Dartmouth Health Financial Assistance: Free Care at 225% FPL + Vermont Act 21 Protections (2026 Guide)
Dartmouth Health is the major academic health system for New Hampshire and Vermont, anchored by Dartmouth Hitchcock Medical Center in Lebanon, NH, and affiliated with Dartmouth's Geisel School of Medicine. Their financial assistance program offers 100% free care at 225% FPL, sliding scale discounts at 226-300% FPL, and a catastrophic medical expense provision for patients above 300% FPL. Because the system spans two states, your legal protections depend on where you live. Vermont residents benefit from Act 21, which sets a higher free care floor than Dartmouth's own policy.
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Quick Eligibility Summary
Who Qualifies for Dartmouth Health Financial Assistance?
100% Free Care (at or below 225% FPL)
Patients with household income at or below 225% of the Federal Poverty Level qualify for complete free care at Dartmouth Health. For a single person in 2026, this is approximately $35,910/year. For a family of four, it is approximately $73,800/year. Your entire bill is written off under this tier.
Sliding Scale Discounts (226-300% FPL)
Patients with income between 226% and 300% FPL receive discounted care on a sliding scale. The exact discount percentage depends on where your income falls within this range. At 226% FPL, the discount is highest, and it decreases as income approaches 300% FPL.
Catastrophic Medical Expense Provision (above 300% FPL)
Even if your income exceeds 300% FPL, Dartmouth Health has a catastrophic medical expense provision for patients facing extreme bills. If your medical expenses are disproportionately large compared to your income and financial resources, you may still receive assistance. This is evaluated on a case-by-case basis.
Vermont Residents: Act 21 Provides a Higher Floor
If you are a Vermont resident, state law (Act 21) requires hospitals to provide 100% free care at 250% FPL. This is higher than Dartmouth Health's own 225% FPL threshold. Vermont law sets the floor, meaning VT residents between 225% and 250% FPL are entitled to free care under state law even though the hospital policy alone would not cover them at that level.
Two-State System: Your Rights Depend on Where You Live
Dartmouth Health is unusual because it operates across both New Hampshire and Vermont. These two states have very different medical debt laws. Your legal protections are determined by which state you live in, not which Dartmouth Health facility treated you. This is one of the most important things to understand as a Dartmouth Health patient.
Vermont Residents
- Act 21 bans medical debt on credit reports
- Wage garnishment for medical debt prohibited
- Mandatory free care at 250% FPL (higher than Dartmouth's 225%)
- Strong consumer protections for medical billing
New Hampshire Residents
- Unlimited homestead exemption for catastrophic medical debt
- Trustee process makes wage garnishment impractical
- No state-mandated free care floor (hospital policy applies)
- Strong asset protection for homeowners
Key takeaway: Vermont residents have stronger billing protections (credit report ban, garnishment ban, higher free care floor). New Hampshire residents have stronger asset protections (unlimited homestead exemption). Understand both to know your full rights.
Vermont Act 21: How It Helps Dartmouth Health Patients
Vermont Act 21 is one of the strongest medical debt protection laws in the country. If you are a Vermont resident receiving care at any Dartmouth Health facility (including those in New Hampshire), these protections apply to you.
Act 21 protections for Vermont residents:
- Credit report ban: Medical debt cannot be reported to credit bureaus. Your credit score is protected.
- Garnishment ban: Wages cannot be garnished for medical debt. Your paycheck is safe.
- Free care floor at 250% FPL: Hospitals must provide 100% free care to patients at or below 250% FPL. This overrides Dartmouth Health's 225% FPL threshold.
- Applies to all Dartmouth Health facilities: Whether you are treated at DHMC in Lebanon, NH, or Mt. Ascutney in Vermont, your Act 21 rights follow you as a VT resident.
Important: If your income is between 225% and 250% FPL and you are a Vermont resident, Dartmouth Health's own policy would place you in the sliding scale discount tier. But Vermont law requires 100% free care at that level. Always cite Act 21 if your income falls in this gap.
New Hampshire Protections for Dartmouth Health Patients
While New Hampshire does not have a law equivalent to Vermont's Act 21, NH residents have their own meaningful protections when dealing with medical debt from Dartmouth Health.
NH protections for medical debt:
- Unlimited homestead exemption: New Hampshire provides an unlimited homestead exemption for catastrophic medical debt. Your home is protected from medical debt judgments.
- Wage garnishment effectively impractical: New Hampshire's trustee process makes wage garnishment for medical debt extremely difficult to execute. In practice, most medical debt collectors cannot garnish NH wages.
- Strong asset protection for homeowners: Combined with the homestead exemption, NH residents who own homes have significant protection from medical debt collection.
