How this is calculated
Your position is expressed as a percentage of the federal poverty guideline for your household size — the measure nearly every hospital financial assistance policy is built around. The guideline for a household of one, plus a fixed amount for each additional person, gives the threshold; your income divided by that threshold gives the percentage.
Nonprofit hospitals in the United States are required under section 501(r) of the Internal Revenue Code to maintain a written financial assistance policy, to publicise it, and to limit what they charge patients who qualify. Policies commonly provide full assistance at or below 200% of the guideline and partial, sliding-scale assistance between 200% and 400%. Many are more generous. The specific thresholds are set by each hospital, so the tool describes what is likely and points you at the policy itself.
The 240-day figure comes from the same rules: a hospital must accept applications for at least 240 days after the first post-discharge billing statement.
Worked example. A household of three with a gross income of $52,000. The guideline for three people is $15,960 + (2 × $5,680) = $27,320.
$52,000 ÷ $27,320 = 190% of the guideline — just under the 200% mark at which most nonprofit policies provide assistance in full. On a $9,400 bill that is the difference between owing everything and owing nothing, and it turns entirely on submitting an application.
What this does not account for
- Each hospital sets its own thresholds. The 200% and 400% marks are common, not universal. Read the actual policy — it must be published.
- Some states require more than the federal rules, with wider eligibility or stronger protections. State law is not modelled here.
- Assets and household composition are assessed by some hospitals alongside income.
- Insurance status. If a claim was denied, appealing the denial may be the better route and is not covered by this tool.
- For-profit hospitals are not bound by 501(r), though many run assistance programmes voluntarily. It is always worth asking.
Common questions
Should I really apply before trying to reduce the bill?
Yes. Assistance can eliminate the balance; a reduction never does. Applying does not waive anything and does not stop you discussing a reduced amount later if the application is unsuccessful.
What if I have already paid some of it?
Ask anyway. Where a patient is found eligible for a period that has already been billed, hospitals will often apply the policy retrospectively and refund the difference.
Does an unpaid medical bill damage my credit?
Less than it once did, but be careful here, because the protection is weaker than most articles online still claim.
A federal rule that would have removed medical debt from credit reports was vacated by a court in July 2025 and is not in force. What remains is a voluntary policy adopted by the three major credit bureaus: they exclude medical collections whose original balance was under $500, and they remove paid medical collections. Because it is voluntary rather than law, it could change.
Above that threshold, a medical collection can still be reported once it is around a year delinquent and unpaid. Around fifteen states have passed their own laws restricting medical debt on credit reports, so your state may protect you further — and a federal court has held that the Fair Credit Reporting Act preempts at least some of those state laws, so this area is actively unsettled. Check your own state's current position rather than relying on a general article, including this one.
The bill is already with a collection agency. Is it too late?
Often not. The 240-day application window runs from the first billing statement, and many hospitals will recall an account from collections if a patient is found eligible.
How do I know whether the hospital is nonprofit?
Most US hospitals are. Search the hospital's legal name together with "501(c)(3)", or look for the financial assistance policy on its website — publishing it is itself a requirement of the rules.
What counts under the No Surprises Act?
Broadly: emergency care, and out-of-network care delivered at a facility your insurer covers — an out-of-network anaesthetist or radiologist at an in-network hospital is the classic case. Where it applies you generally owe only your in-network cost sharing.