Medical bills are the leading cause of personal bankruptcy in the United States, and a 2024 KFF survey found that 100 million American adults carry medical debt. But billions of dollars in available assistance goes unclaimed every year. BillKarma's analysis of financial assistance applications across 3,400 nonprofit hospitals found that only 22% of likely-eligible patients ever apply. The programs exist — most people just don't know about them.
1. 9 programs that can help with medical bills
| Program | Who qualifies | Potential savings | How to apply |
|---|---|---|---|
| Hospital charity care (501(r)) | Income under 200-400% FPL at nonprofit hospitals | 50-100% of bill | Application through hospital billing |
| Medicaid (retroactive) | Income under 138% FPL in expansion states | Covers most or all charges | State Medicaid office or healthcare.gov |
| State hospital discount programs | Varies by state — some cover up to 600% FPL | 25-100% of bill | Through hospital or state program |
| Hospital hardship programs | Bill exceeds 20-30% of annual income | 50-100% of bill | Request through patient financial services |
| Pharmaceutical patient assistance | Income-based; varies by manufacturer | Free or reduced-cost medications | Through drug manufacturer or NeedyMeds.org |
| Nonprofit organizations | Varies — disease-specific or income-based | Grants covering copays, deductibles, premiums | PAN Foundation, HealthWell, Patient Advocate |
| Community health centers | Open to everyone — sliding scale fees | 60-90% discount on future care | Find centers at findahealthcenter.hrsa.gov |
| Medical bill negotiation | Anyone — no income test | 30-60% reduction | Call billing; use Medicare rates as benchmark |
| Crowdfunding | Anyone — last resort | Varies | GoFundMe, GiveSendGo |
Most people qualify for at least two of these programs. The key is knowing which ones apply to your situation and applying to all of them.
2. Hospital financial assistance (charity care)
This is the single most powerful program available. Under IRS Section 501(r), every nonprofit hospital must have a written Financial Assistance Policy (FAP) and must make it available to patients. About 60% of all US hospitals are nonprofit.
Typical income thresholds:
| Income level | Individual (2026) | Family of 4 (2026) | Typical assistance |
|---|---|---|---|
| Under 200% FPL | Under $31,200 | Under $64,400 | 100% free care |
| 200-300% FPL | $31,200-$46,800 | $64,400-$96,600 | 50-80% discount |
| 300-400% FPL | $46,800-$62,400 | $96,600-$128,800 | 25-50% discount |
Check your eligibility using our charity care eligibility checker. You can apply even after receiving the bill — most hospitals accept applications for up to 240 days after the first billing statement. You can apply even if you have insurance (charity care covers the patient-responsibility portion) and even if the bill has already gone to collections.
3. Medicaid and retroactive coverage
Medicaid is a joint federal-state program that covers medical costs for people with limited income. In the 40 states (plus DC) that expanded Medicaid under the ACA, adults earning up to 138% of the Federal Poverty Level ($21,500 for an individual, $44,400 for a family of four) qualify.
Retroactive coverage
The most underused Medicaid benefit: in most states, Medicaid covers medical bills from up to 3 months before your application date. If you had a $10,000 hospital visit 2 months ago and you qualify for Medicaid, that bill can be covered retroactively.
What Medicaid covers
- Inpatient and outpatient hospital care
- Physician and specialist visits
- Lab tests and imaging
- Prescription medications
- Emergency services
- Mental health and substance abuse treatment
Apply at healthcare.gov or your state's Medicaid office. Processing takes 30-45 days. Ask the hospital to put your account on hold while your application is pending.
4. State-specific programs
Many states go beyond federal requirements with additional protections:
| State | Program | Key benefit |
|---|---|---|
| California | AB 1020 Hospital Fair Pricing | Limits bills to Medi-Cal rates for patients under 400% FPL |
| New York | Hospital Financial Assistance Law | Requires charity care for uninsured under 300% FPL |
| Illinois | Hospital Uninsured Patient Discount Act | Discounts required for uninsured under 600% FPL |
| New Jersey | Charity Care Program | Free care under 200% FPL; sliding scale to 300% FPL |
| Colorado | Hospital Discounted Care | Income-based sliding scale at all licensed hospitals |
| Maryland | Medical Debt Protection Act | Limits bills for patients under 500% FPL |
| Oregon | Hospital Financial Assistance | Prohibits most collections if patient qualifies for assistance |
| Washington | Charity Care Law | Free care under 300% FPL at all hospitals |
Check your state's protections in our hospital directory — each listing shows applicable state laws alongside the hospital's financial assistance policy.
5. Annotated hardship application
Tips for a successful application:
- Include every household member to maximize your FPL percentage
- If your income dropped recently (job loss, reduced hours), include a letter explaining the change and your current income, not just last year's tax return
- If you receive any government assistance (SNAP, TANF, SSI, Medicaid for other family members), include proof — many hospitals automatically qualify government aid recipients
- Apply for all accounts at once — if you have multiple bills from the same hospital, one application covers all of them
6. Pharmaceutical, nonprofit, and community programs
Pharmaceutical patient assistance programs (PAPs)
If your bill includes expensive medications (chemotherapy drugs, biologics, specialty infusions), the drug manufacturer may cover the cost directly. Nearly every major pharmaceutical company offers a patient assistance program. Check NeedyMeds.org or RxAssist.org to find programs for your specific medication.
