- I got a $1,000 medical bill that was more than I expected, but I knew the ACA may be able to help.
- The ACA requires nonprofit hospitals to offer financial assistance programs to patients in need.
- I qualified for the plan (earning a middle-class income) and got my full bill wiped out.
A number of years ago, my then-husband broke his hand in an unfortunate accident.
As his fingers started swelling up purple, we rushed to the hospital. We had health insurance thanks to the Affordable Care Act, but our copay for the ER was still absurd. We were going to have to pay at least $500 for this visit.
The doctors determined the damage wasn’t going to be healed by a cast, so they wrapped him up with some bandages and braces and sent him on his way.
When we got the bill, it turned out there were a total of $1,000 in costs that insurance wouldn’t cover. The $500 deductible plus an additional $500 in medical costs.
A little-known ACA policy helped me wipe out our medical debt
After my initial panic, I looked up the hospital’s financial assistance policy. I knew from my work in personal finance that if a hospital was a nonprofit, they had to offer financial help under the ACA — a benefit many people aren’t aware of.
We were insured. And at the time, we were pulling in pretty close to the average household income. I wasn’t sure if we’d qualify. The ACA does not have any specific guidelines around income and asset limits when it comes to these programs. The hospital is required to provide a program, and it should be advertising its program to its patients, but how the program actually functions is almost completely up to the institution itself, depending on state law. In Pennsylvania at the time, there weren’t any further rules for the hospital to follow.
When I looked up the income limits, I breathed a sigh of relief. For a household of our size, we could get 100% forgiveness. But we’d have to work for it. We had to gather up all of our W2s for the past several years. Our household expenses, like rent, factored into the equation and required paperwork as well. I gathered them all up, filled out a four-page form illustrating our entire financial picture, and sent it to the listed address.
About a month later, we received news that the debt had been 100% wiped out. I have since used this same program at an ER in California, specific doctor’s offices that were closely associated with a nonprofit hospital, and for a bout of strep that kept me in the ER overnight.
How to use the ACA’s financial assistance plan
You can use these programs, too. First, make sure the hospital you’re visiting is a nonprofit hospital. If they are, they are legally required to offer one of these programs and legally required to advertise it to you.
Some hospitals don’t do so well on this second part. If you don’t see the financial assistance plan advertised, you can ask for information at intake. Or, when you get your bill, there should be a phone number listed somewhere on it that will give you more information about the financial assistance policy.
If your hospital fails to even do that, call the billing department directly and explicitly ask about the financial assistance program. Try to do it within 30 days of your visit, as you don’t want to risk the bill getting caught up in collections.
Then, know that while there are no income limits set by the federal government, each hospital can write their own. That might discourage you, making you think that only low-income or uninsured people qualify for these programs. But in every case I’ve seen in my personal experience, that couldn’t be further from the truth.
Even as an insured family with a solidly middle-class income, we repeatedly qualified for 100% forgiveness across multiple programs in multiple states.
The ACA is a flawed compromise that doesn’t do enough to help the average American household deal with the exorbitant costs of our healthcare system. But it’s also the only reason millions of Americans can access insurance at all, and provides little-known protections to patients in select circumstances, as with financial assistance plans at nonprofit hospitals.