Who qualifies for charity care?

It depends on the hospital. Each nonprofit hospital sets its own income limits and writes them in its financial assistance policy. Federal rules don't set a minimum. Ask the billing office for the policy, or search the hospital's website for "financial assistance."

Can I apply for charity care after my bill goes to collections?

Often, yes. A nonprofit hospital must accept your application until at least 240 days after your first bill, even if it has started collections. If you qualify, it must take all reasonably available steps to undo those actions, such as fixing a credit report. After 240 days, ask anyway. The hospital's own policy may allow more time.

Does charity care cover doctors' bills?

Not always. Doctors who work in the hospital but bill on their own may not be covered. The hospital's policy must list which providers it covers and which it doesn't. Check that list, and ask each doctor's office about its own help.

Can I get charity care if I have insurance?

Sometimes. The federal rules don't shut out people with insurance, and the limit on charges applies to everyone who qualifies, insured or not. Whether a policy helps with deductibles and copays is up to each hospital, so read the policy or ask.

Is charity care the same as Medicaid?

No. Medicaid is health coverage run by your state. Charity care is help the hospital gives on its own bills. If you might qualify for Medicaid, apply for it too. The hospital may wait for the Medicaid decision before it decides on charity care.

Hospital charity care: how to get a bill reduced or forgiven

The short answer

Charity care, also called hospital financial assistance, is free or discounted care for people who can't afford their hospital bills. Every nonprofit hospital must have a written policy for it. The hospital must accept applications from the day you get care until at least 240 days after your first bill. Each hospital sets its own income limits.

By Constantino LardiLast reviewed October 19, 2026Sources

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.

Your options, cheapest first

Got a hospital bill you can't pay? Start at the top card. Many people can use more than one. In this guide, charity care and hospital financial assistance mean the same thing: free or discounted care that the hospital gives on its own bill.

Medicaid, if you qualify

Who qualifies: People with limited income who meet their state's rules. Rules depend on your state, income and household size.
What it costs: Medicaid is free or very low cost for people who qualify. It can also pay some bills from before you applied.
How to get it: Apply through your state or HealthCare.gov at any time of year. At the hospital, ask if it can check you for Medicaid on the spot.

The hospital's financial assistance (charity care)

Who qualifies: Patients who meet the hospital's own rules. Each hospital sets its own income limits.
What it costs: Free care or a discount, depending on your income and the hospital's rules.
How to get it: Ask the billing office for the financial assistance policy and the form. The steps are below.

A payment plan that charges no interest

Who qualifies: Anyone can ask. The hospital decides.
What it costs: The bill, or what is left after a discount, paid a little at a time.
How to get it: Ask the billing office, and get the terms in writing.

A fourth route, Hill-Burton, exists at only 126 places in the country (HRSA list (hrsa.gov)). See the note further down.

What charity care is, and which hospitals must offer it

Most people call hospitals with 501(c)(3) tax status "nonprofit hospitals." These hospitals must follow federal rules in section 501(r) of the tax code. One rule says each hospital must have a written financial assistance policy, or FAP. The policy must say who gets free or discounted care, how the hospital works out what you owe, and how to apply (IRS (irs.gov)). It must cover all emergency and other medically necessary care the hospital gives (26 CFR 1.501(r)-4 (law.cornell.edu)).

The federal rules don't set an income limit. Each hospital picks its own. A hospital that doesn't follow the rules can lose its tax-exempt status (IRS (irs.gov)).

Hospitals without 501(c)(3) status, such as for-profit hospitals and some public hospitals, don't have to follow 501(r) (IRS (irs.gov)). Ask them about help anyway. Some states have their own rules that reach more hospitals. For example, New Jersey's program covers care at all acute care hospitals in the state (NJ Department of Health (nj.gov)). Not sure if your hospital is tax-exempt? Search its name, or the name of the health system that owns it, in the IRS Tax Exempt Organization Search (irs.gov).

State laws: this page doesn't have a state-by-state table yet. We will add one only after every row is checked against the state's own law. Until then, ask the hospital whether a state law gives you more help.

Your rights at a nonprofit hospital

These rights come from the federal 501(r) rules. They apply at every hospital with 501(c)(3) status, in every state.