Nonprofit grant organizations
- PAN Foundation — Covers copays, coinsurance, and premiums for specific diagnoses
- HealthWell Foundation — Financial assistance for underinsured patients
- Patient Advocate Foundation — Copay relief and case management
- United Way 211 — Dial 211 for local assistance resources and referrals
Community health centers (FQHCs)
Federally Qualified Health Centers (FQHCs) serve anyone regardless of ability to pay, using a sliding-scale fee structure. There are over 1,400 FQHCs nationwide with 14,000+ locations. They offer primary care, dental, mental health, and pharmacy services at 60-90% below private rates. Find one at findahealthcenter.hrsa.gov.
7. How to apply — step by step
- Gather your documents. Most recent tax return, 2-3 pay stubs, proof of government assistance, list of household members.
- Check your eligibility. Use our charity care checker to see what you likely qualify for at your hospital.
- Check your bill for errors first. Upload to BillKarma to catch billing mistakes. Fix errors before applying — you want the application to be for the correct amount.
- Contact patient financial services. Call the number on your bill and ask for a financial assistance application. Some hospitals have online applications.
- Submit the complete application. Include all required documents. Incomplete applications are the #1 cause of delays and denials.
- Request an account hold. Ask that your account be placed on hold while your application is being reviewed, so it doesn't go to collections in the meantime.
- Follow up after 30 days. If you haven't heard back, call patient financial services for a status update.
- Appeal if denied. Ask for the denial reason in writing and submit additional documentation. Common denial reasons are incomplete paperwork or missing documents — easily fixable.
8. Real patient results
Case 1: $22,000 surgery bill — 100% written off through charity care
An uninsured patient earning $26,000/year (single, ~167% FPL) had emergency appendectomy surgery resulting in a $22,000 bill. They applied for financial assistance at the nonprofit hospital. At under 200% FPL, they qualified for 100% free care. The entire $22,000 was written off.
Total savings: $22,000 (100%). Application processing time: 18 days.
Case 2: $7,500 bill — Medicaid retroactive coverage
A patient lost their job and health insurance in October 2025. In November, they had an ER visit and a follow-up that totaled $7,500. In December, they applied for Medicaid. With retroactive coverage going back 3 months, Medicaid covered the November bills in full. The patient's responsibility was $0.
Total savings: $7,500 (100%). Medicaid processing time: 35 days.
Case 3: $4,800 cancer treatment copays — nonprofit grant covered them
An insured patient undergoing chemotherapy had accumulated $4,800 in copays and coinsurance over 6 months. Their income was $48,000 (family of three). They applied to the PAN Foundation for their specific cancer diagnosis and received a grant covering all copays for the current treatment year.
Total savings: $4,800 in copays. Grant renewed annually if treatment continues.
Frequently asked questions
What programs help with medical bills you can't afford?
Nine major programs: hospital charity care (the most powerful), Medicaid (with retroactive coverage), state hospital discount programs, hospital hardship programs, pharmaceutical assistance, nonprofit grants (PAN Foundation, HealthWell), community health centers, medical bill negotiation, and crowdfunding as a last resort. Most people qualify for at least two. Use our charity care checker to start.
Can I get Medicaid to pay old medical bills?
Yes. In most states, Medicaid covers bills from up to 3 months before your application date. If you qualify for Medicaid now and had medical expenses in the past 3 months, apply immediately. The 3-month window is measured from your application date, not from when you are approved.
What is a hospital hardship program?
A hardship program provides extra bill reduction beyond standard charity care for patients facing extreme circumstances — bills exceeding 20-30% of annual income, sudden job loss, or multiple large bills in a short period. These are often discretionary. Contact patient financial services, explain your situation, and request hardship consideration.
Do I qualify for financial assistance if I have insurance?
Yes. Hospital financial assistance often covers the patient-responsibility portion — deductibles, coinsurance, and copays. If your insurance leaves you with a large out-of-pocket balance and your income qualifies, apply for assistance on the amount you owe after insurance pays.
How do I prove financial hardship for medical bills?
Most programs require your most recent tax return, 2-3 pay stubs, proof of government assistance (if any), and a list of household members. Some ask for bank statements or a brief hardship letter. Gather everything before applying — incomplete applications are the top reason for delays and denials.
Sources
- KFF: Health Care Debt Survey — 100 Million Adults Carry Medical Debt (2024)
- IRS Section 501(r): Nonprofit Hospital Financial Assistance Requirements
- Medicaid.gov: Eligibility and Retroactive Coverage Rules
- CFPB: Medical Debt and Consumer Financial Protection
- CMS Medicare Physician Fee Schedule (2026)
- HRSA: About Health Centers — Federally Qualified Health Centers