Medical bills in Washington: free care, credit reports and your rights
Washington has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
Washington law bans medical debt from credit reports.
Charity care means free or discounted care for people with low income. Hospitals also call it financial assistance.
Checked against official sources: October 30, 2026.
Federal rules for nonprofit hospitals apply in every state. Free help can review your bill.
Can I get my bill reduced in Washington?
Washington has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
| Income (% of poverty level) | What you get | Details |
|---|---|---|
| Up to 300% | Free care | If your family income is not more than 300% of the federal poverty level, the hospital must treat your whole share of the bill as charity care (free). Tier 1 hospitals: hospitals owned or operated by a health system with three or more acute hospitals in Washington, acute care hospitals with over 300 beds in King County, and acute care hospitals with over 200 beds in a county of at least 450,000 people on the southern border (Clark County) |
| 301% to 350% | Discount | If your family income is between 301% and 350% of the federal poverty level, you get a 75% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 1 hospitals |
| 351% to 400% | Discount | If your family income is between 351% and 400% of the federal poverty level, you get a 50% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 1 hospitals |
| Up to 200% | Free care | If your family income is not more than 200% of the federal poverty level, the hospital must treat your whole share of the bill as charity care (free). Tier 2 hospitals: all other hospitals |
| 201% to 250% | Discount | If your family income is between 201% and 250% of the federal poverty level, you get a 75% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 2 hospitals |
| 251% to 300% | Discount | If your family income is between 251% and 300% of the federal poverty level, you get a 50% discount on your share of the bill. The hospital may reduce the discount based on certain assets. Tier 2 hospitals |
These are the income levels written in the law. Each hospital decides using its own policy.
- The law
Washington hospital charity care law
Law: RCW 70.170.060 and WAC 246-453; RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
- Which hospitals
All hospitals licensed in Washington, including for-profit hospitals and behavioral health hospitals. Larger hospital systems (Tier 1) must give more help than other hospitals (Tier 2).
- Who can get help
Patients and their guarantors with incomes up to the levels below, whether or not they have insurance, for the part of the hospital bill that insurance or another payer does not cover.
- Deadline to apply
The hospital must look at your income at the time of care, or at the time you apply if you apply within two years of the care, have been making good faith efforts to pay, and show you qualify. A hospital may also choose to consider an application at any time, for example if your finances change.
- Find a hospital's policy
Law: RCW 70.170.020, 70.170.060; WAC 246-453-010 to 246-453-090
Check your income level
Find out what percent of the federal poverty level your household income is, and compare it with the income levels in Washington law.
Is my debt too old in Washington?
| Kind of agreement | Time limit to sue |
|---|---|
| Written contract | 6 years |
| Open account | 6 years |
| Oral (spoken) agreement | 3 years |
A lawsuit on a written contract must be filed within 6 years. A lawsuit on an account receivable (a debt from the ordinary course of a business or profession) also has 6 years. A contract that is not in writing has 3 years.
- What can restart the clock
A payment made before the time limit runs out restarts the clock from that payment. A promise or acknowledgment counts only if it is in writing and signed by you. A payment, promise or acknowledgment made after the time limit has run out does not restart or revive it.
Law: RCW 4.16.040(1), (2), 4.16.080(3), 4.16.270, 4.16.280
A time limit to sue can differ by kind of agreement, and when it starts and what restarts it can differ; a court decides.
Can they sue me or report it in Washington?
- Credit reports
Full ban
Medical debt may not appear on a credit report in Washington. Credit bureaus may not include it, hospitals and the doctors who work with them may not report it, and collection agencies may not report it.
- Waiting rules
Wait before collections: 120 days after the first bill
A health care provider or facility may not sell or assign a medical bill to a collection agency until at least 120 days after it sent you the first bill. A hospital may not start collecting from you until it has made an initial check for insurance and charity care, and must wait for a final charity care decision if you may qualify. A collection agency may not collect a hospital bill while your charity care application or appeal is pending, once it has been told about it. A collection agency's first letter on a medical debt must tell you that you can ask for the original account number, the date of the last payment and a free itemized statement. On a hospital debt, it must also tell you that you may be eligible for charity care and give the hospital's contact information.
- Interest
At most 9% a year
Interest charged on medical debt before a court judgment may not be more than 9% a year. Collection agencies may add only interest, costs and fees allowed by statute.
- Wage garnishment
For a judgment on consumer debt, you keep the greater of 80% of your weekly disposable earnings or 35 times the state minimum hourly wage each week. This is more protection than federal law.
- Selling the debt
A health care provider or facility may not sell or assign medical debt to a collection agency until at least 120 days after the first bill.
- Lawsuit rules
A licensed collection agency may not serve you with a summons and complaint unless they have already been filed with the court and show the court's case number.
Law: RCW 70.54.470, 19.16.250(21), (27), (28), (29), 19.52.010(2), 6.27.150(4); WAC 246-453-020
Surprise bills and ambulance bills in Washington
- State law
Balance Billing Protection Act, including ground ambulance rules (2024)
Law: RCW 48.49; RCW 48.49.020, 48.49.030, 48.49.120, 48.49.130, 48.49.200, 41.05.017
- Which plans it covers
Health plans regulated by the Washington Office of the Insurance Commissioner, health plans for public and school employees offered through the Health Care Authority (PEBB and SEBB), and self-funded employer plans that choose to join.
