Many hospitals offer financial assistance, often called charity care, that can reduce or erase what you owe after Medicare pays. Nonprofit hospitals are required by Internal Revenue Service (IRS) rules to have a written financial assistance policy, publish it, and tell patients about it on their bills. Having Medicare doesn't automatically rule you out, and each hospital sets its own eligibility rules, so ask for the policy and apply if your income is limited.
What is hospital financial assistance?
Financial assistance is a hospital program that gives free or discounted care to patients who qualify, usually based on income and sometimes on assets or medical expenses. Hospitals may call it charity care, financial aid, or a patient assistance program.
For people with Medicare, it can help with the part Medicare doesn't pay, like the Part A hospital deductible, Part B coinsurance for outpatient care, or services Medicare doesn't cover.
Do hospitals have to offer financial assistance?
Nonprofit (tax-exempt) hospitals do. The IRS says that under Section 501(r)(4), each nonprofit hospital facility must have a written financial assistance policy (FAP). The policy must:
- Apply to all emergency and other medically necessary care the hospital provides.
- Spell out who qualifies and whether help includes free care, discounts, or both.
- Explain how to apply and what documents you may need.
- List which other providers in the hospital, like emergency doctors or anesthesiologists, are covered by the policy and which aren't.
The IRS also says nonprofit hospitals must make the policy, the application, and a plain-language summary available on a website and on paper for free, and must put a notice about financial assistance on billing statements.
For-profit hospitals aren't covered by these IRS rules, but some have their own assistance programs, so it's worth asking.
Can I get financial assistance if I have Medicare?
You may. Each hospital decides its own eligibility criteria, and the IRS rule on charge limits says it applies to all patients eligible under the policy, without regard to insurance status. Policies differ on how they treat balances left after insurance pays, so read the policy for your hospital or ask the financial assistance office directly.
How much can a hospital charge me if I qualify?
The IRS says that once you're found eligible under a nonprofit hospital's policy, the hospital can't charge you more than the "amounts generally billed" (AGB) to people with insurance for emergency or other medically necessary care. For other care covered by the policy, the hospital must charge less than its full "gross charges."
The policy itself tells you exactly what discount or free care you'd get at each income level.
How do I apply for hospital financial assistance?
- Find the policy. Look for a notice on your hospital bill, search the hospital's website for "financial assistance policy," or call the billing office.
- Get the application. The IRS says hospitals must provide paper copies free on request.
- Gather documents. Policies commonly ask for proof of income (like a Social Security benefit statement), and sometimes bank statements. The IRS says a hospital can't deny you for leaving out information the policy didn't require.
- Include all the bills. List every account from the hospital, including bills from doctors who work there if the policy covers them.
- Send it and keep a copy. Ask the hospital to hold the account while it reviews your application.
You might say on the phone: "I'd like to apply for financial assistance for my account [number]. Can you send me the application and the plain-language summary? Will you hold the account while I apply?"