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Uninsured in California: your rights before and after the visit

CALIFORNIA · STATUTE-SOURCED · MAINTAINED — LAST REVIEWED 2026-10-01 · FREE, NO ACCOUNT

No insurance in California means you pay the bill yourself, and that changes which laws protect you. Two sets apply: federal rules that work the same in every state, and California’s own. This page puts them in the order you will need them: before the visit, in an emergency, after the bill arrives, and the state’s rules on going without coverage. Nothing here tells you whether to carry insurance. It tells you what you are owed if you don’t.

California — hospital financial assistance floor
Applies toEvery licensed hospital
Discount, income at or under 400% of the poverty levelexpected payment capped at the greater of the Medicare or Medi-Cal rate
Uninsured charges capped atthe Medicare or Medicaid rate
Screening before billingRequired
Federal rule (nonprofit hospitals)Written policy required · IRS §501(r)
SOURCE: Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297) · IN EFFECT 2025-01-01 · VERIFIED 2026-09-09

Before the visit: three things to ask for in writing

  1. A Good Faith Estimate. Federal law (45 CFR 149.610) requires any licensed provider or facility to give an uninsured or self-pay patient a written, itemized estimate for scheduled care: within one business day when the appointment is three or more business days out, within three business days when it is ten or more days out, and on request before you book. Say the words “I am self-pay and I want the Good Faith Estimate.” Keep it. It becomes evidence if the bill is wrong. How the estimate and the $400 rule work →
  2. The self-pay rate. Hospitals publish a “discounted cash price” in their price transparency file, and many providers charge self-pay patients less than the list price if asked before the visit, not after. In California, Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297) caps what an eligible uninsured patient can be charged at the Medicare or Medicaid rate, so ask the billing office to confirm the rate they will apply to you. How to read a hospital’s price file →
  3. The financial assistance policy, before the bill. Every nonprofit hospital must have a written Financial Assistance Policy and a plain-language summary (IRS §501(r)), and must tell you about it. Ask for the application when you schedule, not after the statement arrives. In California, hospitals must also screen uninsured patients for assistance before billing or collecting (Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297)). How charity care works and what the application asks →

Where to go when it is not an emergency

  • Community health centers. Federally funded health centers must see you regardless of insurance and charge on a sliding scale set by federal rule (42 CFR 51c.303): a nominal fee at or under 100% of the poverty guideline, discounts up to 200%, full charge above that. They do primary care, dental, mental health, and prescriptions. Find a health center near you (HRSA, the federal health center agency) →
  • Free and charitable clinics. Volunteer-run, income-tested, and often the fastest door for a chronic prescription or a basic visit. Find a free clinic (National Association of Free and Charitable Clinics) →
  • Prescriptions. You can always pay the cash price. Federal law since 2018 bars pharmacy “gag clauses,” so the pharmacist may tell you when cash is cheaper than a copay. Discount cards and cost-plus pharmacies price most generics far below list.
  • Labs and imaging. Direct-to-consumer lab ordering and cash imaging networks post all-inclusive prices. For anything scheduled, get the Good Faith Estimate first.

If it is an emergency

Go. Under the federal Emergency Medical Treatment and Labor Act, any hospital with an emergency department that accepts Medicare must give you a medical screening exam and stabilize an emergency condition before asking how you will pay. What EMTALA does not do is make the care free: the bill arrives later, and every rule in the next section applies to it. Tell registration you are self-pay, and ask for the Financial Assistance Policy before you leave.

After the visit: the bill

  1. Compare the bill to the estimate. If a provider or facility bills at least $400 more than its Good Faith Estimate, you can file the federal patient-provider dispute within 120 calendar days of the bill date. The fee is $25, collections stop while the dispute is open, and the outcome cannot raise what you owe. The threshold is per provider. CMS: dispute a bill →
  2. Get the itemized bill. Ask for every charge with its code before you pay anything. What to ask for, and the letter →
  3. Apply for financial assistance. Nonprofit hospitals must accept your application for at least 240 days after the first bill (26 CFR 1.501(r)-6), may not report you, sue, or sell the debt for the first 120 days, and must reverse those actions if you are found eligible later. Under Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297), every licensed hospital in California must offer discounted care up to 400% of the guideline, charges to eligible uninsured patients capped at the Medicare or Medicaid rate. A hospital's own policy can be more generous, never less.
  4. Check California’s medical-debt protections.
    • Medical debt credit-reporting ban (SB 1061, 2024) (Cal. Civ. Code § 1785.27) — As of Jan. 1, 2025, providers, collectors, and credit bureaus may not report medical debt to consumer credit reporting agencies regardless of amount; from July 1, 2025 every contract creating medical debt must contain a disclosure of this ban, and a contract missing the disclosure is void and unenforceable.
    • Hospital Fair Pricing Act / charity care (as expanded by AB 1020 (2021) and AB 2297 (2024)) (Cal. Health & Safety Code § 127400 et seq.) — Hospitals must offer free or discounted care to patients at or below 400% of the federal poverty level, wait at least 180 days before sending bills to collections, and (per AB 2297, eff. 2025) may not place liens on primary residences or consider assets in charity-care eligibility.
    • Rosenthal Act and Fair Debt Buyer Practices Act coverage of medical debt (Cal. Civ. Code §§ 1788-1788.33; §§ 1788.50-1788.66) — California's mini-FDCPA applies to original creditors (including hospitals and medical groups) as well as third-party collectors, and Civ. Code § 1788.14 bars suing or threatening suit on time-barred debt and requires time-barred-debt disclosures.
  5. Know the clock. The statute of limitations on medical debt in California is 4 years (Cal. Code Civ. Proc. § 337 (4 years, written contracts and book accounts/accounts stated/open mutual accounts); Cal. Code Civ. Proc. § 339 (2 years, oral contracts); Cal. Code Civ. Proc. § 360 (acknowledgment/payment)). Medical debt laws in California →

Insured, but this isn’t covered, or not covered enough?

