What Is Charity Care and How Nonprofit Hospitals Use It
Charity care, also called financial information or hardship programs, is a program that many nonprofit hospitals offer to patients who cannot pay for their medical services. These programs exist because nonprofit hospitals receive special tax benefits from the government in exchange for providing community benefits, including care for uninsured and underinsured patients. When a nonprofit hospital provides charity care, they reduce or eliminate a patient's bill based on their financial situation.
Nonprofit hospitals are different from for-profit hospitals. Because they are organized as nonprofits, they do not have shareholders expecting profits. Instead, they reinvest money back into their organizations and communities. Part of this reinvestment includes offering financial information to people who struggle to pay hospital bills. The amount of charity care a hospital provides varies widely depending on the hospital's size, location, and resources.
Charity care programs are not the same as Medicaid or Medicare. These are separate programs that the federal government runs. Charity care is managed directly by individual hospitals. Each hospital creates its own charity care policy, which means the rules and amounts of information can differ from one hospital to another. Understanding how your specific hospital's program works is important if you are facing medical debt or cannot pay your bills.
Many patients do not know that charity care exists. Hospital staff may not always tell patients about these programs unless patients ask. Learning about charity care policies can help you understand what options may be available to you when facing large medical bills.
How to Find and Understand Your Hospital's Charity Care Policy
Every nonprofit hospital is required by law to have a written charity care policy. This policy must be made public, which means you can find it and read it. The policy explains who may be considered for charity care, how much financial information the hospital offers, and how to request it. Finding this information is an important first step in understanding what your hospital offers.
You can find your hospital's charity care policy in several ways. Start by calling the hospital's main phone number and asking to speak with someone in the billing department or financial information office. You can ask them directly about the charity care policy and request a copy. Many hospitals also post their policies on their websites. Look for sections titled "Financial information," "Charity Care," "Patient Financial Services," or "Billing Information."
When you read the policy, look for specific information. The policy should explain the income limits or financial thresholds that determine who may receive information. It should describe what types of bills are covered by charity care. Some hospitals cover all services, while others may limit charity care to certain departments or types of care. The policy should also explain the process for requesting information, including what documents you may need to provide and how long the review process takes.
Hospital charity care policies can be complex and use medical or legal language that is hard to understand. If you have trouble understanding the policy, ask hospital staff to explain it in simpler terms. Many hospitals have financial counselors or patient advocates who can walk you through the process and answer your questions.
Income Limits and Financial Thresholds for Charity Care
Nonprofit hospitals use income limits to decide who may receive charity care. These income limits are usually based on the federal poverty level. The federal poverty level is a measure created by the government that shows how much money a family needs to meet basic needs. It changes each year and depends on family size. For example, in 2024, the federal poverty level for a single person is around $15,000 per year, but this number is higher for families with more members.
Each hospital sets its own income limits for charity care. Some hospitals offer full charity care to patients whose income is below 100 percent of the federal poverty level, meaning their income is at or below the poverty line. Other hospitals may offer full charity care to patients at 200 percent of the federal poverty level, which means their income is twice the poverty line. Many hospitals use a sliding scale, which means the amount of information decreases as income increases.
A sliding scale works like this: a patient whose income is at 100 percent of the poverty level might receive 100 percent charity care, meaning their bill is completely covered. A patient whose income is at 150 percent of the poverty level might receive 50 percent charity care, meaning they pay half the bill and the hospital covers the other half. A patient whose income is at 200 percent of the poverty level might receive 25 percent charity care. Income limits vary significantly between hospitals, so what qualifies you for information at one hospital may not at another.
When calculating your income, hospitals typically look at your household income from the past month or past year. They may ask about income from employment, Social Security, disability payments, child support, or other sources. Some hospitals also consider family size, assets, and expenses when making decisions about charity care. Understanding how your hospital calculates income and applies their sliding scale can help you understand what level of information you might receive.
