Duke Health Financial Assistance: Free Care to 200% FPL + Discounts to 300% FPL (2026 Guide)
Duke University Health System (DUHS) offers 100% free care for patients with household income at or below 200% of the Federal Poverty Level, and sliding-scale discounts for those between 201-300% FPL. The policy covers Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, and Duke Primary Care clinics across the Triangle region of North Carolina. As a $12+ billion academic medical center, Duke charges premium prices, making financial assistance critical for eligible patients.
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Quick Facts
100% Free Care
Household income at 0-200% FPL (single: up to ~$31,920/yr) qualifies for full charity care, covering all eligible services
Sliding Scale to 300% FPL
Income between 201-300% FPL (~$31,921 to ~$47,880/yr single) receives percentage-based discounts on a sliding fee schedule
Medical Indigence Safety Net
If total bills exceed 15% of your annual household income, you may qualify regardless of FPL level
No Lawsuits Since 2017
Duke stopped suing patients, placing liens, and garnishing wages in 2017. No credit reporting since 2020.
$1.021 Billion in Community Benefit (FY2024)
Duke Health reported $175 million in direct financial assistance for 457,946 patients in its most recent community benefit report. As a tax-exempt nonprofit, Duke is required to provide meaningful charity care.
Eligibility & Income Limits (2026 Federal Poverty Guidelines)
| Income Level (% FPL) | Approximate Income (Single) | Discount Level |
|---|---|---|
| 0-200% FPL | Up to ~$31,920/yr | 100% Free Care |
| 201-300% FPL | ~$31,921 - ~$47,880/yr | Sliding-scale discount (percentage based on income and household size) |
| Above 300% FPL | Above ~$47,880/yr | May qualify via Medical Indigence (bills exceed 15% of annual income) |
Important Notes
- Both insured and uninsured patients may qualify for financial assistance.
- Medical Indigence: If total patient liability exceeds 15% of your current or prior year annual household income, the excess amount is eligible for a financial assistance adjustment, regardless of FPL level.
- Uninsured patients may need to cooperate with Medicaid screening before FA eligibility is determined.
- NC Medicaid covers adults up to 138% FPL since the state expanded Medicaid in December 2023.
- Duke will never charge FA-eligible patients more than Amounts Generally Billed (AGB) to insured patients.
- Interest-free payment plans are available for patients at 200-300% FPL (up to 36 months, capped at 5% of monthly income).
North Carolina Context: Medicaid Expansion and $6.5B Debt Relief
NC Medical Debt Relief Program
As of October 2025, North Carolina has erased more than $6.5 billion in medical debt for over 2.5 million residents through the state's Medical Debt Relief Program. This is tied to the Healthcare Access and Stabilization Program (HASP), which began alongside Medicaid expansion.
Who Benefits from NC Debt Relief?
- Medicaid enrollees (enrolled as of July 1, 2025): All outstanding medical debt dating back to January 1, 2014 owed to participating hospitals is relieved
- Non-Medicaid patients at or below 350% FPL: Medical debt more than two years old (dating back to January 1, 2014) owed to participating hospitals is relieved
- Patients whose total medical debt exceeds 5% of income: Also eligible for debt relief on qualifying balances
- Every eligible hospital in North Carolina signed on to participate
NC Medicaid Expansion (December 2023)
North Carolina expanded Medicaid in December 2023, covering adults with income up to 138% FPL (~$22,024/yr single). If you are uninsured and earn below this threshold, apply for NC Medicaid first. If approved, Medicaid will cover your Duke Health bills directly. Duke Health requires uninsured patients to cooperate with Medicaid screening as part of the financial assistance process.
Check both programs: You may benefit from NC's medical debt relief program for older balances AND Duke's financial assistance policy for current or recent bills. These programs work independently, so qualifying for one does not disqualify you from the other.
Duke Health Hospitals and Facilities
Major Hospitals
Clinics and Outpatient Facilities
The DUHS Financial Assistance Policy applies to all Duke University Health System facilities. Some independently billing physicians (such as certain specialists) may have separate policies. Always confirm coverage when scheduling.
Documents You Will Need
Income Verification
- Recent pay stubs (most recent 30 days)
- Most recent federal tax return
- Benefit letters (Social Security, disability, unemployment)
- Self-employment income documentation
- Income for all household members
Other Documentation
- Government-issued photo ID
- Proof of North Carolina residency
- Insurance information (if applicable)
- Completed DUHS Financial Assistance Application
- Bank statements (may be requested)
Important: Incomplete applications can delay or prevent approval. Make sure every required field is filled out and all supporting documents are included before submitting.
How to Apply (Step by Step)
Check Your Eligibility
100% free care at 0-200% FPL (~$31,920/yr single). Sliding-scale discounts at 201-300% FPL (~$47,880/yr single). Medical indigence if bills exceed 15% of annual income at any income level.
Contact Duke Health Customer Service
Call 919-620-4555 (local) or 1-800-782-6945 (toll-free). Hours: Mon, Tue, Wed, Fri 8am-5pm and Thursday 8am-4pm. A financial counselor can walk you through the process and help determine which programs you qualify for.
Complete the Application
Download the DUHS Financial Assistance Application from dukehealth.org or request one by phone. Fill out completely with household income and family size information.
Submit Your Application
You can submit by:
- Mail: Duke University Health System, Patient Financial Services, P.O. Box 3677, Durham, NC 27710
- In person: Financial counseling at any Duke Health hospital
- Online: Through My Duke Health (Duke MyChart) portal
Follow Up
Call 919-620-4555 or 1-800-782-6945 to confirm receipt and check status. Keep copies of everything you submit.