You can read the policy before you apply

The policy, the form and a plain-language summary must be on the hospital's website (IRS (irs.gov)).
Paper copies must be available at no charge. You can get them by mail or in public areas, including at least the emergency room and the admissions area.
The hospital must offer you the summary when you are admitted or sent home. Each bill must carry a clear notice that help is available (26 CFR 1.501(r)-4 (law.cornell.edu)).
The summary must say how to apply and where to get the policy and the form. It must give a contact for questions. It must also name a place that can help you fill out the form, such as a hospital office or a nonprofit or government agency (26 CFR 1.501(r)-1 (law.cornell.edu)).
The papers must be translated for any group in the area with limited English that is 1,000 people or 5% of the community, whichever is smaller (IRS (irs.gov)).

Limits on what you can be charged

If you qualify, the hospital can't charge you more for emergency or other medically necessary care than it generally bills people who have insurance. This cap is called the amount generally billed, or AGB. For other care the policy covers, the charge must be less than the hospital's full list price (IRS (irs.gov)).

Emergencies and paperwork

The hospital must treat emergencies whether or not you qualify for help. It can't make emergency patients pay before they are treated. It can't let debt collection get in the way of that care (26 CFR 1.501(r)-4 (law.cornell.edu)).
A separate law, the Emergency Medical Treatment and Labor Act (EMTALA), covers hospitals that take Medicare and offer emergency services. They must give a screening exam to anyone who asks for emergency care, whether or not they can pay. They must treat an emergency until it is stable, or move the patient to a hospital that can (CMS (cms.gov)).
The hospital can't turn you down for leaving out a paper unless its policy or form asks for that paper (26 CFR 1.501(r)-4 (law.cornell.edu)).

Limits on collections

The rules call the harshest steps extraordinary collection actions. They include selling your debt, reporting it to credit bureaus, suing you, putting a lien on your property, taking money from your pay, and holding back needed care because of an old bill. Before any of these, the hospital must make reasonable efforts to find out if you qualify for help (IRS (irs.gov)). Here is the timeline those efforts follow.

The 501(r) timeline at a nonprofit hospital (federal rules)
When	What the hospital must do, or can't do
The day you get care	Your window to apply opens.
Your first bill after you leave	The bill must say that financial help is available. The 120-day and 240-day counts start from this bill.
Days 1 to 120 after that bill	No extraordinary collection actions, such as credit reporting or a lawsuit, for at least 120 days. Holding back needed care over an old bill has its own rule: the hospital must first give you the form and a written notice, and it must handle your application quickly.
At least 30 days before any such action	A written notice that says help is available, names the actions it plans and gives a deadline. It must come with the plain-language summary. The hospital must also try to tell you by phone or in person.
Until at least day 240	The hospital must accept and process your application.
After you send a form that is missing something	It must pause collection actions. It must tell you in writing what is missing and who to contact.
After you send a full application	It must pause collection actions, decide in a timely way and tell you the decision and the reason in writing.
If you qualify	It must refund what you paid beyond what you owe, unless the difference is under $5. It must take all reasonably available steps to undo collection actions, such as fixing a credit report or lifting a lien. If you get a discount instead of free care, it must send a bill that shows what you owe and how it got that amount.
If it gives you a partial discount without an application	It must tell you why and how to apply for more help. It must give you a fair amount of time to apply before it starts collection actions.

Source: IRS, Billing and collections, section 501(r)(6). Verified October 19, 2026.

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

What this means for you: write down the date of your first bill, and apply as soon as you can. If your bill has gone to collections, you can still apply as long as you are inside the 240-day window (26 CFR 1.501(r)-1 (law.cornell.edu)). If you qualify, the hospital must try to reverse what it did. If your form is missing something, the hospital must give you a fair chance to send it. If you may qualify for Medicaid, the hospital can wait for that decision before it decides on charity care (26 CFR 1.501(r)-6 (law.cornell.edu)).

Who qualifies

Each hospital writes its own rules, so read the policy. If it uses the federal poverty level (FPL), it will list a percentage, such as "free care up to 200% of FPL." The FPL is a yearly income amount, called the poverty guideline, that the U.S. Department of Health and Human Services (HHS) sets by household size. Here is how to turn a percentage into dollars.

