US Healthcare · Bills and Rights
How to Apply for Hospital Charity Care
A step-by-step guide to applying for nonprofit hospital financial assistance — what to ask for, what documents you will need, how income is evaluated, and what happens after you submit.
Patients who have received a hospital bill they cannot afford to pay and want to apply for the hospital's financial assistance or charity care program under IRS 501(r).
Nonprofit hospitals in the United States are required by federal tax law to maintain financial assistance programs and to make those programs available to patients who cannot afford their bills. The process is not always advertised clearly, and many patients miss out on assistance they are entitled to simply because they did not know to ask or how to apply. This page walks through the application from beginning to end — who to contact, what to bring, how income is evaluated, and what to do if you run into obstacles.
Who can apply and at which hospitals
Financial assistance under IRS Section 501(r) is available at nonprofit hospitals — those with 501(c)(3) tax-exempt status. This includes many community hospitals, academic medical centers, and health system hospitals. For-profit hospitals and government-owned hospitals are not subject to 501(r), though some state laws require those facilities to offer assistance programs as well.
If you are unsure whether your hospital is a nonprofit, you can check IRS Form 990 filings on ProPublica’s Nonprofit Explorer or GuideStar, or simply ask the billing department directly. Most nonprofit hospitals list their financial assistance programs on their websites.
Step 1: Request the Financial Assistance Policy and application
Your first call is to the hospital’s billing department, patient financial services office, or social work department. Ask for:
- The Financial Assistance Policy (FAP) — the written document describing who qualifies and what assistance is available
- The financial assistance application form
- The name of a financial counselor who can help you complete the application
If you are still in the hospital or recently discharged, a social worker or patient advocate may be assigned to help with financial planning. Ask at discharge if no one has offered this.
Many hospitals post FAP documents and applications on their websites. If you received care at a large health system, search the system’s website for terms like “financial assistance,” “charity care,” or “patient assistance program.”
Step 2: Review the income thresholds in the FAP
The FAP specifies the income thresholds for assistance at that hospital. The IRS requires nonprofit hospitals to provide free care to patients at or below 200% of the federal poverty level (FPL). Most hospitals go further:
| Income level (% of FPL) | Typical assistance level |
|---|---|
| Up to 100% FPL | Full free care at virtually all nonprofit hospitals |
| 101–200% FPL | Full free care (IRS 501(r) minimum) |
| 201–300% FPL | Sliding-scale discount at many hospitals |
| 301–400% FPL | Sliding-scale discount or interest-free payment plan at many hospitals |
| Above 400% FPL | Varies; some hospitals offer reduced self-pay rates |
These ranges are examples — every hospital’s FAP is different. Some hospitals offer full free care up to 350% FPL and discounts up to 500% FPL. Read the actual FAP for the hospital where you received care.
The FPL is based on household size and is updated annually by HHS. A household of four people has a higher FPL threshold than a single adult. Income is typically calculated based on gross household income — all sources — for the prior 12 months or the most recent full tax year.
Step 3: Gather your documents
Having the right documents ready when you apply reduces processing time and avoids delays. Typical required documents include:
- Proof of income: Recent pay stubs (usually the two to three most recent), or a W-2 or 1099 from the most recent tax year. If self-employed, a profit-and-loss statement or business bank statements may be acceptable.
- Federal tax return: Most hospitals ask for the most recently filed return (typically the prior year’s Form 1040). A transcript from the IRS (available at IRS.gov) is accepted if you do not have a copy.
- Proof of household size: Documentation confirming how many people live in your household and their relationship to you — birth certificates, tax returns listing dependents, or school records.
- Bank statements: Some hospitals require recent bank statements to verify assets or as an alternative to pay stubs.
- Proof of other income: Documentation of any Social Security, disability, unemployment, or other benefits received.
If you do not have some of these documents, apply anyway and explain the situation. Under 501(r), hospitals are required to provide applicants with a reasonable opportunity to submit missing materials, and they can verify some information through data-sharing agreements.
Documents and terms you’ll see
During the application process, you will encounter these terms in the hospital’s paperwork:
- Financial assistance policy (FAP) — the hospital’s written document describing eligibility criteria, available assistance levels, and the application process; you have the right to request this at any nonprofit hospital
- Federal poverty level — the income benchmark used to determine how much assistance you qualify for; updated annually by HHS based on household size
- Presumptive eligibility — a hospital determination that you likely qualify for assistance based on available information, without requiring a full application; may result in automatic discounts
- Charity care — the informal term for fully free care provided under a hospital’s financial assistance program to patients who cannot pay
Step 4: Submit the application and follow up
Submit the completed application and all supporting documents to the hospital’s financial assistance office. Request written confirmation that your application was received and is under review. Keep a copy of everything you submit.
Federal rules under 501(r) do not specify a maximum processing time, but most hospitals aim to act within 30 days. If you have a bill with a payment deadline, tell the financial assistance office this immediately — they can often flag the account to prevent collections activity while your application is pending.
If you receive a bill with a “final notice” or collections reference while your application is pending, contact the hospital immediately with documentation that an application is pending. Under 501(r), the hospital should not take extraordinary collection actions on an account while an application is in review.
