Medical Financial Assistance Program for Southern California

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

Kaiser Permanente is 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 Assistance award amounts are based on your household income as a percentage of the 2024 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 400% 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 400% of FPG
1

Up to $2,510

$2,511 to $5,020

2

Up to $3,407

$3,408 to $6,813

3

Up to $4,303

$4,304 to $8,607

4

Up to $5,200

$5,201 to $10,400

5

Up to $6,097

$6,098 to $12,193

6

Up to $6,993

$6,994 to $13,987

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 Kaiser Permanente Medical Financial Assistance (MFA) program helps patients with low-income who are uninsured or underinsured, 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 400% 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.

Which providers are and are not covered under the program?

The list of providers in Kaiser Foundation Hospitals that are and are not covered under the MFA policy can be found in our Kaiser Permanente provider list for Southern California.

How can I get program information?

Copies of the MFA policy, application forms, instructions, and plain language summaries (such as 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, Armenian, Bengali, Chinese, Farsi, French, German, Gujarati, Hebrew, Hindi, Hmong, Italian, Japanese, Khmer, Korean, Laotian, Polish, Portuguese, Punjabi, Russian, Spanish, Tagalog, Thai, Ukrainian, Urdu, Vietnamese
Program Summary (English) Arabic, Armenian, Chinese, Farsi, French, German, Greek, Gujarati, HebrewHindi, Hmong, Hungarian, Italian, Japanese, Korean, Laotian, Mon-Khmer, Polish, Portuguese, Russian, Serbo-Croatian, Spanish, Tagalog, Thai, Urdu, Vietnamese
Program Application (English) Arabic, Armenian, Chinese, Farsi, FrenchGermanGreek, Gujarati, Hebrew, Hindi, Hmong, Hungarian, Italian, Japanese, Korean, Laotian, Mon-Khmer, Polish, Portuguese, Russian, Serbo-Croatian, Spanish, Tagalog, Thai, Urdu, Vietnamese

Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-800-390-3507 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: Program information is available at Admitting, Emergency Room, and Patient Financial Advisors departments at any Kaiser Foundation hospital in Southern California.

Request program information by telephone: Counselors are available by telephone to provide information and answer questions regarding MFA. Counselors can be reached at 1-800-390-3507, Monday through Friday, 8 a.m. to 5 p.m.

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

Kaiser Permanente
Attention: Medical Financial Assistance
P.O. Box 7086
Pasadena, CA 91109-7086

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 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 1-866-519-1693.

Mail it

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

    Kaiser Permanente MFA Program
    PO Box 7086
    Pasadena, CA 91109-7086

     

Drop it off

  • Complete the MFA application.
  • Drop off your completed application at your local Kaiser Permanente Hospital Admitting Department.

Meet with a financial counselor

  • Meet with a financial counselor at one of our designated facilities, Monday through Friday, 8 a.m. to 5 p.m. Pacific time.
  • 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

Amounts generally billed is based on the lowest average of the amounts that were paid to a KP facility by private health insurers, Medicare fee-for-service and Medicaid fee-for-service (and co-pays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2022, to September 30, 2023,  which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2024 AGB reduction to gross charges is 65% for hospital charges.

Is there language assistance?

Interpreters are available to you at no cost. The medical financial assistance application, policy, and policy summary may be available in your language. For more information, call 1-800-464-4000.

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 1-800-390-3507, or speak to a financial counselor within the Admitting Department at any Kaiser Permanente hospital.

Help paying your bill

There are free consumer advocacy organizations that will help you understand the billing and payment process. You may call the Health Consumer Alliance at 1-888-804-3536 (TTY 711) or go to healthconsumer.org for more information.

Hospital Bill Complaint Program

The Hospital Bill Complaint Program is a state program, which reviews hospital decisions about whether you qualify for help paying your hospital bill. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program. Go to HospitalBillComplaintProgram.hcai.ca.gov for more information and to file a complaint.