As a result of legislation proposed by the Attorney General’s Office and adopted by the Legislature, 4 million Washingtonians now qualify for free or discounted care at hospitals across Washington state.
Approximately half of all Washingtonians are eligible for free or reduced-cost care at Washington state hospitals. These protections apply to out-of-pocket hospital costs, including co-pays and deductibles, regardless of insurance status. Washington law now provides the strongest protections in the country for out-of-pocket hospital costs.
The new law significantly increases eligibility for out-of-pocket hospital costs, such as co-pays and deductibles, as well as expanding eligibility for discounts. Prior to the new law, a single parent working two minimum wage jobs at 50 hours per week was not eligible for financial assistance at Washington hospitals. The new law changes that.
The law ensures all Washingtonians within 300 percent of the federal poverty level are eligible for financial assistance on out-of-pocket hospital bills. Families making up to 400 percent of the federal poverty level could be eligible for financial assistance depending on the hospital. The new law establishes two tiers of financial assistance — one for large hospitals and large health care systems (Tier 1) and another for smaller, independent hospitals (Tier 2).
Check the chart below to see if you or anyone in your family qualifies. The chart shows the income levels that qualify for discounts at Tier 1 and Tier 2 hospitals (click here for an unofficial list of which hospitals fall into which tier):
Calculate your income's percentage of the federal poverty level:
Chart and calculator are provided for estimation purposes only. Consult with your hospital directly to determine your specific eligibility. If you think your hospital is not following the law, file a complaint with the Attorney General at https://www.atg.wa.gov/file-complaint
What is “charity care”?
Washington’s charity care law requires that hospitals make financial assistance available for low-income patients to help with their out-of-pocket medical costs. To be clear, we’re talking about people with insurance, not just uninsured folks. Many people face significant out-of-pocket costs even with insurance, and our charity care law helps those individuals.
Is there a minimum age requirement?
No. There is no minimum or maximum age requirement for eligibility. All Washingtonians are eligible.
Do you have to be on Medicare or Medicaid to use charity care?
No, charity care applies to all Washingtonians, whether they have public medical insurance, private medical insurance or are uninsured. Charity care covers your out-of-pocket costs, regardless of insurance status, based on your income level alone.
Do I have to be a citizen of the United States to apply for charity care?
No, all patients can apply for charity care regardless of their immigration status.
Does receiving charity care impact my eligibility for Social Security, Medicare or Medicaid?
It does not. Charity care applies to the part of your hospital bill that you pay — like deductbles and copays. Medicaid and Medicare will still cover their share, and then charity care will apply to the what remains for the patient to pay out-of-pocket.
Doesn’t Medicaid and/or Medicare pay for everything?
Not necessarily. There can be out-of-pocket costs associated with any hospital care depending on what is covered. That goes for private insurance, as well.
Isn’t this kind of financial assistance only for those who are very low income? I doubt I qualify for “Charity.”
You’d be surprised. Hospital bills are expensive for everyone. That’s why this new legislation expanded eligibility. For instance, a family of four with a household income up to about $83,000 is eligible for at least a discount at every hospital in the state. At the largest hospitals, they’re eligible for no out-of-pocket costs. At the state’s largest hospitals, families of four making up to $111,000 per year are eligible for at least a discount on the their out-of-pocket expenses.
Does charity care only apply to hospital care? What about clinic visits?
Charity care applies to medical care received at a hospital. However, sometimes hospitals that are associated with clinics will extend their charity care policy to those clinics. The best thing to do is always ask.
Does it cover ER visits, or x-rays or outpatient procedures that are done at hospitals?
Charity care applies to medical care received at a hospital. That includes emergency room care at a hospital. It also includes any other scan, test or procedure done at a hospital. Charity care may not cover bills from physicians or other providers not employed by the hospitals.
Does charity care only apply to future bills, or does it apply to past bills as well?
Charity care applies to both future care and past bills, as long as they have not been subject to a court judgment. It does not matter how old the bills are, or whether they have been sent to collections. If you are eligible, charity care can apply to your hospital bill.
What is the difference between “Tier 1” and “Tier 2”?
Large, urban hospitals that represent 80 percent of hospital beds are in their own tier with more robust discounts. We’re calling these larger hospitals Tier 1, and approximately 3 million Washingtonians will have access to free hospital care at Tier 1 hospitals, and another 1 million will have access to discounted care. The smaller independent hospitals and rural hospitals — which represent only about 20 percent of the beds around the state — are in Tier 2, and offer slightly smaller discounts.
When I had hospital care, I received two different bills — one from the hospital, and one from the physician. Are both bills eligible for financial assistance under the charity care law?
Only hospitals are required to provide charity care. The statute does not require physician bills to be eligible. However, many hospitals do require that physicians who operate in their hospitals honor their charity care policies. Check with your hospital to see if they do.
What if I own a home, or have retirement accounts. Can those type of assets disqualify me?
Most importantly, hospitals cannot consider your ownership of your primary residence, or its value, when assessing charity care eligibility, so personal home ownership would have no impact on charity care. Hospitals can consider some assets in assessing eligibility, but the thresholds are high and most consumers who are income-qualified for charity care will not be excluded based on their assets.
Does charity care cover care for conditions like Alzheimer's?
Charity care applies to medical care received at a hospital. Eligibility is not determined by specific medical conditions. However, sometimes hospitals that are associated with clinics will extend their charity care policy to those clinics. The best thing to do is always ask.
Will these increased discounts cause financial difficulties for hospitals?
Oregon passed a similar charity care expansion in 2019. Our legal team spoke to the Oregon Health Authority. They reported that they have not seen any evidence that their charity care requirements are causing hospitals financial difficulties. We should also be clear that we are talking about out-of-pocket medical costs, not a patient’s entire medical bill, in most cases. Hospitals will still receive payment from the patient’s health insurance or Medicaid.
How can a patient find out if they are eligible for financial assistance under Washington’s charity care law?
The calculator above can give you an idea if you may qualify, but the simple answer is just ask your hospital. But patients shouldn’t have to. Under state law, hospitals are required to provide notice of the availability of charity care to patients both verbally and in writing, and screen patients for charity care eligibility before attempting to collect payment from them for their out-of-pocket costs.
What if I have adult children, or other adult family members living with me under the same household? How is our eligibility determined?
The charity care regulations define family as “a group of two or more persons related by birth, marriage, or adoption who live together.” This means the incomes of adult family members living together can be considered in a charity care application.Always be sure to explain your individual situation to the hospital in your charity care application because hospitals may make exceptions based on individual circumstances.
What happens if hospitals don’t follow the state’s charity care law?
We want to hear from people if they’re having any difficulties. We have a team of attorneys who’ve been watching this issue, and I have filed several lawsuits against hospitals for failing to ensure that eligible low-income Washingtonians receive the discounts to which they are legally entitled. We’re ready to take action if hospitals aren’t upholding their obligations. If you think your hospital is not following the law, file a complaint with us at https://www.atg.wa.gov/file-complaint
How long has Washington required hospitals to provide financial assistance?
Washington’s original charity care legislation passed in 1989, so this assistance has been available to Washington patients for more than three decades.
Medical debt is a serious issue for many Americans, isn’t it?
Absolutely. Nationwide, about two-thirds of individuals who file for bankruptcy cite medical issues as a key contributor, and more than half of collection items on credit reports are for medical debts. Access to care is also an equity issue. Communities of color are disproportionately underinsured, and especially vulnerable to catastrophic and unexpected medical expenses.