What hospital charity care is
Hospital charity care, which the tax rules call financial assistance, is free or discounted care a nonprofit (tax-exempt) hospital must offer under a written financial assistance policy for emergency and other medically necessary care. Each hospital writes its own policy, and the policy must state the eligibility criteria, whether help means free or discounted care, how charges are calculated and how to apply.[1] There is no single national income limit: you qualify by meeting the criteria in that hospital's policy. These rules come from section 501(r) of the tax code and bind tax-exempt hospitals only; for-profit hospitals are not covered by them.[3]
Hospital financial assistance: what nonprofit hospitals must do
A nonprofit hospital must publish its financial assistance policy, the application form and a plain-language summary on a website, give paper copies free on request by mail and in the emergency room and admissions areas, and tell the community it serves about the policy.[1]
| Rule | What it means for you | Regulation |
|---|---|---|
| Written financial assistance policy | Eligibility criteria, free or discounted care, how charges are figured, how to apply | 26 CFR 1.501(r)-4 |
| Published and free | Policy, application and plain-language summary online and on paper at no charge | 26 CFR 1.501(r)-4 |
| Price cap for eligible patients | Emergency and medically necessary care: no more than the amounts generally billed to insured patients; other care: less than gross charges | 26 CFR 1.501(r)-5 |
| Application period | At least until 240 days after the first post-discharge bill | 26 CFR 1.501(r)-1 |
| Collection limits | No extraordinary collection actions for 120 days after the first bill, and written notice at least 30 days before | 26 CFR 1.501(r)-6 |
| Emergency care | Emergency medical conditions treated without discrimination, whether or not you qualify | 26 CFR 1.501(r)-4 |
How much eligible patients can be charged
If you qualify, a nonprofit hospital may charge no more than the "amounts generally billed" (AGB) to people with insurance for emergency or medically necessary care, and less than its gross charges for any other care.[2] The policy must explain how the hospital calculates its AGB, or tell you how to get that explanation in writing and free of charge.[1] Gross charges are the full list (chargemaster) prices, so the cap matters most for patients without insurance, who are otherwise billed at those prices.
Deadlines: the 120-day and 240-day clocks
Two clocks start with the first bill sent after you leave the hospital: the hospital cannot start extraordinary collection actions for at least 120 days, and you can apply for financial assistance until at least the 240th day.[4][3] The hospital must also send written notice at least 30 days before it first starts such an action.[4]
| Day | Date | What happens |
|---|---|---|
| 0 | September 1, 2026 | First post-discharge bill; both clocks start |
| 120 | December 30, 2026 | Earliest day extraordinary collection actions may begin (after 30 days’ written notice) |
| 240 | April 29, 2027 | Last day the hospital must accept a financial assistance application, at minimum |
Extraordinary collection actions include steps such as reporting the debt to credit bureaus, selling the debt or taking legal action.[4] Applying early is safer than waiting for the deadline.
How to apply for hospital charity care
Before you sign up for financingThe Consumer Financial Protection Bureau found that many people who sign up for medical credit cards or financing plans at hospitals and doctors’ offices may be eligible for financial assistance or charity care instead.[5] Ask about the policy first.
If the hospital is for-profit, these federal rules do not apply, but you can still ask for a self-pay discount and a payment plan. Community health centers set fees on a sliding scale by income; see sliding scale clinics.[6] For a counteroffer see how to negotiate medical bills. Emergency rooms must screen and stabilize you regardless of ability to pay;[7] see what an ER visit costs.
Check a bill that is higher than its good faith estimate
General information, not legal advice.Each hospital’s policy sets its own eligibility rules. This page summarizes the federal requirements; read the hospital’s policy and contact your state’s consumer protection office or a licensed legal professional about your situation.
Frequently asked questions
What is hospital charity care?
Free or discounted care a nonprofit hospital gives under its written financial assistance policy to patients who meet that policy’s criteria.[1]
How long do I have to apply for hospital financial assistance?
At least until 240 days after the first bill sent after you leave the hospital.[3] Some hospitals allow longer; the policy says.
Can a nonprofit hospital send my bill to collections?
Not with extraordinary collection actions for at least 120 days after the first bill, and only after at least 30 days’ written notice.[4]
Do for-profit hospitals have to offer charity care?
The federal section 501(r) rules apply to tax-exempt hospitals only. For-profit hospitals may have their own discount programs; ask the billing office.
Sources
- 26 CFR 1.501(r)-4: Financial assistance policy and emergency medical care policy
- 26 CFR 1.501(r)-5: Limitation on charges (amounts generally billed)
- 26 CFR 1.501(r)-1: Definitions (240-day financial assistance application period)
- 26 CFR 1.501(r)-6: Billing and collection (120-day notification period)
- Medical Credit Cards and Financing Plans
- Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program
- Emergency Medical Treatment & Labor Act (EMTALA)