Worked example (2026 guidelines). For a household of three, the 2026 guideline is $27,320 in the 48 contiguous states and DC (HHS (aspe.hhs.gov)). If a hospital gives free care up to 200% of FPL, the cutoff for that family is $54,640 a year (2 × $27,320). A family of three earning $50,000 is under that cutoff. It would get free care at that hospital if it meets the policy's other rules. At a hospital whose free-care limit is 100% of FPL, the same family would be over the $27,320 cutoff, so it should check that hospital's discount levels instead.

Guidelines are higher in Alaska and Hawaii. A few more things to check in the policy:

Insurance. Having insurance doesn't rule you out under the federal rules. The cap on charges applies to everyone who qualifies, with or without insurance (IRS (irs.gov)). Ask if the policy helps with your deductible and copays. A deductible is what you pay for care before your plan starts to pay.
Doctors' bills. Doctors who work in the hospital may bill you on their own. The policy must list which providers it covers and which it doesn't (IRS (irs.gov)).
Other rules. Look for limits on savings, rules about where you live, and any deadline of the hospital's own.

How to apply, step by step

Ask before you pay. If a bill is large, call the billing office before you pay it. Ask for the financial assistance policy, the form and the plain-language summary. You can also search the hospital's website for "financial assistance." The Consumer Financial Protection Bureau (CFPB) says to be careful about paying a hospital bill with a credit card or a medical credit card. The interest can be high, and you may lose the chance to bargain over the bill (CFPB (consumerfinance.gov)).
Ask for an itemized bill. This lists each charge. Check it against the care you got, and ask about anything you don't recognize (CFPB (consumerfinance.gov)).
Read the limits and the provider list. Find the income limits for free care and for a discount. Check which doctors' bills are covered.
Check Medicaid at the same time. Some hospitals can approve temporary Medicaid on the spot if you seem to qualify. This is called hospital presumptive eligibility (42 CFR 435.1110 (law.cornell.edu)). If you don't file a full Medicaid application, it ends at the end of the next month (42 CFR 435.1101 (law.cornell.edu)).
Fill out the form and send it with copies of your papers. Keep a copy of everything. Write down the date you sent it and how you sent it.
Follow up. The federal rules say the hospital must decide in a timely way, but they don't set a number of days (26 CFR 1.501(r)-6 (law.cornell.edu)). If you hear nothing in a few weeks, call. Ask for the decision in writing.

What to have ready

Your bills, with the account number and the date of your first bill.
Proof of income for everyone in your household, such as recent pay stubs, a benefits letter or last year's tax return.
The number of people in your household.
A list of your monthly costs, such as rent, utilities and debts, if the form asks about them.
Any insurance card, and any letter from Medicaid that approved or denied you.
If you have no income or can't get a paper, ask if the hospital will take a signed statement instead. The federal rules let hospitals accept one (26 CFR 1.501(r)-4 (law.cornell.edu)).

What to say when you call the billing office

"Hi, my name is ___ and my account number is ___. I got care on [date], and I can't afford this bill. I'd like to apply for financial assistance. Can you send me your financial assistance policy, the application and the plain-language summary? Please put a hold on my account while I apply. Which doctors' bills does your policy cover? And what was the date of my first bill, so I know my deadline?"

A cover letter to send with your application

[Date]

To: [Hospital name], Patient Financial Services

Re: Financial assistance application. Patient: [name]. Account: [number]. Date(s) of care: [dates].

I am applying for financial assistance under your financial assistance policy. My application and copies of my papers are enclosed. There are [number] people in my household. Our yearly income is about [amount].

Please review my application and send me your decision in writing. While it is under review, please pause any collection actions on this account. If anything is missing, please tell me in writing what you need.

If I qualify, please send me a corrected bill, refund any amount I paid beyond what I owe, and reverse any collection actions on this account.

Thank you. [Your name], [mailing address], [phone number]

A note on Hill-Burton

Hill-Burton is an older federal program. Starting in 1946, it gave health facilities money to build. In return, they agreed to give some care to people who couldn't pay. The money stopped in 1997, but some facilities still owe free or reduced-cost care, according to the Health Resources and Services Administration (HRSA (hrsa.gov)).