The Process for Requesting Charity Care information
Requesting charity care from your hospital involves several steps. The process usually begins by contacting your hospital's financial information office or billing department. You can do this in person, by phone, or sometimes by mail or online. When you contact them, let them know that you are having difficulty paying your bill and ask about the charity care program. Hospital staff can provide you with an process form or direct you to where you can get one.
The process process typically requires you to provide financial information about your household. You will likely need to share your income, family size, and sometimes information about your expenses and assets. The hospital may ask you to provide documents that prove your income, such as recent pay stubs, tax returns, Social Security statements, or unemployment benefit letters. Having these documents ready can speed up the process.
After you submit your process, the hospital's financial information team will review your information. This review process can take anywhere from a few days to several weeks, depending on the hospital. During this time, the hospital staff will determine whether you meet the income requirements for charity care and, if so, how much information you may receive. Some hospitals may contact you with questions or ask for additional information during this review.
Once the hospital makes a decision, they will notify you in writing or by phone. If you are approved for charity care, they will explain how much of your bill will be covered and what you still owe, if anything. If you are not approved, the hospital should explain why and may discuss other payment options or programs that might help you. You typically have the right to ask questions about the decision or request that the hospital review your case again if your circumstances change.
What Charity Care Covers and What It Does Not
Charity care policies cover different types of medical services depending on the hospital. Most nonprofit hospitals cover inpatient hospital services, which means care you receive when you stay overnight in the hospital. This includes room charges, nursing care, medications given during your stay, and procedures performed while you are hospitalized. Emergency room visits are usually covered by charity care programs as well.
However, charity care policies often do not cover all medical expenses. Outpatient services, which are services you receive without staying overnight, may or may not be covered. This includes office visits with doctors, tests done in a lab, imaging like X-rays or CT scans, and other procedures done outside the hospital. Some hospitals limit charity care to emergency services only, while others cover a broader range of services. It is important to ask your hospital specifically what services their charity care program covers.
Charity care also typically does not cover services provided by doctors who are not employed by the hospital. If a surgeon or specialist who works independently treats you at the hospital, their bill may not be covered by the hospital's charity care program. You would need to contact that doctor's office separately to discuss payment options. Additionally, charity care usually does not cover prescription medications you take at home after you leave the hospital, though some hospitals may have separate programs to help with prescription costs.
Some hospitals exclude certain types of care from their charity care programs. For example, cosmetic procedures, fertility treatments, or elective surgeries may not be covered. If you have questions about whether a specific service or bill is covered by charity care, contact your hospital's financial information office. They can tell you exactly what is and is not covered under their policy.
Other Financial information Options When Charity Care Is Not Enough
If charity care does not cover your entire bill or if you do not meet your hospital's income requirements for charity care, other options may be available. Many hospitals offer payment plans that allow you to pay your bill over time in smaller monthly payments. These payment plans sometimes charge interest, but some hospitals offer interest-free plans. Ask your hospital's billing department about payment plan options and the terms they offer.
Government programs may also help pay for medical bills. Medicaid is a joint federal and state program that provides health insurance to people with low incomes. If you do not currently have Medicaid, you may be able to explore. Medicare is a federal program for people age 65 and older and some younger people with disabilities. If you are not currently covered by either program, learning about how they work might help you understand what options may be available.
Some nonprofit organizations and charities offer help paying medical bills. These organizations work with patients who have specific diseases or conditions, or they may help any patient with medical debt. You can search online for organizations that help with medical bills in your area. Local community health centers, religious organizations, and social service agencies may also know about local resources that help with medical bills.
You can also negotiate your hospital bill directly. If you receive a large bill, you can contact the hospital's billing department and ask if they can reduce the amount you owe. Some hospitals will negotiate bills with patients even if they do not meet the requirements for charity care. It never hurts to ask about options. Additionally, some hospitals have financial counselors who can review your situation and suggest programs or payment options that might work for you.