Most of this page applies to you as well. The pre-visit rights turn on whether a claim will be filed, not on whether you hold a card.

  • Choose self-pay for the service. Federal rule (45 CFR 149.610) treats a patient who has coverage but does not want a claim submitted as self-pay for that item of care. Say so in writing before the visit, and the Good Faith Estimate and the $400 dispute apply to you. The trade: what you pay this way does not count toward your deductible or out-of-pocket maximum, so compare the self-pay quote with your plan’s allowed amount before you choose.
  • Financial assistance with insurance. Federal law requires a nonprofit hospital’s policy to say who qualifies, and many cover the patient’s share after insurance. California's floor (Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297)) reaches insured patients when out-of-pocket costs are high relative to income; the statute sets the test, and the hospital's policy may go further.
  • A denied claim is a different path. Appeal it, first inside the plan and then through independent external review. How to appeal an insurance denial →
  • A high deductible. Until you meet it you are paying the plan’s negotiated rate yourself. Ask for the self-pay price too; it can be lower, but paying it means that visit will not count toward the deductible.

Going without coverage in California: the state’s own rules

  • Penalty. The federal penalty has been $0 since 2019, but California runs its own coverage mandate (Cal. Rev. & Tax. Code § 61000 et seq. (Individual Shared Responsibility Penalty)). Going without coverage can mean a penalty on your state return unless you qualify for an exemption, such as a short gap or unaffordable coverage. The California Franchise Tax Board publishes this year’s amounts and exemptions.
  • Getting back on. Losing coverage opens a 60-day special enrollment window on the marketplace; so does a move, a marriage, or a birth. Outside those windows, the next chance is open enrollment each fall. If your income drops, check Medicaid: in many states it can start retroactively, though that lookback shrinks to one or two months on January 1, 2027.
  • Savings accounts. You cannot contribute to a Health Savings Account without a qualifying high-deductible plan, though you can still spend an existing balance tax-free on care. Unreimbursed medical costs above 7.5% of adjusted gross income remain deductible if you itemize.

Common questions

Can a hospital in California refuse to treat me because I have no insurance?

Not in an emergency. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), any hospital with an emergency department that takes Medicare must give you a medical screening exam and stabilize an emergency condition regardless of your ability to pay. EMTALA does not make the care free: the bill still comes, and that is when the financial assistance rules on this page apply. For non-emergency care, a hospital or clinic can ask for payment arrangements first.

Do hospitals in California have to give uninsured patients a discount?

Under Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297), every licensed hospital in California must offer discounted care up to 400% of the guideline, charges to eligible uninsured patients capped at the Medicare or Medicaid rate. A hospital's own policy can be more generous, never less.

What is a Good Faith Estimate, and when am I owed one?

If you are uninsured or tell a provider you will not use insurance, federal law (45 CFR 149.610, part of the No Surprises Act) requires a written, itemized estimate of expected charges for scheduled care: within one business day if the appointment is at least three business days away, within three business days if it is at least ten days away, and on request before you book. It applies to every licensed provider and facility, not only hospitals.

What if the bill comes in higher than the estimate?

If a provider or facility bills you at least $400 more than its Good Faith Estimate, you can start the federal patient-provider dispute resolution process within 120 calendar days of the bill date. The filing fee is $25, the provider cannot send the bill to collections while the dispute is open, and the outcome cannot raise what you owe. The $400 threshold is per provider, not per episode of care.

Is there a penalty for not having health insurance in California?

The federal penalty has been $0 since 2019, but California runs its own coverage mandate (Cal. Rev. & Tax. Code § 61000 et seq. (Individual Shared Responsibility Penalty)). Going without coverage can mean a penalty on your California return unless you qualify for an exemption, such as a short gap or unaffordable coverage. The California Franchise Tax Board publishes this year's amounts and exemptions.

How long do I have to apply for hospital financial assistance after the visit?

Under federal rules for nonprofit hospitals (26 CFR 1.501(r)-6), you can apply for at least 240 days after the first bill is sent, and for 120 days the hospital may not report you to a credit bureau, sue, or sell the debt. If you are found eligible later, those collection actions must be reversed. California's own rule (Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297)) applies on top of that.

I have insurance, but this service is not covered. Does any of this apply to me?

Yes. The Good Faith Estimate and the $400 dispute rule apply to anyone who tells the provider they will not use insurance for a service, including people who have a plan that does not cover it. Say so in writing before the visit; what you pay that way does not count toward your deductible. Hospital financial assistance often reaches insured patients' out-of-pocket share as well: federal law leaves that to each nonprofit hospital's policy. California's floor (Cal. Health & Safety Code § 127400 et seq. (AB 1020; AB 2297)) reaches insured patients when out-of-pocket costs are high relative to income; the statute sets the test, and the hospital's policy may go further. A denied claim is a different path: appeal it, internally and then through external review.

Where can I get care in California without insurance when it is not an emergency?

Federally funded community health centers must see you regardless of insurance and charge on a sliding scale: a nominal fee at or under 100% of the federal poverty guideline, with discounts up to 200%. Find one through the HRSA health center locator. Free and charitable clinics are listed by the National Association of Free and Charitable Clinics. For prescriptions, you can always pay the cash price instead of using insurance.

Keep reading

Legal information, not legal advice. Statutes change and courts interpret them — for advice on your situation, talk to a lawyer or your state’s legal aid office. Last reviewed AUG 2026.

State debt-law citations reviewed AUG 2026 · uninsured section reviewed 2026-10-01

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