The list is short. HRSA's list, dated December 12, 2024, shows 126 facilities in 36 states and Puerto Rico. Only 18 are general hospitals. Most (86) are outpatient clinics, and 10 are nursing homes. There are none in Alaska, Delaware, DC, Indiana, Maryland, Minnesota, Nebraska, Nevada, North Dakota, Ohio, Rhode Island, South Dakota, Utah, Vermont or Wyoming. Most listed facilities (105 of 126) run their program under different rules, so their limits may differ from the ones below (HRSA facility list (hrsa.gov)).

Who qualifies: free care if your income is at or below the poverty guidelines. Some facilities give reduced-cost care up to twice the guidelines, or three times for nursing home care. The facility uses your income for the last 12 months or your last 3 months' income times 4, whichever is less. You don't need to be a citizen, but you must have lived in the U.S. for at least 3 months.
What it covers: facility costs only, not private doctors' bills. It doesn't cover care that insurance, Medicare or Medicaid fully pays for. It can help with a Medicaid spenddown (the bills some people must pay before Medicaid starts to pay) and, outside nursing homes, a Medicaid copay. It doesn't help with Medicare deductibles or coinsurance. A facility can also say no once it has given out its required amount of free care for the year.
How to apply: at the admissions or business office of a listed facility, before or after you get care. You can apply even after a bill goes to a collection agency. Bring proof of income, such as a pay stub. The facility may ask you to apply for Medicaid or Medicare first.
If you're turned down: the facility must tell you why in writing. If you think the denial was unfair, you can send a written complaint. Include your name and address, the facility's name and city, and what you think it did wrong (HRSA FAQ (hrsa.gov)). HRSA lists this address: Director, Division of Poison Control and Healthcare Facilities, 5600 Fishers Lane, Room 8W, Rockville, MD 20857. You can also email DFCRCOMM@hrsa.gov (HRSA (hrsa.gov)).

Check the Hill-Burton facility list (hrsa.gov), then call the facility. Ask if it still has funds and covers the service you need. HRSA's Hill-Burton hotline is 1-800-638-0742 (HRSA (hrsa.gov)).

If you're turned down, or the bill is still too big

Read the written decision. The hospital must tell you the reason. If it says something is missing, send it. If your income has dropped since you applied, ask if you can apply again. Ask if the hospital has a way to review its decision.
Apply for Medicaid. Medicaid can pay some bills from before you applied, if you qualified at the time. Under the federal rule, coverage can start up to 3 months before the month you apply (42 CFR 435.915 (law.cornell.edu)). For applications made on or after January 1, 2027, that becomes 1 month for adults in the Medicaid expansion group and 2 months for everyone else (Public Law 119-21, section 71112 (govinfo.gov)). Your state's rules may differ, so ask your state Medicaid agency.
Ask for a payment plan that charges no interest. The CFPB suggests asking for one (CFPB (consumerfinance.gov)). Get the terms in writing.
Report a hospital that broke the rules. You can send the IRS a referral online about a tax-exempt hospital. The IRS keeps your name private but won't tell you the outcome. State charity regulators also oversee nonprofits (IRS (irs.gov)). Your state attorney general's office may also take complaints (CFPB (consumerfinance.gov)). For a problem with a debt collector, you can file a complaint with the CFPB (consumerfinance.gov).
Get help near you. Call 211 or visit 211.org to find local programs. Civil legal aid groups help people with low income. Find one near you with the Legal Services Corporation's search (lsc.gov).
Plan for your next visit. For checkups and care that isn't an emergency, community health centers charge on a sliding scale based on income; some visits cost little or nothing. A free clinic may also see you. For other kinds of bills, start with our guide to medical bills.

Find it near you (official and nonprofit finders)

HRSA Find a Health Center (findahealthcenter.hrsa.gov)Search by address or ZIP code; results list federally funded health centers by distance.
NAFC Find a Free Clinic (nafcclinics.org)Search by city or ZIP code; call the clinic before you go, because hours and rules vary.