Note: Unlike Vermont, New Hampshire does not ban medical debt from credit reports, and there is no state-mandated free care floor. NH residents rely on Dartmouth Health's own financial assistance policy (225% FPL free care) rather than a state law mandate.
Need Help with a Dartmouth Health Bill?
CareRoute can help you understand your state-specific rights, draft appeal letters, and navigate the financial assistance application process. Our tools are designed for patients in both New Hampshire and Vermont.
Try Bill DefenseDartmouth Health Facilities
Dartmouth Hitchcock Medical Center (DHMC)
Lebanon, New Hampshire
Flagship academic medical center and regional referral hospital. Affiliated with Geisel School of Medicine.
NH law applies to NH residentsAlice Peck Day Memorial Hospital
Lebanon, New Hampshire
Community hospital serving the Upper Valley region of NH and VT.
NH law applies to NH residentsMt. Ascutney Hospital and Health Center
Windsor, Vermont
Community hospital located in Vermont. Subject to Vermont state law including Act 21 protections.
VT law applies (Act 21)New London Hospital
New London, New Hampshire
Critical access hospital serving the Lake Sunapee region of central NH.
NH law applies to NH residentsCheshire Medical Center
Keene, New Hampshire
Regional hospital serving southwestern NH and the Monadnock area.
NH law applies to NH residentsDartmouth Health Clinics
Various locations in NH and VT
Outpatient clinics and specialty practices across both states. Financial assistance covers employed physicians.
Varies by locationAll Dartmouth Health facilities follow the same financial assistance policy. Your application will be evaluated consistently regardless of which facility you visit. Remember that your state of residence determines which state law protections apply.
Geisel School Physicians: Watch for Separate Bills
As an academic medical center affiliated with Dartmouth's Geisel School of Medicine, some physician services at Dartmouth Health may be billed separately through the Dartmouth-Hitchcock Medical Group. This can create confusion when applying for financial assistance.
What to watch for:
- You may receive separate bills from the hospital (facility fees) and from physician groups (professional fees) for the same visit.
- Dartmouth Health financial assistance covers all hospitals and employed physicians, but confirm that your application covers all billing entities.
- When you apply, explicitly ask whether Geisel-affiliated physician charges and Dartmouth-Hitchcock Medical Group bills are included.
Tip: If you receive a physician bill that appears separate from your hospital bill, do not assume it is automatically covered by your financial assistance approval. Call Patient Financial Services at (603) 650-2211 and ask them to confirm that all billing entities are included.
Out-of-Area and Rural Patients
Dartmouth Hitchcock Medical Center is a rural referral center, meaning patients travel from across northern New England (and beyond) for complex and specialized care. This has important implications for financial assistance.
Key facts for out-of-area patients:
- Full eligibility: Out-of-area patients are eligible for financial assistance under the same guidelines as local patients. You do not need to live near a Dartmouth Health facility.
- Maine residents: Patients from northern Maine frequently travel to DHMC. Maine has its own medical bill protections that may complement Dartmouth Health's financial assistance.
- Telehealth options: For rural patients facing seasonal access barriers (especially during winter), Dartmouth Health offers some telehealth financial assistance options. Ask about remote application assistance.
Note: Your state of residence determines your state law protections. A Maine resident treated at DHMC has Maine state protections, not NH or VT protections. Check the state rights guides linked below for your specific state.
How to Apply for Dartmouth Health Financial Assistance
Determine Your State of Residence
Before you begin, know which state you live in. Vermont residents are entitled to Act 21 protections including free care at 250% FPL. New Hampshire residents follow the Dartmouth Health policy directly (free care at 225% FPL). This distinction affects your eligibility and rights.
Contact Patient Financial Services
Call (603) 650-2211 or visit the Patient Financial Services office at any Dartmouth Health facility. You can also find information online at dartmouth-health.org/patients/billing-insurance. Staff can help you understand your options and begin the application.
Gather Your Documents
You will typically need: proof of income (recent pay stubs, tax returns, or a signed statement of no income), proof of household size, government-issued identification, and your Dartmouth Health bills or account numbers. If you are claiming catastrophic expenses, gather documentation of all outstanding medical obligations.
Complete and Submit the Application
Fill out the Dartmouth Health financial assistance application. Make sure to include all billing entities (hospital bills, physician group bills, any Geisel-affiliated charges). If you are a Vermont resident, note your VT residency on the application to ensure Act 21 protections are applied. Keep copies of everything.
Follow Up and Receive Your Determination
Dartmouth Health will review your application and notify you of the decision. If approved, the discount or free care will be applied to your eligible bills retroactively. Follow up within 2 weeks if you have not received confirmation of receipt. For rural patients, ask about completing the follow-up process by phone or telehealth.
