Most people open a hospital bill, wince and start figuring out how to pay it. Some even put it on a credit card.
Before you do that, here’s something hospitals don’t go out of their way to advertise: You may qualify for free or discounted care, and the hospital may already have the information it needs to know it.
Most U.S. community hospitals — 58% — are nonprofits, according to KFF, the health policy research group. In exchange for their tax exemption, federal law requires them to have a written financial assistance policy for patients who qualify.
That tax break is worth a fortune. KFF estimated that the value of nonprofit hospitals’ tax exemption was about $28 billion in 2020, well above the roughly $16 billion they spent on charity care that year.
And many of these hospitals say they can now tell whether you qualify without your ever filling out a form.
As of 2022, nearly 90% of tax-exempt hospitals reported checking patients’ eligibility and cutting bills without being asked, up from about 70% in the first year the federal rules applied, according to KFF Health News, citing an analysis by RTI International for the health policy show Tradeoffs.
Yet patients still get billed. In a single year, hospitals billed patients at least $2 billion they likely didn’t owe, according to one analysis cited by KFF Health News. And only six states require hospitals to use this kind of automatic screening for certain patients.
So before you pay a dime, ask these five questions.
1. Is this hospital a nonprofit?
This matters because the federal rules for financial assistance apply to tax-exempt hospitals.
Under federal tax law, every nonprofit hospital must have a written financial assistance policy that spells out who qualifies for free or discounted care and how to apply, according to the IRS.
The hospital also has to publicize it, including posting the policy, the application and a plain-language summary on its website.
So start there. Search the hospital’s website for “financial assistance” or “charity care,” or call the billing office and ask for a copy of the policy.
2. Do I qualify under your policy?
Don’t assume the answer is no. Income limits vary widely, and they can be higher than you think.
In Georgia, for example, hospitals must provide free care to people with incomes just above the federal poverty line, KFF Health News reported. In Oregon, North Carolina and Maryland, patients can earn about double that and still get free care.
For 2026, the federal poverty guideline is $15,960 for a single person and $21,640 for a couple in the 48 contiguous states, according to the Department of Health and Human Services. Double that and you get $31,920 for a single person and $43,280 for a couple.
Some states go further. In Washington, for example, every hospital must provide medically necessary care free to patients earning up to twice the poverty guideline, and the state’s larger hospital systems must give partial discounts up to four times the guideline, according to the state’s Department of Health.
Have insurance? Don’t skip this step. Even insured, middle-income patients can sometimes get a break, particularly when the bill would swallow a large chunk of their earnings, KFF Health News reported.
3. Did you screen me automatically?
IRS rules allow a nonprofit hospital to presumptively decide that a patient qualifies for assistance, based on information it already has instead of an application from the patient.
That’s what most of these hospitals now say they do. But the rule allows it; it doesn’t require it. Only California, Delaware, Illinois, Maryland, North Carolina and Oregon make hospitals automatically screen certain patients and waive the application, according to KFF Health News.
Where it’s used, it works. In Oregon, roughly 80% of patients who got help with their bills in 2025 skipped the application entirely, according to figures the first 26 hospitals to report have made public, KFF Health News reported.
So ask the billing office directly: Did you check whether I qualify for financial assistance? If not, will you?
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4. Can I still apply if I’ve already paid — or I’m in collections?
Often, yes. The IRS gives patients an application period of 240 days after the hospital’s first bill following discharge, under its billing and collections rules.
The same rules protect you while you wait.
A nonprofit hospital generally can’t take what the IRS calls “extraordinary collection actions” — such as reporting you to the credit bureaus, suing you, garnishing your wages or placing a lien on your property — for at least 120 days after that first bill.
If you submit a complete application during the 240-day window, the hospital has to suspend those collection efforts while it decides. And if you qualify, it must refund anything you paid beyond what you owe under its policy and take reasonable steps to reverse collection actions already taken against you.
Qualifying also caps your price. For emergency and other medically necessary care, a nonprofit hospital can’t charge you more than what it generally bills people with insurance, the IRS says.
5. What does my state require?
Federal rules set the floor. Some states, like the six that require automatic screening and states such as Washington with their own charity care rules, go further.
Your state attorney general’s office or health department is a good place to ask what protections apply where you live.
Here’s the bottom line. Financial assistance isn’t a favor. For nonprofit hospitals, it’s part of the deal they get in exchange for their tax break.
But hospitals don’t always make it easy, and as far back as 2022, the Consumer Financial Protection Bureau warned that not all patients who are eligible for financial assistance actually get it.
So read every bill carefully. If it’s confusing, that’s not your imagination — here are five reasons your medical bill is deliberately confusing, and how to read it anyway. Then ask these five questions before you pay a dime.
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