Medical Financial Assistance Program for the Mid-Atlantic States
- What's new? »
- Who is eligible? »
- What does the program cover? »
- How do I apply? »
- Appeal process »
- Other programs and resources »
- Need help? »
- Leer esto en español »
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. Patients must meet the eligibility requirements explained below to qualify.
What's new?
As of June 1, 2022, when applying for medical financial assistance, award amounts will be based on your gross household income (before taxes) as a percentage of the federal poverty guidelines. If your household has a higher income, you may qualify for an award equal to a maximum of 50% of your share of eligible medical expenses. Households with lower incomes can qualify for an award covering up to 100% of their share of eligible medical costs.
As of October 1, 2022, patients with Medicare Part D who are approved for a partial MFA award will be expected to pay the remaining pharmacy balance at the point of sale or when ordering by mail.
Award amounts are based on your household income as a percentage of the 2023 federal poverty guidelines:
- 100% of your share of eligible costs for households with incomes at or below 200% of the federal poverty guidelines
- 50% of your share of eligible costs for households with incomes between 201% and 300% of the federal poverty guidelines
| If your household or family size is: | 2023 federal poverty guidelines (FPG) |
|
|---|---|---|
| 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 $2,430 | $2,431 a $3,645 |
| 2 | Up to $3,287 | $3,288 a $4,930 |
| 3 | Up to $4,143 | $4,144 a $6,215 |
| 4 | Up to $5,000 | $5,001 a $7,500 |
| 5 | Up to $5,857 | $5,858 a $8,785 |
| 6 | Up to $6,713 | $6,714 a $10,070 |
Disclaimer aspe.hhs.gov/poverty to find the guidelines for larger households.
Disclaimer
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, and 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, 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) | Spanish, Vietnamese |
| Program Summary (English) | Spanish, Vietnamese |
| Program Application (English) | Spanish, Vietnamese |
Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-844-412-0919 to request electronic copies. Please be prepared to provide an email address that the information can be sent to when calling.
Obtain program information in person: Visit Member Services at any Kaiser Permanente medical center.
Request program information by telephone: Counselors are available by telephone to provide information, determine MFA eligibility, and assist a patient to apply for MFA. Counselors can be reached at: 1-844-412-0919 Monday through Friday, 9:30 a.m. to 3:30 p.m.
Request program information by U.S. mail: A patient can request program information by mail. Information requests can be mailed to:
Kaiser Permanente
Attention: Medical Financial Assistance Program
2101 East Jefferson Street
Rockville, MD 20852-9468
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, you can fax or mail your MFA program application, along with your supporting financial documentation, as specified below.
Household income source |
Financial documentation to submit |
|---|---|
| Employment income wages | Current pay stub with pay period and year-to-date gross wages |
| Business income/rental property | Most recent tax return and all schedules |
| Unemployment benefits/disability income | Unemployment Benefit Payment Summary showing your gross weekly benefits |
| Alimony/child support | Court Divorce Decree/amount awarded |
| Pension or retirement/annuities | Monthly gross benefit letter or most recent tax return and all schedules filed |
| Social Security/Supplemental Security Income/veterans benefits | Social Security and/or monthly veterans benefit letter showing the gross benefit |
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.
Mail it
- Complete the MFA application.
- Mail your completed application to:
Kaiser Permanente MFA Program
2101 East Jefferson Street
Rockville, MD 20852
Drop it off
- Complete the MFA application.
- Drop off your completed application at Member Services at any Kaiser Permanente medical center.
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 Mid-Atlantic States 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 1-844-412-0919.
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 or housing, or need assistance paying bills, start your search at kp.org/communityresources or 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 1-844-412-0919, or speak to a MFA Specialist within the MFA Department or the Administration office at your local Kaiser Permanente Medical Center Building.