- I got a $1,000 medical bill that was more than I expected, but I knew the ACA could help.
- The ACA requires nonprofit hospitals to offer financial assistance programs to patients in need.
- I qualified for the plan (earned a middle class income) and had my bill paid in full.
Several years ago, my then-husband broke his hand in an unfortunate accident.
When her fingers began to swell purple, we rushed to the hospital. We had health insurance thanks to the Affordable Care Act, but our emergency room copay was still ridiculous. We were going to have to pay at least $500 for this visit.
Doctors determined the damage wasn’t going to heal with a cast, so they wrapped him up in some bandages and braces and sent him on his way.
When we received the bill, it turned out that there was a total of $1,000 in costs that insurance would not cover. The $500 deductible plus an additional $500 in medical costs.
A Little Known ACA Policy Helped Me Pay Off 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, had to offer financial aid under the ACA – a benefit that many people are not aware of.
We were insured. And at that time, we were pretty close to the median household income. I wasn’t sure if we would qualify. The ACA does not have specific guidelines on income and asset limits when it comes to these programs. The hospital is required to provide a schedule, and should advertise their program to their patients, but the actual operation of the program is almost entirely up to the institution itself, depending on state law. In Pennsylvania at the time, there were no more rules to follow in the hospital.
When I looked up the income limits, I breathed a sigh of relief. For a household our size, we could get 100% forgiveness. But we would have to work for it. We had to round up all of our W2’s from the last few years. Our household expenses, like rent, were 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 mailed it to the address indicated.
About a month later, we received news that the debt had been 100% written off. I have since used this same program in an ER in California, specific medical offices that were closely associated with a non-profit hospital, and for a strep attack that kept me in the ER overnight.
How to use the ACA financial assistance plan
You can also use these programs. First, make sure the hospital you are visiting is a non-profit hospital. If they are, they are legally required to offer one of these programs and legally required to advertise it to you.
Some hospitals do not do so well in this second part. If you don’t see the financial assistance plan advertised, you can request information during intake. Or, when you get your bill, there should be a phone number somewhere that gives you more information about the financial assistance policy.
If your hospital doesn’t even do that, call the billing department directly and explicitly ask about the financial assistance program. Try to do this within 30 days of your visit, as you don’t want to risk the bill getting caught up in collections.
Next, know that while the federal government doesn’t set income limits, each hospital can write its own. That could put you off, making you think that only low-income or uninsured people qualify for these programs. But in all the cases I’ve seen in my personal experience, that couldn’t be further from the truth.
Even as an insured family with a solid middle-class income, we have repeatedly qualified for 100% forgiveness in 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 skyrocketing costs of our health care system. But it’s also the only reason millions of Americans can afford insurance, and it provides little-known protections for patients in certain circumstances, such as financial assistance plans at nonprofit hospitals.