How to Get Charity Care from a Hospital (Even If You Have Insurance)

More than 58% of US hospitals are nonprofit. Under IRS rules (specifically Section 501(r) of the tax code), every nonprofit hospital must have a written financial assistance policy and must offer reduced or free care to patients who qualify. Most people never apply — either because they don't know it exists, or because the hospital doesn't advertise it. Here's how to find it and use it.

What Is Charity Care?

Charity care is discounted or free hospital care based on your income. The IRS requires nonprofit hospitals to:

• Have a written Financial Assistance Policy (FAP)
• Limit charges to patients who qualify to no more than "amounts generally billed" (basically Medicare/Medicaid rates — often 20-40% of the listed price)
• Not send bills to collections or take legal action until they've checked whether the patient qualifies for assistance
• Notify patients about the FAP on the bill and on the hospital website

Who Qualifies?

Each hospital sets its own income thresholds, but federal rules require them to provide free care to patients with income below 100% of the Federal Poverty Level (FPL) and discounted care to patients up to 200-400% FPL. Some hospitals go higher. A family of four with income under $62,000 (2024) is typically at 200% FPL.

Having insurance doesn't disqualify you. If you have a large out-of-pocket balance after insurance pays, you can still apply for financial assistance on the remaining amount.

How to Apply — Step by Step

1. Find the hospital's Financial Assistance Policy. Search the hospital's website for "financial assistance," "charity care," or "FAP." It must be publicly posted. If you can't find it, call the billing department and ask for it directly.
2. Get the application form. Most hospitals have a 1-2 page form asking for income, household size, and recent pay stubs or tax returns.
3. Submit before the collection deadline. Federal rules require hospitals to give you at least 240 days after the first bill to apply for financial assistance. They cannot send your account to collections until this period expires and they've screened your eligibility.
4. Follow up in writing. Send the application by certified mail and keep a copy. Note the date you submitted.
5. Appeal if denied. If denied, ask for the specific reason and income thresholds used. Many denials are based on incomplete information — you can reapply with additional documentation.

What to Say When You Call

Call the billing department and say: "I'd like to apply for financial assistance under your 501(r) charity care policy. Can you tell me the income thresholds and send me the application?"

Mentioning "501(r)" shows you know your rights and typically gets you transferred to someone who can actually help instead of just the standard collections script.

What Happens If You Already Paid?

If you paid a bill in full before applying for assistance, you may still be able to request a refund of the portion that would have been covered — but rules vary by hospital and state. It's worth asking, especially if the bill was large.

Charity care is a legal entitlement at nonprofit hospitals, not a favor. The hospital got its nonprofit tax status partly in exchange for providing this benefit. Use it.

This article is for informational purposes only and does not constitute legal advice.