- What it adds
Out-of-network providers and facilities may not balance bill you for emergency services, for non-emergency care by out-of-network providers at in-network facilities, or for air ambulance services.
- Ground ambulance
The state protects you
For state-regulated plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not bill you more than your in-network cost sharing for a covered ride. The insurer pays the ambulance directly.
Law: RCW 48.49.200, 48.49.130
Law: RCW 48.49.020, 48.49.030, 48.49.120, 48.49.130, 48.49.200, 41.05.017
Itemized bills and price estimates in Washington
Washington law gives you a right to an itemized bill.
If a collection agency is collecting a medical debt, you can ask in writing or by phone for a free itemized statement. Until the agency sends it, it must stop all collection efforts (court writs already issued may continue). The statement must show the provider's name and address, the dates of service, the services, the principal, insurance adjustments and discounts, payments received, any interest or fees, and whether you were found eligible for charity care and the amount due after it. Hospitals must also give inpatients, at or before discharge, a list of the doctor groups that may bill them separately, with phone numbers.
Law: RCW 19.16.250(28)(a); RCW 70.41.400(1)
Health coverage and Medicaid in Washington
Washington Apple Health (Medicaid) is Washington's Medicaid program. Apply for it here:
Where to complain in Washington
- Hospital bills and financial assistance: Washington State Department of Health, charity care program · 360-236-4210
A hospital is not following its charity care policy, unfairly denied you charity care, or refused to give you an application. - Hospital licensing: Washington State Department of Health, complaints about providers and facilities · 360-236-4700
Other complaints about a hospital or a licensed health care provider. - Health insurance: Washington State Office of the Insurance Commissioner · 1-800-562-6900
A surprise bill, ground ambulance bill or claim denial under a state-regulated health plan. - Attorney general: Washington State Attorney General, Consumer Protection · 1-800-551-4636
A collection agency or business broke consumer protection rules, including medical debt collection and credit reporting rules.
Free help in Washington
Free tools, letters and checklist
Good to know in Washington
- Washington's charity care rules apply to every licensed hospital, including for-profit hospitals, and cover insured patients' remaining bills too.
Law: RCW 70.170.020, 70.170.060
- A medical debt becomes void and unenforceable if a provider, facility or collection agency reports it to a credit bureau.
Law: RCW 70.54.475
- The Department of Health can fine hospitals that violate the charity care law.
Law: RCW 70.170.070; WAC 246-453-090
Changes in 2024–2026
January 1, 2025: Laws of 2024, ch. 218 protects people in state-regulated plans from out-of-network ground ambulance balance bills. July 27, 2025: Laws of 2025, ch. 145 (ESSB 5480) banned medical debt from credit reports and voids medical debt that is reported.
Law: RCW 48.49.200; RCW 70.54.475, 19.182.040, 70.41.400, 19.16.250
Questions about medical bills in Washington
Does Washington require hospitals to give free or discounted care?
Washington has a law that requires hospitals to give free or discounted care to people with income up to 400% of the federal poverty level (the exact level depends on the hospital and your situation).
Can medical debt be reported to credit bureaus in Washington?
Washington law bans medical debt from credit reports. Medical debt may not appear on a credit report in Washington. Credit bureaus may not include it, hospitals and the doctors who work with them may not report it, and collection agencies may not report it.
How long can a medical bill be collected or sued on in Washington?
A lawsuit on a written contract must be filed within 6 years. A lawsuit on an account receivable (a debt from the ordinary course of a business or profession) also has 6 years.
Can a medical debt lead to wage garnishment or a lien on my home in Washington?
For a judgment on consumer debt, you keep the greater of 80% of your weekly disposable earnings or 35 times the state minimum hourly wage each week. This is more protection than federal law.
Am I protected from ground ambulance bills in Washington?
For state-regulated plans issued or renewed on or after January 1, 2025, an out-of-network ground ambulance may not bill you more than your in-network cost sharing for a covered ride. The insurer pays the ambulance directly.
Do I have a right to an itemized bill in Washington?
If a collection agency is collecting a medical debt, you can ask in writing or by phone for a free itemized statement. Until the agency sends it, it must stop all collection efforts (court writs already issued may continue).
More help
Nearby states
Sources
- RCW 70.170.060, charity care (Washington State Legislature)
- RCW 70.170.020, definitions
- WAC 246-453, hospital charity care rules
- Department of Health: Hospital Patient Information and Charity Care
- Department of Health: Charity Care Rules in Progress
- ESSB 5480, Laws of 2025 ch. 145 (session law)
- RCW 70.54.470, 70.54.475 (medical debt sale and credit reporting)
- RCW 70.41.400 (hospital billing, credit reporting)
- RCW 19.16.250 (collection agency prohibited practices)
- RCW 19.52.010 (9% cap on prejudgment interest on medical debt)
- RCW 19.182.040 (consumer reports)
- RCW 48.49 (Balance Billing Protection Act, ground ambulance)
- RCW 4.16.040, 4.16.080, 4.16.270, 4.16.280 (time limits)
- RCW 6.27.150 (wage garnishment exemption)
- Health Care Authority: Apply for or renew Apple Health
- Office of the Insurance Commissioner: File a complaint
- Attorney General: File a complaint
- DOH: Hospital Policies (approved charity care policies on file)
- RCW 41.05.017 (public employee plans subject to chapter 48.49)