Medical Financial Assistance Program for Georgia

Having trouble paying for your Kaiser Permanente medical and pharmacy expenses?

Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, collectively referred to as Kaiser Permanente, are committed to providing programs that facilitate access to care for vulnerable populations. This commitment includes providing financial assistance to qualified patients who are uninsured or underinsured and have low incomes, when the ability to pay for services is a barrier to accessing emergency and medically necessary care.

Medical Financial Award amounts are based on your household income (income before taxes and deductions) as a percentage of the 2024 federal poverty guidelines:

  • 100% of your share of eligible medical costs for households with incomes at or below 200% of the federal poverty guidelines
  • 50% of your share of eligible medical costs for households with incomes between 201% and 300% of the federal poverty guidelines
Visit aspe.hhs.gov/poverty to find the guidelines for larger households.
2024 federal poverty level guidelines 
If your household or family size is: 100% award for gross monthly household income at or below 200% of FPG 50% award for gross monthly household income between 201% and 300% of FPG
1

Up to $2,510

$2,511 to $3,765

2

Up to $3,407

$3,408 to $5,110

3

Up to $4,303

$4,304 to $6,455

4

Up to $5,200

$5,201 to $7,800

5

Up to $6,097

$6,098 to $9,145

6

Up to $6,993

$6,994 to $10,490

Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. An MFA award is not a covered benefit and does not change the services covered or cost-sharing owed under your plan.

Who is eligible for Financial Assistance and what are the requirements?

The Medical Financial Assistance (MFA) program helps low-income, uninsured, or underinsured patients who need help paying for all or part of their medical care received from Kaiser Permanente. Patients are eligible for financial assistance when their family income is at or below 300% of the federal poverty guidelines. Patients should consult with a counselor to determine eligibility and for assistance applying. Patients who have experienced unusually high medical expenses may be eligible for the program, regardless of household income. Refer to the MFA Policy for a complete description of the program eligibility requirements.

What does the program cover?

The MFA program covers emergency and medically necessary health care services, pharmacy services and products, and medical supplies provided at Kaiser Permanente facilities (such as hospitals, medical centers, and medical office buildings), at Kaiser Permanente outpatient pharmacies, or by Kaiser Permanente providers. Services that are not considered emergent or medically necessary as determined by a Kaiser Permanente provider include, but are not limited to, cosmetic surgery or services, infertility treatments, retail medical supplies, surrogacy services, and services related to third-party liability, or workers’ compensation cases. Refer to the MFA Policy for a complete list of eligible and ineligible services.

How can I get program information?

Copies of the MFA policy, application forms application forms, instructions, and plain-language summaries (including policy summaries or program brochures) are available to the general public, without charge, from Kaiser Permanente's website, by email, in person, by telephone, or by U.S. mail.

Download program information: 

Medical Financial Assistance Policy (English) Arabic, Bengali, Chinese, Croatian, Farsi, French, Gujarati, Haitian, Hindi, Hmong, Japanese, Korean, Laotian, Portuguese, Russian, Spanish, Tagalog, Tamil, Telugu, Thai, Ukrainian, Urdu, Vietnamese
Program Summary (English) Spanish
Program Application  (English) Spanish

Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-404-949-5112 to request electronic copies. Please be prepared to provide an email address that the information can be sent to when calling.

Request program information by telephone:  1-404-949-5112, or TTY: 1-800-255-0056.  Monday through Friday, 8:30 a.m. to 4:30 p.m.

Obtain program information in person: Counselors are available at Kaiser Permanente facilities to provide program information and will forward the application for review to the appropriate medical financial department at the following locations:

  • Cascade Medical Center
  • Crescent Medical Center
  • Cumberland Medical Center
  • Glenlake Comprehensive Specialty Center
  • Gwinnett Medical Center
  • Panola Medical Center
  • Southwood Comprehensive Medical Center
  • Sugar Hill-Buford Medical Center
  • TownPark Medical Center

Request program information by U.S. mail: A patient can request program information by mail. Information requests can be mailed to:

Kaiser Permanente
Attention: Patient Financial Services
Nine Piedmont Center
3495 Piedmont Road, Northeast
Atlanta, Georgia 30305-1736

How do I apply?

You can apply for medical financial assistance through Kaiser Permanente during or following a course of care or treatment received from Kaiser Permanente. To be eligible for the program, you must demonstrate an immediate need caused by a bill for an outstanding balance for Kaiser Permanente services, a scheduled appointment with Kaiser Permanente, or a pharmacy prescription ordered by a Kaiser Permanente provider for eligible services and meet income qualifications.