What happens if you are approved
If your application is approved, the hospital will adjust your bill to reflect the assistance level you qualified for — either reducing it to zero (full charity care) or applying a discount. You should receive a written notice explaining the determination, the adjusted amount, and any remaining balance.
If a remaining balance exists, ask about an interest-free payment plan. Under 501(r), nonprofit hospitals must offer interest-free payment plans to patients who qualify for financial assistance and whose income is at or below 400% of the FPL.
Presumptive eligibility: automatic screening
Some hospitals screen patients for potential financial assistance eligibility automatically, without waiting for a formal application. This process, called presumptive eligibility, uses publicly available data or patient information gathered at registration to identify patients who appear likely to qualify. If you are determined to be presumptively eligible, the hospital may provisionally reduce or waive your bill and ask you to complete a formal application to confirm.
Even if no one mentions presumptive eligibility, ask your financial counselor whether the hospital uses this process — it can result in faster relief for patients in clear need.
If you are denied: appealing the decision
If your application is denied, you have the right to appeal. Request the hospital’s appeals process in writing. In your appeal:
- Explain any factors the hospital may have misunderstood, such as a one-time income event that inflated your reported income
- Provide documentation of current income if your situation has changed since your tax return
- Cite the hospital’s FAP and the specific threshold you believe you meet
If you believe the hospital is not complying with its 501(r) obligations — for example, by refusing to accept applications, failing to notify you of assistance, or initiating collection before the 120-day window closes — you can file a complaint with the IRS (which enforces 501(r)) and your state attorney general.
For a broader explanation of the legal obligations nonprofit hospitals must meet and the full scope of the 501(r) requirements, see the Nonprofit Hospital 501(r) Obligations page. For an overview of the full financial assistance and charity care landscape, visit the Hospital Financial Assistance and Charity Care guide.
Key terms
| Term | Plain meaning | Glossary |
|---|---|---|
| Charity care | Free or discounted hospital care for patients who cannot pay, required of nonprofit hospitals under IRS 501(r) | → |
| Financial assistance | Hospital programs that reduce or eliminate bills for eligible low-income patients | → |
| FAP | Financial Assistance Policy — the written document each nonprofit hospital must maintain describing its charity care eligibility rules | → |
| Federal poverty level | An income measure set annually by HHS used to determine eligibility for assistance programs | → |
| Presumptive eligibility | A process by which a hospital identifies patients who likely qualify for assistance without a full formal application | → |
Common questions
- When should I apply for charity care — before or after treatment?
- You can apply before, during, or after treatment, but earlier is always better. Applying before or immediately after treatment gives the hospital time to process your application before a bill escalates. Many hospitals post applications on their websites and will accept them even after you have received a final bill. Under IRS 501(r), nonprofit hospitals must give you at least 120 days from the first billing statement before initiating most collection actions, so you have time — but do not wait.
- Who do I contact to start the application?
- Contact the hospital's billing department, patient financial services office, or social work department and ask for the Financial Assistance Policy (FAP) and the assistance application form. Many hospitals also have financial counselors on staff who can walk you through the process and help you gather required documents.
- What income level qualifies for free charity care?
- Under IRS 501(r), nonprofit hospitals must provide free care to patients with income at or below 200% of the federal poverty level. Many hospitals are more generous — some provide full free care up to 250%, 300%, or even 350% of FPL, and sliding-scale discounts at higher income levels. The specific thresholds are in each hospital's FAP. Always request the FAP to see the exact numbers for the hospital where you received care.
- What if I was not told about financial assistance and my bill already went to collections?
- Contact the hospital's patient financial services office and ask to apply retroactively. Under IRS 501(r), the hospital is required to make reasonable efforts to notify patients about assistance and give them an opportunity to apply before initiating extraordinary collection actions. If those steps were skipped, you may be able to apply even after the account was sent to collections. The hospital must return the account from collections if it processes an assistance application in good faith.
- What documents will I need for the application?
- Most hospitals ask for recent pay stubs (typically the last two to three), a recent federal tax return, and proof of household size (such as birth certificates or tax records listing dependents). If you are self-employed, unemployed, or have variable income, the hospital may accept bank statements, a profit-and-loss statement, or a signed self-attestation form. Ask the financial counselor exactly what is accepted at that hospital.
- How long does the charity care application process take?
- Processing times vary by hospital. Many hospitals aim to process applications within two to four weeks. If you have a bill in dispute or approaching a payment deadline, tell the hospital this — they can often expedite review. During the review period, the hospital should not take collection actions on the account. Follow up in writing if you have not heard within a reasonable time.
- Can I appeal if my charity care application is denied?
- Yes. Hospitals must have an appeals process for denied applications. Ask the billing department or patient financial services office for the appeals procedure. In your appeal, explain why you believe you qualify — for example, if your income changed after the tax year shown on your return, provide documentation of current income. State attorney general offices can be a resource if you believe a nonprofit hospital is not complying with its 501(r) obligations.
Sources
Last reviewed: September 2026