What is the HCRA surcharge on a hospital bill?
HCRA is the New York Health Care Reform Act, the state law that sets surcharges on payments for hospital and certain clinic services and sends the money to state pools that fund indigent care and other health programs. The Department of Health’s table is titled “Indigent Care and Health Care Initiatives Surcharges by Payor.” It applies to inpatient hospital, outpatient hospital and diagnostic and treatment center services.
When an insurer pays a hospital, the insurer handles the surcharge and you never see it. When you are the payor, because you are uninsured, chose to pay yourself, or received a service your plan does not cover, the hospital adds the surcharge to your bill. That is the line people search for: “New York State surcharge,” “HCRA” or “NYS surcharge 9.63%.”
The rates, by who pays
The Department of Health’s table, for services from April 1, 2009 through December 31, 2026, lists these surcharge rates:
| Who pays the hospital | Surcharge in the state table |
|---|---|
| Self-pay, uninsured or unspecified | 9.63% |
| NYS Medicaid and state government agencies | 7.04% |
| HMOs and PHSPs, for Medicaid patients | 7.04% |
| NYS-licensed commercial insurers and HMOs for non-Medicaid patients | 9.63% (with a 28.27% figure also listed) |
| Self-insured funds | 9.63% (with 28.27% also listed) |
| Workers’ compensation, no-fault auto and similar payors | 9.63% (with 28.27% also listed) |
| Secondary coverage | Same as the primary payor |
The table does not list Medicare among the payors, and it does not explain the second 28.27% figure in the commercial rows. For a patient paying the hospital directly, the line that applies is the self-pay row: 9.63%.
How the 9.63% is calculated on your bill
The surcharge is a percentage added on top of the amount the hospital collects from you. The Department’s 2011 training presentation shows the method: a $1,000 self-pay bill becomes $1,000 × 1.0963 = $1,096.30. The same presentation shows how to back the surcharge out of a payment by dividing by 1.0963.
The Department’s Q&A works an example for an insured patient with a $500 deductible and a $400 contracted rate. Because $400 plus the surcharge stays under the deductible, the patient pays it: the hospital “should assess the surcharge to the patient, bringing the total bill to $438.52.”
| What you owe before the surcharge | Surcharge at 9.63% | Total |
|---|---|---|
| $100 | $9.63 | $109.63 |
| $400 | $38.52 | $438.52 |
| $1,000 | $96.30 | $1,096.30 |
| $5,000 | $481.50 | $5,481.50 |
To check your bill, divide the total by 1.0963. If the result matches the subtotal before the surcharge line, the hospital applied the self-pay rate.
When the surcharge lands on the patient
The Department’s Q&A names three situations in which the self-pay rate applies to money a hospital receives from a patient:
- You are uninsured or paying yourself.
- The service is not covered by your plan. The Q&A’s example is a cosmetic procedure: revenue for non-covered services “is subject to the self-pay rate.”
- A Medicare patient without Part B, or who has no other coverage for the service or has exhausted Medicare benefits. The Q&A says that revenue is subject to the surcharge at the self-pay rate.
The Q&A also confirms that hospitals may collect the surcharge from patients, “provided the hospital has billed the surcharges.” In short: it should appear as a line before you are asked to pay it, not get added afterward.
How to lower the surcharge
You cannot ask a hospital to waive a state surcharge. You can lower the amount it applies to, because the surcharge is a percentage of what you pay.
- Ask for an itemized bill and check every line before anything else. Each charge removed takes its 9.63% with it. How to request one.
- Apply for financial assistance. At or below 200% of the federal poverty level an uninsured patient owes nothing out of pocket for emergency and medically necessary care, so there is nothing to surcharge. From 200% to 400% the charge is capped at 10% or 20% of the Medicaid amount. Who qualifies.
- Check whether coverage applies. If you had Medicaid, an insurance plan or Emergency Medicaid on the date of service, the hospital should bill the payor, and the self-pay surcharge should not be on your bill.
- Ask how the surcharge was calculated if the line does not match 9.63% of the subtotal.
“Please show me the subtotal the 9.63% HCRA surcharge was applied to. I’ve applied for financial assistance, and I’d like the surcharge recalculated on the amount I owe after the decision.”
What the surcharge is not
It is not a hospital fee. The hospital passes it to the state’s pool administration; it is not the facility fee some hospital clinics add, which is the hospital’s own charge.
It is not a sales tax. It applies only to certain health care services, and the rate depends on who pays.
It is not negotiable on its own, which makes it the least useful line to argue about. The lines worth disputing are the charges underneath it. How to negotiate a medical bill.
The honest limit of this page: the state’s table is a reference document for hospitals and payors, last revised in November 2023, and the Q&A dates from a 2011 training session. The posted table stops at services on December 31, 2026; if your bill is for services after that date, ask the hospital which rate table it used.
Questions people ask
What is the New York State surcharge on my hospital bill?
It is the surcharge under New York’s Health Care Reform Act (HCRA). For uninsured and self-pay patients the state’s table sets it at 9.63% of the amount paid, and the hospital passes it to the state.
Why was I charged 9.63% on my hospital bill?
Because you paid the hospital yourself, as an uninsured or self-pay patient or for a service your plan did not cover. The state’s table sets the self-pay surcharge at 9.63%.
Do insured patients pay the HCRA surcharge?
Insurers pay surcharges directly, so it does not usually appear on an insured patient’s bill. The Department of Health’s Q&A shows it can apply to a patient’s payment toward a deductible.
Does Medicaid pay the HCRA surcharge?
Medicaid payments carry a 7.04% surcharge in the state’s table, paid by the program, not by the patient.
Can I get the HCRA surcharge removed?
Not on its own, because it is set by the state. Lowering the bill underneath it lowers the surcharge, and financial assistance at or below 200% of the poverty level removes your share entirely.
Sources
- NYS Department of Health — Indigent Care and Health Care Initiatives surcharges by payor, services rendered 4/1/09 to 12/31/26 (checked 2026-11-03)
- NYS Department of Health — HCRA hospital conference webinar, questions and answers (checked 2026-11-03)
- NYS Department of Health — HCRA hospital conference presentation (February 15, 2011) (checked 2026-11-03)
- New York State Attorney General — Hospital financial assistance (checked 2026-11-03)
More in Health Care Costs in New York City
- Montefiore Bills and Financial Assistance — A self-pay Montefiore bill often means no one screened you for coverage. Ask about Emergency Medicaid and financial assistance; collections is not a deadline.
- What Childbirth Costs in New York: How the Bill Is Built — What does childbirth cost in New York? Expect separate bills for the mother, the newborn, anesthesia and the doctor. Add the baby to coverage immediately.
- Maimonides Bills and Financial Assistance — Maimonides has financial counselors in thirteen languages and a program broader than the law requires. Where to start, and what state law guarantees regardless.
This page explains how the system works. It is not medical advice. More.