When you apply, you will be asked to list your household size and total gross household income, which will be validated by an external data source. Applying online is the quickest and easiest way to apply. If your income recently changed or you prefer to submit current financial documentation, the table below lists the optional documents to submit according to your household income source(s).

Income verification is part of determining eligibility for medical financial assistance. Including proof-of-income documentation with your completed application will assist in confirming the accuracy of your income during the review process.

Household income source(s) Provide only one of the following per income source
Business, rental income
  • Recent W-2s, 1099 statement(s)
  • Tax return
Employment income, wages
  • Recent pay stubs 
  • Recent W-2s, 1099 statement(s)
  • Tax return
Received pension, retirement, annuities income
  • Recent pay stubs
  • Pension/retirement disbursement statement
  • Recent W-2s, 1099 statement(s)
  • Tax return
Self-employed income
  • Recent pay stubs
  • Recent W-2s, 1099 statement(s) 
  • Tax return
Social Security, Supplemental Security Income
  • Benefit verification letter from the Social Security Administration
  • Social Security statement
Unemployment benefits, disability income
  • Unemployment/disability benefits verification letter
  • Recent W-2s, 1099 statement(s)
  • Tax return
Veteran benefits income
  • VA benefits verification letter
  • Recent W-2s, 1099 statement(s)
  • Tax return
Government assistance
(ex. Medicaid, TANF, SNAP, WIC, or low-income housing)
  • Approval of eligibility letter
Interest or dividends income
  • Recent tax return
Spousal/child support payments received
  • Written explanation

Important: Any missing or unclear information may delay the application process or result in a denial.

What should I expect after I apply?

After we review your completed application, we’ll send you a decision within thirty (30) days of receipt. If it is not approved, we will provide a reason for the denial and instructions on how to appeal the decision if you disagree. 

Apply online

  • Before starting the online application process, be prepared to provide all the information listed on the MFA application.
  • To begin your application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to complete your application. 

Fax it

  • Complete the MFA application.
  • Fax your completed application to 404-364-4985.

Mail it

  • Complete the MFA application.
  • Mail your completed application to:

    Kaiser Permanente MFA Program
    Nine Piedmont Center
    3495 Piedmont Rd, NE
    Atlanta, GA 30305

Drop it off

  • Complete the MFA application.
  • Drop off your completed application at the Patient Business Office at any Kaiser Permanente Medical Office Building.

Meet with a financial counselor

Schedule an appointment with a financial counselor at one of our designated facilities, Monday through Friday, 8:30 a.m. to 4:00 p.m. EST.

  • Cascade Medical Center
  • Crescent Medical Center
  • Cumberland Medical Center
  • Glenlake Medical Center
  • Gwinnett Medical Center
  • Panola Medical Center
  • Southwood Medical Center
  • Sugar Hill-Buford Medical Center
  • Town Park Medical Center

Be prepared to provide all the information listed on the MFA application.

Kaiser Permanente will review submitted applications when they are complete and will determine whether you are eligible according to the Kaiser Permanente Medical Financial Assistance Policy. Incomplete applications may result in a delay in processing or denial of your MFA application, but Kaiser Permanente will notify applicants and provide an opportunity to send in the missing documentation or information, by the required deadline.

Appeal process

Amounts Generally Billed (AGB)

Amounts Generally Billed apply to eligible hospital services rendered at a Kaiser Foundation Hospital only and do not apply to services provided by the Georgia Region.

Is there language assistance?

Interpreters are available to you at no cost. The medical financial assistance application, policy, and the policy summary may be available in your language. For more information, call 1-404-949-5112.

Other beneficial programs and extra resources:

If you don’t have health care coverage and would like more information, call us at 1-800-479-5764 (TTY 711) Monday through Friday between 9 a.m. and 5 p.m. to learn more about your coverage options.

We’re here to support you however we can. If you need help with essentials like food, housing, paying for internet or other utilities, and more, the Kaiser Permanente Community Support Hub can help connect you to resources in your community. Call 1-800-443-6328 (TTY 711), Monday through Friday between 8 a.m. and 5 p.m.

Need help?

For help or questions about the Medical Financial Assistance application process or other questions, please call 1-404-949-5112, or speak to a Business Office Supervisor within the Patient Business Office.