To be eligible for Charity Care, you must meet the following requirements:
Financial Eligibility—Income: You will be eligible for full Charity Care coverage in 2023 if your annual gross income (calculated as described below) at the time of your hospital care was not more than 200% of the federal poverty level (FPL). If your annual gross income is more than 200% of FPL but does not exceed 300%, Charity Care will cover a percentage of the bill (after it has been adjusted based on the Medicare rate as described below). The percentage of the charge a hospital can charge ranges from 20% to 80% and is based on a sliding income scale, which can be found at the New Jersey Hospital Care Payment Assistance Fact Sheet (from the New Jersey State Department of Health and Senior Services). The FPL is based on family size and is adjusted every year based on increases in the cost of living. See Poverty Guidelines (from the Assistant Secretary for Planning and Evaluation) for the current FPL. For hospital services received in 2023, 200% FPL for a single individual is $29160 and 300% is $43740. If your family size is four—your family includes you, your spouse, any minor children you support, and adults for whom you are legally responsible—you will be eligible for full charity care coverage for services received in 2023 if your countable gross annual gross income for the applicable period in 2023 does not exceed $60,000 (200% FPL) and for partial Charity Care coverage if this income does not exceed $90,000 (300% FPL).
What if I make too much money?
If your medical expenses are greater than 30% of your family’s annual income (and you meet the Charity Care asset limit), the amount greater than 30% will be fully covered by Charity Care.
If your income meets the Charity Care income limit, but your assets are too high ($7,500 for an individual; $15,000 for a family), you may spend down your assets on the unpaid hospital bill until your assets are within the Charity Care limit. This can make you eligible for Charity Care coverage for the rest of your bill.
There is also a special program for children in New Jersey with very large medical bills that are not covered by insurance, the Catastrophic Illness in Children Relief Fund. See How Does a Family Apply for the Fund? (from the New Jersey State Department of Human Services) for more information, or call 1-800-335-FUND (3863).
How much can a hospital charge me if my annual income is more than 200% of the poverty level?
In February 2009, a law went into effect in New Jersey that requires hospitals to charge uninsured patients whose income does not exceed 500% FPL no more than 15% above what the Medicare program pays the hospital for the same procedure. Medicare’s fee schedules can be found online by matching the CPT codes (Current Procedural Technology, 4th Edition) at All Fee-For-Service Providers (from Centers for Medicare & Medicaid Services (CMS).
The law also requires the creation of a sliding scale, based on income, for the percentage of 115% of the Medicare rate that an uninsured patient must pay, but that sliding scale has not yet been established by the State. Therefore, for now, if your income is between 200% and 300% of the poverty level, the applicable Charity Care discount must be applied to your hospital bill after it has already been adjusted to not more than 115% of the Medicare rate.
This information last reviewed: Feb 23, 2023