it needs (26 CFR 1.501(r)-6 (law.cornell.edu)). Send it as soon as you can.

What to have ready

  • The bill, the itemized bill and your account number.
  • Your insurance card and your insurer's statement for the visit, if you had coverage.
  • Proof of income for your household, such as recent pay stubs, a benefits letter or last year's tax return. The policy lists what it accepts.
  • The number of people in your household.
  • Any Medicaid decision letter. A hospital may wait for a Medicaid decision before it decides on your request (IRS (irs.gov)).

What to say when you call the billing office

"Hi, I'm calling about account number [your number]. Before I pay, I'd like to apply for financial assistance. Can you send me your financial assistance policy, the application and the plain-language summary? Please also send me an itemized bill. While you review my application, will you hold my account so it isn't sent to collections?"

What happens after you apply

At a nonprofit hospital, federal rules spell out the next steps once you apply within the window (26 CFR 1.501(r)-6 (law.cornell.edu)):

  • Collection actions go on hold. This applies even if your application is missing papers. The hospital must write to tell you what is missing and who to contact.
  • You get a decision in writing. It must say whether you qualify, what help you get and the reason.
  • If you get a discount instead of free care, the hospital must send a bill that shows what you now owe and how it got that number. It must charge you less than its full list price for care the policy covers (IRS (irs.gov)).
  • You get money back. If you already paid more than your new amount, the hospital must refund the extra, unless it is under $5.
  • Past collection actions get undone where possible. That can mean asking a court to cancel a judgment, lifting a lien or removing a credit report entry (IRS (irs.gov)). A sale of the debt is one action the hospital doesn't have to reverse.

If the hospital says no, or the bill is in collections

How to keep the next bill smaller

  • No insurance? When you book care at least 3 business days ahead, or when you ask, the provider must generally give you a good faith estimate of the cost (CMS (cms.gov)). Keep it. You need it if you dispute the bill later.
  • Check for coverage. If your income is low, read how Medicaid works and apply through your state's official site. Medicaid and CHIP are free or very low cost for people who qualify. Rules depend on your state, income and household size.
  • Ask about help early. The hospital's application window opens on the day you get care (26 CFR 1.501(r)-1 (law.cornell.edu)). You don't have to wait for the bill to apply.

Common questions

Can hospital bills be forgiven?
It can be, if you qualify. Nonprofit hospitals must have a financial assistance policy that says whether it gives free or discounted care and who qualifies. If you meet its rules, part or all of your bill can be written off. Each hospital sets its own income limits, so ask for its policy and application.
Can I apply for financial assistance after I paid the bill?
Yes. The CFPB (consumerfinance.gov) says you still have the right to seek financial assistance even if you've already paid. At a nonprofit hospital, if you send a complete application within the application window and you qualify, the hospital must refund what you paid above your new amount, unless the extra is under $5.
Do I have to pay the bill while my application is reviewed?
Ask the hospital, in writing, to hold your account. Once a nonprofit hospital gets your application within the application window, even an incomplete one, it must pause collection actions, such as credit reporting, selling the debt or a lawsuit, until it decides. It must then tell you in writing whether you qualify.
How long do I have to apply for hospital financial assistance?
At a nonprofit hospital, you have at least 240 days after the first bill it sends once you leave. The window can be longer if the hospital gives a later deadline in a written notice. For-profit and public hospitals may follow other rules, so ask the billing office.

Sources

  1. 26 CFR 1.501(r)-1, Definitions (application period of at least 240 days; amounts generally billed) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
  2. 26 CFR 1.501(r)-6, Billing and collection (120-day wait, 30-day notice, suspending collections, refunds) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
  3. IRS, Financial assistance policies (FAPs) (irs.gov), accessed October 19, 2026
  4. IRS, Billing and collections, Section 501(r)(6) (irs.gov), accessed October 19, 2026
  5. IRS, Limitation on charges, Section 501(r)(5) (irs.gov), accessed October 19, 2026
  6. IRS, Requirements for 501(c)(3) hospitals under the Affordable Care Act, Section 501(r) (irs.gov), accessed October 19, 2026
  7. IRS, Complaint process for tax-exempt organizations (irs.gov), accessed October 19, 2026
  8. 42 CFR 435.915, Effective date (retroactive eligibility up to the third month before the month of application) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
  9. CMS, "Working Families Tax Cut" Legislation, Public Law 119-21: Summary of Medicaid and CHIP Related Provisions (slide deck, Nov 18, 2025; section 71112 retroactive coverage) (medicaid.gov), accessed October 19, 2026
  10. HealthCare.gov, Getting Medicaid & CHIP, accessed October 19, 2026
  11. MACPAC, Medicaid retroactive eligibility changes under Section 1115 waivers (Aug 2019) (macpac.gov), accessed October 19, 2026
  12. HRSA, Hill-Burton free and reduced-cost health care (facility costs only; apply before or after care) (hrsa.gov), accessed October 19, 2026
  13. HRSA, Hill-Burton obligated facilities list (hrsa.gov), accessed October 19, 2026
  14. 42 CFR 124.505, Hill-Burton uncompensated services: eligibility (Cornell LII) (law.cornell.edu), accessed October 19, 2026
  15. 42 CFR 124.501, Hill-Burton uncompensated services: applicability and annual compliance level (Cornell LII) (law.cornell.edu), accessed October 19, 2026
  16. CMS, Medical bill rights (No Surprises Act protections) (cms.gov), accessed October 19, 2026
  17. CMS, Dispute a bill (uninsured or self-pay: $400 over the estimate, 120 days, $25 fee credited if you win) (cms.gov), accessed October 19, 2026
  18. CMS, Understanding costs in advance (good faith estimates) (cms.gov), accessed October 19, 2026
  19. HealthCare.gov, Internal appeals, accessed October 19, 2026
  20. HealthCare.gov, External review, accessed October 19, 2026
  21. CFPB, What should I know about medical credit cards and payment plans for medical bills? (consumerfinance.gov), accessed October 19, 2026
  22. CFPB, Consumer advisory: Pause and review your rights when you hear from a medical debt collector (Oct 1, 2024; archived) (consumerfinance.gov), accessed October 19, 2026
  23. CFPB, What information does a debt collector have to give me about the debt? (consumerfinance.gov), accessed October 19, 2026
  24. CFPB, Have medical debt? Anything already paid or under $500 should no longer be on your credit report (May 8, 2023; archived) (consumerfinance.gov), accessed October 19, 2026
  25. CFPB, Medical debt credit reporting rule (Regulation V): vacated by court order of July 11, 2025 (consumerfinance.gov), accessed October 19, 2026
  26. CFPB, How do I get a free copy of my credit reports? (weekly at AnnualCreditReport.com; last reviewed Oct 15, 2026) (consumerfinance.gov), accessed October 19, 2026
  27. HHS ASPE, 2026 Poverty Guidelines (aspe.hhs.gov), accessed October 19, 2026
  28. Dollar For (nonprofit), patient help with charity care applications (dollarfor.org), accessed October 19, 2026