Common Pitfalls to Avoid
- Missing the deadline: Apply within 240 days of your first billing statement.
- Incomplete application: Missing documents or blank fields will delay your application. Double-check before submitting.
- Skipping Medicaid screening: Uninsured patients must cooperate with Medicaid or government assistance screening before FA eligibility is determined.
- Ignoring the medical indigence provision: Even if your income is above 300% FPL, you may qualify if bills exceed 15% of annual household income.
- Assuming physicians are covered: Some Duke physicians bill independently and may have separate financial assistance policies. Confirm coverage for each provider.
Struggling with a Duke Health Bill?
CareRoute Bill Defense can review your Duke Health bill for errors, identify financial assistance you may be missing, and negotiate directly with Duke on your behalf. No upfront cost.
Get Help with Your Duke BillPayment Plans
Interest-Free Payment Plans (200-300% FPL)
- Available to NC residents with income between 200-300% FPL
- No interest charged
- Term of up to 36 months
- Monthly payments capped at 5% of monthly household income
- Plans may extend beyond 36 months, as long as total collected does not exceed what would have been collected under the 36-month/5% arrangement
Standard Payment Plans (All Patients)
- Available to any patient with a balance
- Set up 24/7 through My Duke Health (Duke MyChart)
- Or call Customer Service at 919-620-4555 / 1-800-782-6945
- Terms vary based on balance amount
Collection Practices: What to Know
The Good News
- Duke Health stopped suing patients in 2017 (no lawsuits, liens, or wage garnishment)
- Since 2020, Duke no longer reports to consumer credit agencies
- Duke does not sell debt to third-party debt buyers
What Still Happens
- After 120 days of unpaid bills, Duke sends four contact attempts (statements, calls, and/or emails)
- If the balance remains unresolved, the account may be placed (not sold) with a collection agency
- Collection agencies will contact you on Duke's behalf to resolve the balance
Apply for financial assistance as soon as possible. Do not ignore bills, even if Duke's collection practices are less aggressive than many hospitals.
What If You Are Denied?
1. Ask Why and Reapply
Call 919-620-4555 or 1-800-782-6945 to learn the specific reason for denial. Common reasons include income above 300% FPL, incomplete documentation, or missing information. You can reapply with corrected or additional documentation.
2. Check the Medical Indigence Provision
Even if your income is above 300% FPL, if your total medical bills exceed 15% of your annual household income, ask about the medical indigence provision. This is separate from the standard FPL-based assistance and is often overlooked.
3. Explore Other Options
- NC Medicaid: Covers adults up to 138% FPL since December 2023 expansion
- NC Medical Debt Relief: Check if your older debt qualifies under the state program
- Payment plans: Interest-free options available for qualifying patients
- Request an itemized bill: Review all charges for errors or duplicate billing
- Dollar For: Nonprofit that helps patients apply for charity care at Duke (dollarfor.org)
Let CareRoute Bill Defense Help
If your application was denied or you need help negotiating your Duke Health bill, CareRoute Bill Defense can review your case and negotiate on your behalf at no upfront cost.
Get Help with Your BillContact Information
Customer Service
Mon, Tue, Wed, Fri: 8:00 AM - 5:00 PM | Thu: 8:00 AM - 4:00 PM
Mail & Online
Frequently Asked Questions
Who qualifies for Duke Health financial assistance?
Patients with household income at or below 200% FPL (~$31,920/yr single) qualify for 100% free care. Those between 201-300% FPL get sliding-scale discounts. If your total medical bills exceed 15% of annual household income, you may qualify through the medical indigence provision at any income level.
Does Duke Health sue patients for unpaid bills?
No. Duke Health stopped pursuing lawsuits, liens, and wage garnishment against patients in 2017. Since 2020, they also no longer report unpaid medical debt to credit bureaus. However, unpaid accounts may still be placed with collection agencies after 120 days.
What is the medical indigence provision?
If your total patient liability exceeds 15% of your current or prior year annual household income, the excess amount qualifies for a financial assistance adjustment. This applies regardless of your FPL level, making it a safety net for patients whose income is above 300% FPL but who face high medical bills.
Which Duke facilities are covered?
The DUHS Financial Assistance Policy covers Duke University Hospital, Duke Regional Hospital, Duke Raleigh Hospital, Duke Primary Care clinics, and other DUHS-affiliated facilities. Some independently billing physicians may have separate policies, so always confirm coverage when scheduling.
Can I get help with my Duke bill if I have insurance?
Yes. Both insured and uninsured patients may qualify for financial assistance. Insured patients can receive help with out-of-pocket costs including deductibles, copays, and coinsurance after insurance has paid its portion.
What about North Carolina's medical debt relief program?
NC has erased over $6.5 billion in medical debt since 2024. Medicaid enrollees can have all hospital debt dating back to January 1, 2014 relieved. Non-Medicaid patients at or below 350% FPL (or those whose debt exceeds 5% of income) can have debt more than two years old relieved. This is separate from Duke's own financial assistance policy.
Need Help with Your Duke Health Bill?
CareRoute Bill Defense can review your medical bills, identify savings opportunities, and negotiate with Duke Health on your behalf. No upfront cost.
Start Your Free Case ReviewThis guide is for informational purposes only and does not constitute legal or financial advice. Information is based on publicly available Duke University Health System financial assistance policies as of 2025. Eligibility requirements, income thresholds, and application processes may change. Always verify current requirements directly with Duke Health at 919-620-4555 or 1-800-782-6945, or visit dukehealth.org.