Guides / Medical bills

Hospital charity care in Montana

Most Montana hospitals are legally required to have a programme that can reduce your bill to nothing. Hardly anyone knows to ask.

If you are staring at a hospital bill you cannot pay, read this before you do anything else, including before you set up a payment plan.

The rule almost nobody knows

Non-profit hospitals have to run a financial assistance policy to keep their tax-exempt status. It is a federal requirement under section 501(r) of the tax code, not a courtesy. The policy has to say who qualifies, how the amount is worked out, how to apply, and what the hospital will do if you do not pay.

Most Montana hospitals are non-profit, including nearly all of the critical access hospitals that serve rural counties. If you were treated at one, a policy exists whether or not anyone mentioned it to you.

You are probably not too late

This is the part that costs people the most money. The application period has to stay open for at least 240 days after your first bill after discharge. That is roughly eight months.

So a bill from four months ago is not a lost cause. A bill already in collections is often not a lost cause either, because hospitals routinely reverse accounts when an application is approved. Ask anyway. The worst outcome is the answer you already have.

The window is longer than people think

Federal rules require the application period to stay open for at least 240 days after your first bill following discharge.

Day 0 You are discharged.
First bill The 240-day clock starts here, not at discharge.
Day 120 Most people have given up or set up a payment plan by now. You can still apply.
Day 240 The earliest the hospital may close the application period.
After that Still worth asking. Hospitals routinely pull accounts back from collections when an application is approved.

IRS section 501(r), cited below.

What qualifying usually looks like

Thresholds are set by each hospital and are expressed as a percentage of the Federal Poverty Level, adjusted for household size. Two real Montana examples, which show how much they vary:

Billings Clinic writes off the bill entirely for households up to 200% of the Federal Poverty Level, with a discount between 200% and 400%. There are asset tests alongside the income test.

Logan Health Chester gives free care under 100% and a sliding-scale discount up to 200%, running from a 100% write-off down to 20%.

That is a wide gap between two hospitals in the same state, which is exactly why you check the policy of the hospital that treated you rather than assuming you earn too much.

Two Montana hospitals, two different lines

Where each hospital's help starts and stops, as a percentage of the Federal Poverty Level. This is why you check the policy of the hospital that treated you rather than assuming you earn too much.

See the numbers

Hospital	Free care	Discounted
Billings Clinic	to 200%	200% to 400%
Logan Health Chester	to 100%	100% to 200%

Billings Clinic and Logan Health published financial assistance policies, cited below. Both carry asset tests alongside the income test.

Policies differ inside the same system

Worth knowing before you rely on a number: large Montana systems publish separate policies for individual facilities, and the thresholds are not always the same. Find the policy for the specific hospital named on your bill.

How to apply

1. Search for the hospital's name plus "financial assistance policy". They are legally required to publish it and make it easy to find.

2. Ask the billing department for the application and the plain language summary. Both must exist.

3. Expect to provide last year's tax return and roughly three months of income documentation. Self-employed people are usually asked for a profit and loss statement.

4. Ask for the account to be put on hold while the application is reviewed, and get that in writing.

5. If you are denied, ask what specifically disqualified you. Household size and which income counts are the two things most often recorded wrongly.

If the paperwork is the barrier

Dollar For is a non-profit that helps people apply for hospital charity care for free. They know the policies, they do the paperwork, and they take no cut. If the form is what is stopping you, use them.

Sources

Checked 21 August 2026. Rules and thresholds change, so follow the source before relying on a figure here.

Who publishes this. CoreMed Healthcare is a Montana healthcare membership company. We publish these guides because we think the information should be easy to find, and because our own members need it. They are written to answer your question rather than to sell you a membership: where the right answer is a hospital charity care programme or a different kind of plan, that is what they say. Nothing here is legal, tax or medical advice.

Common questions

Do I have to be uninsured to qualify?

No. Financial assistance policies are based on income and household size, not on whether you have insurance. People with insurance qualify regularly when the balance left over is more than they can pay.

My bill is already in collections. Is it too late?

Often not. The application period has to run at least 240 days from your first post-discharge bill, and hospitals routinely pull accounts back from collections when an application is approved. Ask.

Does asking hurt my credit or my care?

No. Applying is not a credit event, and a hospital cannot use it as a reason to treat you differently. Emergency care cannot be withheld while you sort out payment.

What if the hospital is for-profit?

The 501(r) requirement applies to non-profit hospitals. For-profit facilities are not bound by it, though many still run discount programmes. Ask what they have.