Do I have to pay a hospital bill I cannot afford?

Not necessarily — a nonprofit hospital is required by federal tax law to have a written financial assistance policy, and if your income falls within it the hospital must discount or erase the bill, so the first step is always to ask for the financial assistance application rather than to pay or ignore the bill.

What this means

Roughly half of American hospitals are nonprofit and must follow section 501(r) of the Internal Revenue Code to keep their tax exemption.
The policy is a written document with an income table. If you fall in the table, the discount is not discretionary.
Many hospitals help people earning several times the federal poverty guideline, so do not rule yourself out.
Asking for financial assistance does not affect the care you receive, and it does not go on your credit report.

What to do first

Call the hospital billing office and say: I would like to apply for financial assistance under your 501(r) policy. Ask them to pause collections while you apply.
Ask for an itemized bill and check it for services you did not receive.
Use Dollar For, a national nonprofit, to check your hospital's policy and file the application with you at no charge.
If the bill is from a Medicare-covered service and you have QMB, tell the provider, because they are not allowed to bill you.

Patient Advocate Foundation TotalAssist

Grants that pay the copays, deductibles, and travel costs that come with a serious diagnosis.

Hospital Charity Care (Dollar For)

Nonprofit hospitals are required by law to wipe out bills for people who cannot pay. Dollar For helps you apply, free.

What you'll need

Proof of household income
Tax return if you have one
Photo identification
The hospital bill or account number
Proof of diagnosis
Insurance card
Prescription or treatment records
Proof of income

Deadlines and timing

Most policies allow applications for at least 240 days after the first bill, and many hospitals will still consider one after that, including bills already with a collection agency.
Do not put a hospital bill on a credit card or a medical credit card before you apply, because a paid bill is much harder to get forgiven.
Keep a written record of who you spoke to and when.

Where to go

Patient Advocate Foundation TotalAssist: https://www.patientadvocate.org/connect-with-services/
Hospital Charity Care (Dollar For): https://dollarfor.org/

Reviewed by Jason Burns, Editorial Steward · Last verified August 25, 2026

Sources

Financial assistance policy requirements under section 501(r)(4) · Internal Revenue Service
Dollar For · Dollar For

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