Do You Qualify for Charity Care? Understanding FPL Guidelines

Millions of Americans are eligible for charity care programs that can reduce or eliminate their medical bills—but many don't know these programs exist. Here's everything you need to know about qualifying for hospital financial assistance.

What is Charity Care?

Charity care (also called financial assistance or charity care) is free or discounted medical care that hospitals provide to patients who cannot afford to pay. Under federal law, all nonprofit hospitals (which make up about 60% of U.S. hospitals) must offer charity care programs to maintain their tax-exempt status.

Understanding the Federal Poverty Level (FPL)

Most charity care programs base eligibility on the Federal Poverty Level (FPL), a measure of income issued annually by the Department of Health and Human Services. For 2024, the FPL guidelines are:

Charity care rules vary by state. Explore our state-specific guides for California, New York, and Texas to learn about your state's specific protections.

Typical Charity Care Income Thresholds

While every hospital has different policies, here are common eligibility tiers:

100% Discount (Free Care)

Most hospitals provide completely free care to patients whose income is at or below 200% of FPL. Some hospitals extend this to 250% or even 300% of FPL.

Example: A family of 4 earning up to $62,400 (200% of FPL) would typically qualify for 100% free care.

Partial Discounts

Many hospitals offer sliding-scale discounts for families earning between 200% and 400% of FPL:

• 200-250% FPL: Often 75% discount
• 250-300% FPL: Often 50% discount
• 300-400% FPL: Often 25% discount

Example: A family of 4 earning $90,000 (288% of FPL) might receive a 50% discount on their bill.

What Income Counts?

When calculating your income for charity care purposes, hospitals typically look at:

• Gross household income (before taxes)
• Wages, salaries, and tips
• Self-employment income
• Social Security benefits
• Retirement/pension income
• Unemployment benefits
• Child support and alimony

Who is Included in Your Household?

Your household size typically includes:

• You and your spouse
• Children (biological, adopted, or stepchildren) living with you
• Other dependents you claim on your tax return

Beyond Income: Other Eligibility Factors

Many hospitals also consider:

• Assets: Some hospitals look at bank accounts and property, though primary homes are usually exempt
• Medical expenses: High medical debt may make you eligible even if your income is higher
• Extraordinary circumstances: Job loss, divorce, or catastrophic events may qualify you

How to Apply for Charity Care

Step 1: Request the Application

Contact the hospital's billing or financial assistance department and ask for a charity care application. By law, they must provide this to you. You can usually find the application on the hospital's website as well.

Step 2: Gather Documentation

You'll typically need to provide:

• Recent pay stubs (last 2-3 months)
• Tax returns (most recent year)
• Bank statements
• Proof of any government assistance (SNAP, Medicaid, etc.)
• Documentation of expenses (if applicable)

Step 3: Complete and Submit

Fill out the application completely and accurately. Submit it with all required documentation. Keep copies of everything you send.

Step 4: Follow Up

Hospitals typically respond within 30-60 days. If you don't hear back, follow up regularly. Don't ignore bills while waiting—send a letter explaining that you've applied for financial assistance.

Know Your Rights

Federal law gives you strong protections when it comes to hospital financial assistance. Read our detailed guide on what hospitals must tell you about financial assistance.

Under the Affordable Care Act, nonprofit hospitals must:

• Publicize their charity care policy on their website and provide paper copies upon request
• Provide a plain-language summary of the financial assistance policy
• Notify patients about financial assistance options before taking extraordinary collection actions
• Wait 120 days after sending the first bill before reporting you to credit agencies or suing you
• Not charge more than amounts generally billed (AGB) to insured patients (typically 80% or less of charges)

Presumptive Eligibility

Some hospitals automatically approve patients for charity care if they qualify for:

• Medicaid
• State Children's Health Insurance Program (CHIP)
• Supplemental Security Income (SSI)
• Food stamps/SNAP
• Certain other assistance programs

If you receive any of these benefits, mention it prominently in your application.

What If You're Denied?

If your application is denied:

1. Ask for a written explanation of why you were denied
2. Review the hospital's charity care policy to ensure it was applied correctly
3. Check if you made any errors in your application
4. Submit an appeal with additional documentation if needed
5. Contact a patient advocate or legal aid organization for help

Tips for Success

• Apply early: Don't wait until you're in collections
• Be thorough: Incomplete applications are often denied
• Explain hardships: Include a personal letter explaining your financial situation
• Get help: Hospital financial counselors can assist with applications
• Don't give up: If denied, appeal. Many denials are reversed on appeal

Use Health Bill Central: Our platform can automatically check if you qualify for charity care based on your income and household size, and generate a customized charity care application letter.

The Bottom Line

If you're struggling with medical bills, charity care could reduce or eliminate what you owe. Millions of eligible patients never apply simply because they don't know these programs exist. Don't let medical debt ruin your finances when help is available. Check your eligibility today and take advantage of your legal right to financial assistance.