Pennsylvania Medical Bill Rights & Programs: No Wage Garnishment and Hidden Protections Most Patients Miss

No State-Mandated Charity Care Thresholds

Unlike states such as New York, New Jersey, and California, Pennsylvania does not have a statewide law requiring specific income thresholds for free or discounted care. Instead, PA relies on federal 501(r) requirements for nonprofit hospitals and the Institutions of Purely Public Charity Act (Act 55 of 1997).

• Huge variation across hospitals. Free care thresholds range from 41% to 600% FPL depending on the hospital.
• Average thresholds: About 204% FPL for free care and 322% FPL for discounted care across PA hospitals.
• Always ask. Every nonprofit hospital must have a written financial assistance policy. Request it before paying anything.
• Immigration status does not disqualify you from hospital charity care under federal 501(r) rules.

Federal 501(r) Protections (Apply to All Nonprofit Hospitals):

• Must have a written financial assistance policy available in plain language
• 120-day waiting period before pursuing extraordinary collection actions (lawsuits, liens, garnishment)
• 240-day window for patients to submit a financial assistance application
• Cannot charge more than the amount generally billed (AGB) to insured patients for those eligible for financial assistance
• Third-party debt buyers cannot add interest or fees beyond the original amount owed

What Creditors Cannot Do:

• Cannot garnish your wages for medical debt. This is PA's strongest protection and applies even after a court judgment.
• Cannot pursue extraordinary collection actions for 120 days from the first post-discharge statement (federal 501(r) rule for nonprofit hospitals).
• Third-party debt buyers cannot add interest or fees beyond the original debt amount.
• Cannot seize joint marital property for one spouse's individual medical debt (Tenancy by the Entireties).

What Creditors CAN Do (Know the Gaps):

• Levy bank accounts after obtaining a judgment. Only $300 is exempt from execution.
• Place judgment liens on real estate. PA has no homestead exemption, so your home equity is fully exposed. Judgment liens last 5 years and can be renewed indefinitely.
• In bankruptcy: The federal exemption protects $31,575 (individual) or $63,150 (married) of home equity.

Federal No Surprises Act (Primary Protection)

Pennsylvania did not pass its own comprehensive surprise billing law. PA relies primarily on the federal No Surprises Act, supplemented by some managed care protections under Act 68 of 1998.

• Emergency services: You only pay in-network cost-sharing for emergency care, even at out-of-network facilities.
• In-network facilities: If you receive care at an in-network facility but are treated by an out-of-network provider (such as an anesthesiologist or radiologist), you only pay in-network rates.
• Good faith estimates: Uninsured or self-pay patients can request an advance estimate of costs and dispute bills that exceed the estimate by $400 or more.

Pennsylvania Expanded Medicaid:

• • Adults: Up to 138% FPL (~$20,780/year for a single person)
• • Retroactive coverage: Currently 3 months (dropping to 1 month in 2027)
• • No asset test for MAGI-based Medicaid
• • Apply through PA Department of Human Services or Pennie marketplace

Pennie (PA's ACA Marketplace):

Pennsylvania operates its own ACA marketplace called Pennie (one of about 18 states with a state-run exchange). This can offer better customer service and more tailored plan options.

• • Apply at pennie.com
• • Subsidies available based on income
• • Mini-COBRA: PA requires 9 months of continuation coverage for employers with 2-19 employees

Pennsylvania Resources for Medical Bill Help: