Hospital Financial Assistance in New York: Who Pays Nothing, Who Pays 10%

The number on your bill is not a price

A hospital bill shows chargemaster rates: an internal list price that almost nobody pays. Your insurer pays a negotiated rate. Medicaid pays a fixed rate, typically far lower. The uninsured patient gets billed the list price, which is the highest number in the building, and then, in New York, is frequently entitled to pay a small fraction of it or nothing at all.

That gap is what the financial assistance law closes. It is not a favor and it is not a payment plan. It is a legal ceiling on what you can be charged, and since the 2024 amendments it is one of the strongest in the country.

What the law caps, by income

New York Public Health Law section 2807-k, as amended effective October 20, 2024, sets these limits for emergency care and for medically necessary care:

Insured patients enter the table through a second door: if your out-of-pocket medical costs over the last 12 months exceed 10% of your gross household income, you are “underinsured” under the law and the same tiers apply to your share.

Where you fall depends on household size. The 2026 lines:

Each additional person adds $5,680 to 100% FPL. Annual figures, before taxes.

To find your own position, use the estimator. It runs the same arithmetic in your browser and sends nothing anywhere.

The rules that surprise people

Immigration status may not be considered. It is not a question the hospital is entitled to weigh, and applying for financial assistance is not a public benefit for public charge purposes. Hospitals may not report applicants to immigration authorities.

No asset test. The hospital may not ask about your home, your car or your savings. Eligibility runs on household income alone, and a hospital may not deny an application only because you could not produce a document such as a bank statement or a tax return.

Thirty days. Once your completed application is in, the hospital must decide within 30 days and give you the decision in writing, with an explanation and the appeal procedure.

One form for every hospital. The state Department of Health publishes a uniform application, and every hospital must accept it. It exists in English and 16 other languages. If a hospital hands you its own form instead, you can still use the state’s.

No deadline. You may apply at any time, including throughout billing and collections. “Too late” does not exist here the way it does with most paperwork.

What the hospital may not do while you are in the process

The 2024 amendments added collection limits that did not exist before:

Payment plans are also regulated: if you owe a balance after assistance, the hospital must offer monthly installments, the monthly amount may not exceed 5% of your gross monthly income, and interest may not exceed 2% a year. The rest of the debt rules, including the three-year time limit on medical debt lawsuits and the ban on reporting medical debt to credit bureaus, are on the New York medical debt laws page.

How to apply, step by step

1. Ask for it by name. Call the hospital’s billing or patient financial services department and say: “I’m applying for financial assistance under Public Health Law 2807-k. Please send me the uniform application and your written financial assistance policy, and note on the account that an application is pending so collection activity stops.” Applications exist at every hospital; they are not always offered.

2. Read the hospital’s own policy. The state rules are a floor, not a ceiling. Many New York hospitals go further, some considerably. The policy must also be summarized in writing at registration, at discharge and with every bill, so if you never saw it, that itself is worth mentioning.

3. Submit proof of income. Pay stubs, a tax return, benefit letters, an employer letter, or a written attestation if you are paid in cash. Send copies, keep originals, note the date. If the hospital asks about assets, decline politely and point to the law.

4. Ask for an itemized bill at the same time. Line items, not a total. This is where duplicate charges, services you never received and coding errors surface, and it costs nothing to ask.

5. Wait for the written decision, then check it. Thirty days from a completed application. Compare the tier the hospital applied against the table above and against its own policy. Denials at the counter and denials under the written policy are not always the same thing.

6. Appeal in writing if the answer is wrong. The decision letter must include the appeal procedure. If the hospital ignores the law, two doors are open: the New York State Attorney General’s health care helpline, 1-800-428-9071, and the state Department of Health. Legal services organizations across the city handle medical debt at no cost.

The hospital you were treated at

Every hospital runs the same law through its own paperwork: a different office, a different phone number, sometimes a policy document that has not caught up with the 2024 amendment. These pages carry what each one publishes and where its process differs.

Citywide: NYC Health + Hospitals — the public system, and the only one with a sliding scale that runs on residence rather than status.

Manhattan and beyond: NYU Langone · Mount Sinai · NewYork-Presbyterian · Northwell

Specialty hospitals in Manhattan: Hospital for Special Surgery · Memorial Sloan Kettering — both open their programs to patients who live anywhere in the U.S., well beyond the state minimum.

The Bronx: Montefiore · BronxCare

Brooklyn: Maimonides · One Brooklyn Health (Brookdale, Interfaith, Kingsbrook) · SUNY Downstate · Wyckoff Heights

Staten Island: Richmond University Medical Center

Any other hospital in the state: how to find its policy, its application and its plain language summary — and what to do when the hospital’s own policy is weaker than the law.

What counts as your income

Household income, before taxes, for the people in your household. If your income dropped, because you lost work, hours were cut or you are between jobs, apply based on your current situation and say so explicitly. A form asking for last year’s tax return does not mean last year’s income governs; write down what changed and when.

For insured patients, the 10% test uses out-of-pocket medical costs over the past 12 months: deductibles, copays, coinsurance and bills the plan did not cover, added up across every provider, not just this hospital. Keep every explanation of benefits from the year; that is the evidence.

Where the law stops

Three honest limits.

Physician groups. The law binds hospitals. A separate physician practice billing under its own name is not covered, though many run their own programs and most will discount a self-pay balance if you ask in writing. At an academic medical center one visit can produce several such bills, and each needs its own conversation.

Non-emergency care outside the hospital’s area. Emergency care is covered wherever you live. Non-emergency medically necessary care is covered for people who live in the hospital’s primary service area, which for a New York City hospital generally means the city and nearby counties. If you traveled far for a planned procedure, ask the hospital how it applies the rule.

Above 400%. The statewide floor ends there. Many hospitals discount further under their own policies, and the 10% underinsured rule applies at any income, but nothing forces a hospital to write off a bill for a household at 500% of the poverty level.