If Your Application Is Denied
If Dartmouth Health denies your financial assistance application, you have several options depending on your state of residence:
- 1.Request a written explanation of the denial reason. You need to understand specifically why you were denied before you can effectively appeal.
- 2.Appeal the decision. Provide additional documentation that addresses the specific denial reason. Ask Patient Financial Services about the formal appeal process.
- 3.Cite the catastrophic provision. If denied based on income alone, ask about the catastrophic medical expense provision for patients above 300% FPL. Document why your bills are disproportionate to your ability to pay.
- 4.Vermont residents: Cite Act 21. If you are a VT resident at or below 250% FPL and were denied, remind Dartmouth Health of their obligation under Vermont Act 21 to provide free care. State law overrides hospital policy.
- 5.Request a payment plan. Even without full financial assistance approval, Dartmouth Health may offer interest-free or reduced payment plans to make your balance manageable.
- 6.Contact your state Attorney General. In Vermont, the AG enforces Act 21. In New Hampshire, the AG oversees nonprofit hospital obligations. As a 501(c)(3) organization, Dartmouth Health must comply with IRS Section 501(r) requirements.
Denied? Let Us Help You Appeal
CareRoute can help you draft an appeal letter that cites the right provisions for your state, whether that is Vermont Act 21, the catastrophic expense provision, or IRS 501(r) requirements.
Start Your Appeal with Bill DefenseContact Information
Dartmouth Health Patient Financial Services handles financial assistance applications for all facilities in the system.
Frequently Asked Questions
How do New Hampshire and Vermont laws differ for Dartmouth Health patients?
Vermont has Act 21, which bans medical debt from credit reports, prohibits wage garnishment for medical debt, and mandates free care at 250% FPL. New Hampshire has an unlimited homestead exemption for catastrophic medical debt and a trustee process that makes wage garnishment impractical. Your protections depend on your state of residence, not the location of your Dartmouth Health facility.
Does Vermont Act 21 override Dartmouth Health's own financial assistance policy?
Yes, in cases where Act 21 provides greater protections. Dartmouth Health offers free care at 225% FPL, but Vermont law requires free care at 250% FPL. If you are a Vermont resident with income between 225% and 250% FPL, state law entitles you to 100% free care even though the hospital's own policy would only provide a sliding scale discount. Always cite Act 21 if your income falls in this range.
What is the catastrophic medical expense provision?
Dartmouth Health offers financial assistance for patients above 300% FPL who face catastrophic medical expenses. If your bills are extremely large relative to your income and resources, you may qualify for assistance even if you exceed the standard income thresholds. This is evaluated on a case-by-case basis. Contact Patient Financial Services and specifically request a catastrophic expense review.
Are Geisel School physician bills covered by financial assistance?
Dartmouth Health financial assistance covers all system hospitals and employed physicians. However, some physician bills may come from Dartmouth-Hitchcock Medical Group as a separate billing entity. When you apply, ask explicitly whether all physician charges (including Geisel-affiliated doctors) are included in your application. If you receive a separate physician bill after approval, call (603) 650-2211 to confirm coverage.
Can out-of-area patients qualify for financial assistance?
Yes. Dartmouth Hitchcock Medical Center is a regional referral center, and patients travel from across northern New England for complex care. Out-of-area patients are fully eligible for financial assistance under the same income guidelines. You do not need to live near a Dartmouth Health facility. Patients from Maine, Massachusetts, and other states are all eligible.
Can insured patients qualify for Dartmouth Health financial assistance?
Yes. Both insured and uninsured patients are eligible. Insured patients may receive help with out-of-pocket costs such as deductibles, copays, and coinsurance if they meet the income guidelines or qualify under the catastrophic medical expense provision. Having insurance does not disqualify you.
How do I apply for financial assistance?
Call Patient Financial Services at (603) 650-2211 or visit the financial services office at any Dartmouth Health facility. You will need proof of income, proof of household size, identification, and your medical bills. Vermont residents should note their state of residence to ensure Act 21 protections are applied. Rural patients can ask about completing the process by phone.
Is Mt. Ascutney Hospital subject to Vermont or New Hampshire law?
Mt. Ascutney Hospital and Health Center is located in Windsor, Vermont. As a Vermont facility, it is subject to Vermont state law. Vermont patients treated at Mt. Ascutney receive the full protections of Act 21, including the credit report ban, wage garnishment prohibition, and the 250% FPL free care mandate. This is the only Dartmouth Health hospital physically located in Vermont.
Related State Rights Guides
Your state provides additional protections for medical bills beyond what Dartmouth Health offers through its financial assistance program. Check the guide for your state of residence.
Last updated: May 2026. Information is based on publicly available Dartmouth Health financial assistance policies and state law. Always confirm current eligibility requirements directly with Dartmouth Health Patient Financial Services.