Can a hospital reduce or write off my bill if I cannot afford it?

About half of all US hospitals, and nearly 6 in 10 community hospitals, are private nonprofits. To keep their federal income tax exemption, those that are 501(c)(3) organisations must maintain a written financial assistance policy, publicise it, and apply it consistently.

The policy only helps if you ask for it.

What the law requires

Under Internal Revenue Code section 501(r), a nonprofit hospital must:

• Have a written financial assistance policy setting out who is eligible and how to apply
• Publicise it widely — on the website, in the facility, and in billing communications
• Limit what it charges eligible patients to no more than the amounts generally billed to insured patients, rather than the list price
• Make reasonable efforts to determine eligibility before taking extraordinary collection action — suing, reporting to credit agencies, garnishing wages

That last point matters. A hospital that sues you, reports you to a credit agency or sells your debt without first making reasonable efforts to check your eligibility may not have met its obligation — and a collection agency acting for the hospital counts as the hospital.

Who qualifies

Each hospital sets its own rules, which is why asking is the only reliable way to find out. Policies usually measure income against the federal poverty level, with free care below one threshold and discounts above it, and some also help when a bill is large relative to income. The policy has to say who is eligible and how to apply.

It is worth asking either way

Federal law does not require for-profit hospitals to have a policy, but some states do: Washington, for example, requires every hospital to provide charity care. Some for-profit hospitals run assistance programmes anyway, so the question costs nothing.

What to ask

Please send me the hospital's financial assistance application and the income limits, and please hold the account while my application is reviewed.

The hold is the important half. At a nonprofit hospital, a complete application filed in time means the hospital has to suspend extraordinary collection actions while it decides.

Practical notes

• Apply even if you think you earn too much. Policies differ, and a declined application costs you an afternoon.
• Apply even if the bill is already in collections. At a nonprofit hospital, you can apply until at least 240 days after the first bill sent after discharge, and a complete application in that window means extraordinary collection actions already taken have to be reversed.
• Ask about the amounts-generally-billed limit. If you qualify under the policy at any level of discount, a nonprofit hospital cannot charge you more than it generally bills insured patients for emergency or medically necessary care, and never the full list price. The limit does not cover a patient who does not qualify.
• Get the decision in writing.

Finding out whether a hospital is a nonprofit

The IRS publishes the list of every exempt organisation, including which are classified as hospitals. The name on your bill may be a parent system or a physician group that files separately, so an absence from the list is not proof of anything — asking remains the fastest route.

Sources

1. Requirements for 501(c)(3) hospitals under the Affordable Care Act – Section 501(r) (IRS) checked 3 October 2026
2. 26 CFR 1.501(r)-4, financial assistance policy (eCFR) checked 3 October 2026
3. 26 CFR 1.501(r)-5, limitation on charges (eCFR) checked 3 October 2026
4. 26 CFR 1.501(r)-6, billing and collection (eCFR) checked 3 October 2026
5. Fast Facts on U.S. Hospitals, 2026 (American Hospital Association) checked 3 October 2026
6. RCW 70.170.060, charity care (Washington State Legislature) checked 3 October 2026

Related

• A bill with no itemized detail A summary statement cannot be checked against anything. Asking for the itemized version is the first move, and providers generally have to give you one.
• Your bill came in far above the written estimate If you are uninsured or self-pay and a provider bills $400 or more above its Good Faith Estimate, there is a federal dispute process.
• A bill arrived before the Explanation of Benefits Why a bill without an EOB cannot be checked, and what to do while you wait for one.

This is general information, not legal, medical or financial advice, and not a statement about your particular bill. A difference between two documents often has an ordinary explanation, and the billing office is the one who can give it.

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