Telemedicine lets you receive medical care by video, phone, or remote monitoring without visiting a doctor's office, and billing for these remote visits changed significantly in 2026. Hospital charity programs are separate financial assistance programs that nonprofit hospitals must offer to patients who cannot afford their bills, regardless of how care was delivered. While telemedicine and charity care are distinct, understanding how both work helps patients manage the costs of healthcare—especially when remote visits lead to bills they struggle to pay.
The rules governing both areas changed or expanded in 2026. Medicare updated how it reimburses telemedicine providers, Medicaid coverage varies by state, and hospitals face new requirements to make their financial assistance programs visible. This means patients need current information to understand their options for both accessing affordable remote care and getting help paying hospital bills.
Table of Contents
- How Telemedicine Billing Works Now
- What Hospital Charity Care Covers and Who Qualifies
- Why Many Eligible Patients Never Get Charity Care
- How to Apply for Hospital Financial Assistance
- What Your Insurance Covers: Medicaid and Private Plans
- Frequently Asked Questions
How Telemedicine Billing Works Now
Effective October 1, 2026, Medicare providers must report the specific service code (like 99213 or 99214) when billing telemedicine visits—no longer the G2025 tracking code that was previously used. This change applies to rural health clinics (RHCs) and federally qualified health centers (FQHCs), according to the Centers for Medicare & Medicaid Services.
The shift means clearer coding of what service you actually received during a remote visit. Medicare covers non-behavioral telemedicine in your home through December 31, 2027, and behavioral health services are covered permanently. Geographic restrictions have been lifted, making it easier to see specialists remotely regardless of where you live. Additionally, two new billing codes added in January 2026 make remote patient monitoring more accessible by lowering the minimum requirements to just two days and ten minutes of clinical work per month.
For patients on medication management, the DEA extended telemedicine prescribing of controlled substances through December 31, 2026, continuing emergency flexibilities that allow doctors to prescribe certain medications during remote visits. Understanding these billing rules helps you know what your provider should be charging and whether your insurance should be covering it.
What Hospital Charity Care Covers and Who Qualifies
All nonprofit hospitals must publish a written financial assistance policy covering emergency and medically necessary care, according to the Internal Revenue Service. If your hospital is a 501(c)(3), this law applies—and the policy must be publicly available. This requirement means hospitals cannot keep charity care secret; they are legally required to disclose it.
Eligibility is based on household income compared to the federal poverty level. Patients with income below 200% of the federal poverty level typically qualify for 100% free care, while those between 200% and 400% of poverty level qualify for 50–75% discounts. In 2026, for a single person, this means roughly $30,120 and below for full free care and up to $60,240 for partial discounts.
These thresholds vary by household size—hospitals must consider how many dependents you support. Charity care applies to emergency visits and ongoing medically necessary services. The exact discount you receive may depend on the age of your bill and your specific income, but there is no minimum income to qualify—you start from zero and work upward.
Why Many Eligible Patients Never Get Charity Care
Despite having a legal right to know about hospital financial assistance, only 29% of eligible patients actually receive charity care, according to Health Bill Central. The reason is stark: 52% of uninsured or underinsured patients who qualify are never informed by the hospital that the program exists. hospitals are required to post their policies, but most patients never see them—the information is often buried on a hospital website or tucked into fine print on a bill.
This awareness gap costs patients real money. A patient who qualifies for a 75% discount but never hears about it ends up paying the full bill anyway. If you receive a hospital bill you cannot pay, the first step is not to ignore it or let it go to collections; it is to ask the billing department whether you qualify for financial assistance.
How to Apply for Hospital Financial Assistance
When you contact your hospital's billing department, ask specifically for the financial assistance policy or charity care program. You can apply within 240 days of receiving your first billing statement, and applications are processed retroactively—meaning you can apply even after the bill has gone to collections. If a bill has already been sent to a collection agency, the hospital is required to instruct the collector to stop pursuing the debt while your application is reviewed.
Here's what to do: Once approved, your charity care determination becomes retroactive—the hospital should adjust your bill backward to the first date of service covered by the program, not just from the approval date forward. Ask for a revised bill reflecting the discount or free care your income qualifies you for.
- Prepare documentation of your household income (pay stubs, tax returns, benefit statements)
- Contact your hospital's financial counselor or patient advocate
- Apply in writing if possible and keep copies for your records
- Ask for a timeline on the review process
- Request that collection activity pause while your application is pending
What Your Insurance Covers: Medicaid and Private Plans
Coverage for telemedicine varies dramatically depending on your insurance type. Most states have expanded Medicaid telemedicine coverage, but the specifics—which providers, which services, which modalities—differ by state and managed care organization. If you are on Medicaid, contact your state Medicaid agency or your specific managed care plan to ask which telemedicine services are covered and whether there are copays or restrictions.
On the private insurance side, 44 states plus Washington, DC, Puerto Rico, and the Virgin Islands have enacted laws requiring private insurers to cover telemedicine services as of May 2026. However, "coverage required" does not mean "covered equally"—state mandates require insurers to cover telehealth, but reimbursement rates and specific services covered still vary. Check your insurance plan's summary of benefits to see what telemedicine services are included and what you'll owe out of pocket.
Frequently Asked Questions
Do I have to have an unpaid bill to apply for charity care?
No. You can apply preemptively if you know you'll struggle to pay. However, most patients apply after receiving a bill. The key is applying within 240 days of your first billing statement.
My hospital says it doesn't have a charity care program. What do I do?
All nonprofit hospitals (501(c)(3)) are required by federal law to have one. If a hospital claims otherwise, contact the IRS or your state attorney general's office. If the hospital is for-profit, you may need to negotiate directly or explore other assistance options.
Can I appeal if my charity care application is denied?
Yes. Federal law requires hospitals to inform you of the appeals process when they deny your application. Ask the hospital for its appeals procedure in writing.