Common questions

Who qualifies for charity care?: It depends on the hospital. Each nonprofit hospital sets its own income limits and writes them in its financial assistance policy. Federal rules don't set a minimum. Ask the billing office for the policy, or search the hospital's website for "financial assistance."
Can I apply for charity care after my bill goes to collections?: Often, yes. A nonprofit hospital must accept your application until at least 240 days after your first bill, even if it has started collections. If you qualify, it must take all reasonably available steps to undo those actions, such as fixing a credit report. After 240 days, ask anyway. The hospital's own policy may allow more time.
Does charity care cover doctors' bills?: Not always. Doctors who work in the hospital but bill on their own may not be covered. The hospital's policy must list which providers it covers and which it doesn't. Check that list, and ask each doctor's office about its own help.
Can I get charity care if I have insurance?: Sometimes. The federal rules don't shut out people with insurance, and the limit on charges applies to everyone who qualifies, insured or not. Whether a policy helps with deductibles and copays is up to each hospital, so read the policy or ask.
Is charity care the same as Medicaid?: No. Medicaid is health coverage run by your state. Charity care is help the hospital gives on its own bills. If you might qualify for Medicaid, apply for it too. The hospital may wait for the Medicaid decision before it decides on charity care.

From FreedInsure, the private agency that publishes this guide

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Sources

IRS, Financial assistance policies (FAPs), section 501(r)(4) (page updated Dec 28, 2025) (irs.gov), accessed October 19, 2026
IRS, Billing and collections, section 501(r)(6) (page updated Jul 2, 2026) (irs.gov), accessed October 19, 2026
IRS, Limitation on charges, section 501(r)(5) (page updated Jul 3, 2026) (irs.gov), accessed October 19, 2026
IRS, Requirements for 501(c)(3) hospitals under the Affordable Care Act, section 501(r) (page updated Jul 2, 2026) (irs.gov), accessed October 19, 2026
26 CFR 1.501(r)-1, Definitions (application period; plain language summary; AGB) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
26 CFR 1.501(r)-4, Financial assistance policy and emergency medical care policy (Cornell LII) (law.cornell.edu), accessed October 19, 2026
26 CFR 1.501(r)-6, Billing and collection (Cornell LII) (law.cornell.edu), accessed October 19, 2026
IRS, Complaint process for tax-exempt organizations (page updated Sep 25, 2026) (irs.gov), accessed October 19, 2026
IRS, Tax Exempt Organization Search (page updated Jun 28, 2026) (irs.gov), accessed October 19, 2026
CMS, Emergency Medical Treatment & Labor Act (EMTALA) (page modified Mar 10, 2026) (cms.gov), accessed October 19, 2026
HRSA, Hill-Burton free and reduced-cost health care (page last reviewed Sep 2023) (hrsa.gov), accessed October 19, 2026
HRSA, Hill-Burton facilities obligated to provide free or reduced-cost health care (list dated Dec 12, 2024; 126 facilities) (hrsa.gov), accessed October 19, 2026
HRSA, Hill-Burton frequently asked questions (page last reviewed Oct 2023) (hrsa.gov), accessed October 19, 2026
HHS ASPE, 2026 Poverty Guidelines (Federal Register, Jan 15, 2026) (aspe.hhs.gov), accessed October 19, 2026
42 CFR 435.915, Effective date (retroactive Medicaid eligibility) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
Public Law 119-21, section 71112 (shorter retroactive Medicaid coverage for applications on or after Jan 1, 2027) (GovInfo) (govinfo.gov), accessed October 19, 2026
42 CFR 435.1110, Presumptive eligibility determined by hospitals (Cornell LII) (law.cornell.edu), accessed October 19, 2026
42 CFR 435.1101, Definitions (presumptive eligibility period) (Cornell LII) (law.cornell.edu), accessed October 19, 2026
HealthCare.gov, Medicaid & CHIP coverage, accessed October 19, 2026
CFPB, What should I do if I can't pay a medical bill? (last reviewed Dec 7, 2023) (consumerfinance.gov), accessed October 19, 2026
New Jersey Department of Health, Charity Care (hospital care payment assistance) overview (nj.gov), accessed October 19, 2026
Legal Services Corporation, Get legal help (find a legal aid organization) (lsc.gov), accessed October 19, 2026

Part of: Medical bills