Federal, exists in every state
Help reducing hospital bills (financial assistance)
A hospital’s financial assistance policy can reduce or erase eligible bills, including some bills left by insurance.
What it is
A hospital’s financial assistance policy can reduce or erase eligible bills, including some bills left by insurance.
Insurance can leave bills that are hard to pay during treatment. Hospital financial assistance uses the hospital’s written policy to decide a discount. The financial counselor can explain which bills count and whether a drop in income changes the answer.
The hospital’s policy
- The hospital decides household, income and covered-bill rules. Its financial counselor can check the account and current policy.
- A legal-aid adviser can check any additional Alaska hospital-assistance requirements. The hospital’s own policy and applicable federal nonprofit-hospital protections are separate sources of help.
What you get
- A discount or write-off for bills covered by the hospital’s policy.
- A possible refund when an approved application shows you paid too much.
Federal floor at tax-exempt hospitals
- For a tax-exempt hospital, the federal application period lasts at least 240 days after the first post-discharge bill. Extraordinary collection actions generally cannot start for at least 120 days after that bill.
- A timely approved application can require a refund of payments above the assistance amount when the difference is $5 or more. The federal rules depend on the hospital’s tax status.
If you decide to apply
- Ask the hospital financial counselor for the assistance application, income table and list of covered clinicians.
- Bring current income records, bills and insurance statements, and explain any change in earnings.
- Ask which collection activity can pause during review and request the answer in writing.
The decision
- Ask for a written decision naming the covered accounts, discount and dates, and how to request reconsideration.
Good to know
A separately billed doctor may fall outside the hospital’s policy. A payment plan changes when you pay, not how much you owe.
Care outside Alaska
- A hospital outside Alaska uses its own policy and poverty guideline. OHSU uses the contiguous-48 guideline; the counselor at another hospital confirms its basis and which billing entities participate.
- For a child with Medicaid, billing first checks whether any remaining charge is legally yours. Earlier or otherwise eligible accounts may still qualify for hospital assistance. A Medicaid refusal alone does not make a protected bill collectible.
Official sources
“Could you help us understand the hospital’s assistance rules and apply if it could reduce the bills insurance leaves?”
Why I’m asking: I want to know the correct balance after insurance and assistance before agreeing to payments.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask for the application, send proof of income, and do not pay or put a bill on a card while it is open.
Your social worker
The social worker connects you with the financial counselor. The counselor checks Medicaid and explains which providers the assistance covers.
The care team
Records and letters when the application asks for them.
- Who decides
- The hospital's financial-assistance office under its written policy
- Ask the billing office
- “I would like to apply under the hospital's financial assistance policy. What is the income ceiling, which providers are covered by it, and can you hold collections while it is reviewed?”
How to apply
First step: Call the hospital's financial counselor, say “financial assistance policy”, and ask for the application, the income table and the list of covered providers.
- Call the financial counselor and say “financial assistance policy”.
- Ask which providers are covered by it.
- Ask for a collection hold while it is reviewed.
Where it starts: Apply to the hospital; the financial counselor checks Medicaid at the same time
What to gather
- Proof of household income (pay stubs or last tax return)
- The insurance card and recent explanation-of-benefits statements
- The bills or account numbers
How long: A decision within weeks of a complete application. A nonprofit hospital may not sue, report the debt or garnish wages for at least 120 days after the first bill after discharge, and holds collections while it decides.
What a yes looks like
A letter naming the discount percent and the period it covers (often 12 months). If you paid before the decision, a refund of the difference follows. Re-apply when it lapses.
What a no looks like, and the next move
“Over the income limit”: ask about the high-medical-expense branch, a prompt-pay discount and an interest-free plan. Then go to bill negotiation.
Watch out
- Apply before paying if you can. If you already paid, apply anyway: within 240 days of the first bill after discharge, an approved application means the hospital refunds what you paid above the assistance amount ($5 or more).
- Doctors who bill separately (anesthesia, radiology, some oncologists) may not be under the hospital's policy. Ask which providers are covered.
- Insured families count too: some hospitals have a high-medical-expense branch that discounts at any income when bills pass a share of income.
Each hospital’s own policy
The federal rule sets the floor; each hospital’s policy sets the actual numbers. “Unknown” means the policy could not be read yet: call the number and ask.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 8, 2026.
What it is worth
The hospital's own bill reduced or written off entirely under its published schedule. Collections held while the application is open.
- Discount or charity write-off — Discount or charity write-off
- $240 (at least; a policy can allow longer) — Days to apply after the first bill after discharge
- $120 (at least) — Days after that first bill before the hospital can sue, report the debt or garnish wages
- $5 (refunded when $5 or more) — Refund of what you paid above the assistance amount
Legal protection: A written policy and application, published · Limits on collection actions while the application is reviewed · At a nonprofit hospital, an application filed within 240 days of the first bill after discharge must be taken (federal rule) · No lawsuit, credit reporting, wage garnishment or sale of the debt for at least 120 days after that first bill · If you already paid and the application is approved, the hospital refunds what you paid above the assistance amount ($5 or more)
What it costs the family: Free application.
The eligibility facts, as published
- Tax exempt hospital for federal floor
- yes
- Policy specific
- yes
- Insured patients
- often eligible; some policies add a high-medical-expense branch at any income; a children's hospital policy often reaches families at 400% of the poverty line and above
- Federal 501r floor
- nonprofit (tax-exempt) hospitals: application period runs to at least the 240th day after the first post-discharge bill; no extraordinary collection actions for at least 120 days after that bill; refund of amounts paid above the assistance amount when $5 or more
Decisions this site cannot make: Hospital policy eligibility
Expect friction on: Separately billing physicians · Documentation · Application deadlines
The trap: Paying first and then not applying. If you already paid and the application is approved in time, the hospital must refund what you paid above the assistance amount ($5 or more). Doctors who bill separately may not be under the hospital's policy.
What changes by state: Some states set minimum hospital discounts, including California. Your hospital sets its own assistance limits and provides a financial counselor.
Where I read this
- Financial Assistance Policies for Tax-Exempt Hospitals — Internal Revenue Service, read August 27, 2026
- 26 CFR 1.501(r)-1: Definitions (financial assistance application period) — GovInfo (CFR 2025), read September 8, 2026
- 26 CFR 1.501(r)-6 and -7: Billing and collections; effective dates — GovInfo (CFR 2025), read September 8, 2026
- IRS: Billing and collections — section 501(r)(6) — Internal Revenue Service, read September 8, 2026