Financial Assistance Programs for Medical Bills

A large medical bill can often be reduced. Work through these steps in order, starting with the hospital's own financial assistance policy, before you pay anything.

Financial Hardship Updated October 2026 · 8 min read
Reviewed by the SGB Team

Start with the hospital. Nonprofit hospitals are required by law to have a financial assistance (charity care) policy. Then look at HRSA-funded community health centers for ongoing care on a sliding fee scale, ask whether Medicaid's retroactive coverage applies to bills you already have, and negotiate with the billing office. If you do not know where to begin, call 211, a free helpline that connects you to local resources.

The amount on a medical bill is often not final, especially when the bill comes from a nonprofit hospital. Hospitals have financial assistance programs, clinics charge according to income, and Medicaid can cover some past bills. You do not need a lawyer to use any of them. The steps are listed in the order that helps most people soonest.

Step 1: Ask the hospital for its financial assistance policy

Most U.S. hospitals are nonprofit. Under Internal Revenue Code Section 501(r), a nonprofit hospital has to keep a written Financial Assistance Policy (FAP) to hold its tax-exempt status. The policy states who qualifies, what discounts or free care are offered, and how to apply. The hospital has to publish it on its website in plain language and post a summary in admissions and emergency areas.

Each hospital sets its own income limits. Many give free care at or below about 200% of the federal poverty level and partial discounts up to 300% or 400%. Under the 2026 guidelines, 200% is $31,920 a year for one person and $43,280 for two, and 400% is $63,840 for one person. Many retirees living on Social Security and a small pension fall inside those ranges.

What to do:

  1. Call the billing department and ask for the financial assistance application, or for a financial counselor.
  2. Apply before you pay anything. Hospitals do not offer this unprompted.
  3. Ask whether the policy covers older bills too.
  4. Ask the hospital to put collection activity on hold while your application is reviewed.

Step 2: For ongoing care, look at HRSA-funded health centers

Community health centers funded by HRSA, also called Federally Qualified Health Centers, have to charge on a sliding fee scale based on income and household size. People at or below the poverty level get the full discount. Nobody is turned away for being unable to pay, with or without insurance.

Find one by ZIP code at findahealthcenter.hrsa.gov. They provide primary care, and many also offer dental and behavioral health care on the same scale.

Before you pay a bill

Request an itemized statement, ask about the hospital's financial assistance policy, and ask whether a self-pay or prompt-pay discount applies. The first number listed is often not final.

If a bill has already gone to collections

Nonprofit hospitals must make a reasonable effort to check financial assistance eligibility before taking aggressive collection action. Contact the billing office. It may not be too late.

Step 3: Check whether Medicaid's retroactive coverage applies

In most states, Medicaid can pay eligible unpaid medical bills from up to three months before the date you apply, if you would have qualified during those months. Some states also reimburse bills you already paid in that period. Ask your state agency.

The window is getting shorter. Under a 2025 federal law, from January 1, 2027 retroactive coverage is scheduled to drop to one month for adults covered through the ACA Medicaid expansion, and to two months for children, pregnant women, and people who are elderly or have a disability. If you have recent bills and may qualify, apply now. Our Medicaid Eligibility Calculator gives a first estimate.

Step 4: If you have Medicare, check these two things

  • Medicare Savings Programs. If your income is limited, your state may pay your Part B premium. At the lowest income level, the Qualified Medicare Beneficiary (QMB) program also pays Medicare deductibles and coinsurance, and providers are not allowed to bill you for them. Check with our Medicare Savings Program calculator.
  • Denied claims. If the bill exists because Medicare or your plan denied a claim, you can appeal. See how Medicare appeals work. Do not pay a denied claim before you check whether the denial was correct.

Step 5: Negotiate, even without a formal program

  • Ask for an itemized bill. Coding errors and duplicate charges are common. Compare it with your Medicare Summary Notice or your plan's Explanation of Benefits.
  • Ask for a billing supervisor or financial counselor, not the general customer service line.
  • Ask about discounts. Many hospitals have an uninsured or prompt-pay discount that they do not advertise.
  • Ask for an interest-free payment plan from the hospital before a bill goes to an outside collector or a medical credit card. Agree only to a monthly amount you can keep paying.
  • Get every agreement in writing.

Medical billing advocates review bills for errors and negotiate for patients. Some nonprofits provide the service free to people who cannot afford it.

Not sure where to start? Call 211

211 is a free, confidential helpline, by phone or at 211.org, run by United Way with local agencies. It covers nearly the whole U.S. population. A specialist can point you to hospital charity programs, low-cost clinics and other help in your county, even if you do not know what the program is called.

For help with other bills at the same time, see our financial hardship assistance guide.

Sources: IRS Section 501(r) guidance on hospital financial assistance policies and HRSA Health Center Program requirements. Income examples are our calculation from the 2026 HHS poverty guidelines. This article explains general rules and is not medical, legal or financial advice. See our Editorial & Methodology page for how we verify figures.

Frequently Asked Questions

Do nonprofit hospitals have to offer financial assistance?

Yes. Under IRS Section 501(r), every nonprofit hospital must have a written financial assistance policy, publish it in plain language and post a summary in admitting and emergency areas. Each hospital sets its own income limits, so ask the billing office for the policy.

What if I don't have insurance at all?

You can still apply for hospital charity care, and HRSA-funded community health centers charge on a sliding scale whether or not you have insurance. Check Medicaid eligibility as well, since the rules vary by state and income.

Can Medicaid pay bills I already incurred before I applied?

Often yes, through retroactive coverage. Most states can currently cover eligible unpaid medical bills from up to three months before your application date, if you would have qualified then. The window is scheduled to shorten for some groups from 2027, so apply soon.

Is it too late to get help once a bill has gone to collections?

Not necessarily. Nonprofit hospitals must make reasonable efforts to check whether you qualify for financial assistance before aggressive collection action. Contact the hospital's billing office or financial counselor. Some will still apply their charity care policy.

Where should I call first if I don't know where to start?

Dial 211 or go to 211.org. It is a free, confidential helpline covering nearly the whole country. A specialist can direct you to hospital charity care programs, sliding-scale clinics and other local resources.

This article is for general educational purposes and reflects federal rules as of October 2026. It does not guarantee eligibility for any program and is not legal, medical or financial advice. Rules vary by hospital, state and individual circumstances. Contact the organization concerned to confirm current requirements.