Our Medical Financial Assistance program provides temporary financial assistance to help qualified patients pay for health care based on their financial need. This includes emergency, urgent, or medically necessary care, as well as pharmacy services and products received from Kaiser Permanente providers or facilities.
Patients who qualify get some or all of their costs covered regardless of whether they have health care coverage, or are uninsured, or are underinsured.
Watch our video for a quick overview of MFA, who is eligible, what it covers, and how to apply online.
The policy, application, and plain language summary are available online, by email, in person, by telephone, or by U.S. mail.
Please select the region where you received your service below to find these resources
The MFA program does not cover:
The most convenient option for most people is to apply online.
Alternatively, you can apply via fax, mail, or drop-off.
For more details or to start the application online, see "Get Started" below and select the region where you received the services you need help paying for.
We will make every reasonable effort to process your application promptly. Once we receive the completed application, we’ll send you a letter confirming the outcome within 30 business days. If it is not approved, we will provide a reason for the denial and instructions on how to appeal the decision if you disagree.
You'll need the following information to apply:
Income verification is part of determining eligibility for medical financial assistance. Including proof-of-income documentation with your application will help confirm your income accuracy during the review process. The table below lists the types of documents to submit.
Household income source(s) | Provide only one of the following per income source |
---|---|
Business, rental income |
|
Employment income, wages |
|
Received pension, retirement, annuities income |
|
Self-employed income |
|
Social Security, Supplemental Security Income |
|
Unemployment benefits, disability income |
|
Veteran benefits income |
|
Government assistance (ex. Medicaid, TANF, SNAP, WIC, or low-income housing) |
|
Interest or dividends income |
|
Spousal/child support payments received |
|
Kaiser Permanente offers a variety of bill pay options and resources to help you manage your medical costs. You can pay your bill, set up a payment plan, or view other bill pay options at Help Paying Your Bills.
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 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.
For program materials or to start the application process, please select the region where you received your service:
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at the Admitting, Emergency Room, and Patient Financial Advisors departments at any Kaiser Permanente medical office in Northern California.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 1-800-390-3507 Monday through Friday, 8 a.m. to 5 p.m., Pacific time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente MFA Program
P.O. Box 30006
Walnut Creek, CA 94598
Apply by fax
Fax your completed application to 1-800-687-9901.
Apply by mail
Mail completed application to:
Kaiser Permanente MFA Program
P.O. Box 30006
Walnut Creek, CA 94598.
Drop it off
Drop off your completed application at Patient Financial Operations at any Kaiser Permanente facility.
Call us
Call us at 1-800-390-3507 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Pacific time.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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 |
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.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award, you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
To submit your appeal letter and documentation, please fax or mail using the contact information below:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser Permanente facility by private health insurers, Medicare fee-for-service, and Medicaid fee-for-service (and copays 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, also known as an adjustment, to gross charges is 67% for hospital charges.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-800-464-4000.
Accessible alternative formats include large print, Braille, and audio.
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 in the Admitting Department at any Kaiser Permanente medical facility.
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.
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.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at the Admitting, Emergency Room, and Patient Financial Advisors departments at any Kaiser Permanente medical office in Southern California.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 1-800-390-3507 Monday through Friday, 8 a.m. to 5 p.m., Pacific time
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente MFA Program
P.O. Box 7086
Pasadena, CA 91109-7086
Apply by fax
Fax your completed application to 1-866-519-1693.
Apply by mail
Mail completed application to:
Kaiser Permanente MFA Program
P.O. Box 7086
Pasadena, CA 91109-7086
Drop it off
Drop off your completed application at your local Kaiser Permanente Hospital Admitting Department.
Meet with a financial counselor
Call us at 1-800-390-3507 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Pacific time to find the nearest Kaiser Permanente hospital that provides in-person assistance with your application. (At the prompt, press 1 for Billing and Financial Services.)
Call us
Call us at 1-800-390-3507 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m. Pacific time.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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 |
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.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award, you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, 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 copays 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, also known as an adjustment, to gross charges is 65% for hospital charges.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-800-464-4000.
Accessible alternative formats include large print, Braille, and audio.
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 in the Admitting Department at any Kaiser Permanente medical facility.
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.
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.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at Kaiser Permanente medical facilities.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 303-338-3555, 1-866-899-6018, or TTY: 1-800-659-2656; Monday through Friday, 10 a.m. to 3 p.m. Mountain time.
You can request program information by mail. Information requests can be mailed to:
Northfield Support Services
Attention: MFA Program
11000 E. 45th Ave.
Denver, CO 80239-3004
Apply by fax
Fax your completed application to 1-855-300-3684.
Apply by mail
Mail completed application to:
Northfield Support Services
Attention: MFA Program
11000 E. 45th Avenue
Denver, CO 80239-3004
Drop it off
Drop off your completed application at Patient Registration at any Kaiser Permanente medical office.
Meet with a financial counselor
Schedule an appointment with a financial counselor at one of the designated facilities listed below, Monday through Friday, 8 a.m. to 5 p.m. Mountain time.
Be prepared to provide all the information listed on your application.
Aurora Centerpoint 14701 E. Exposition Ave. Aurora, CO 80012 |
Franklin Medical Offices 2045 Franklin St. Denver, CO 80205 |
Lakewood Medical Offices 8383 W. Alameda Ave. Lakewood, CO 80226 |
Lone Tree Medical Offices 10240 Park Meadows Dr. Lone Tree, CO 80124 |
Rock Creek Medical Offices 280 Exempla Cir. Lafayette, CO 80026 |
Skyline Medical Offices 1375 E 20th Ave. Denver, CO 80205 |
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
Amounts Generally Billed apply to eligible hospital services rendered at a Kaiser Foundation Hospital only and do not apply to services provided by the Colorado Region.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-866-899-6018 or TTY: 1-800-659-2656.
Accessible alternative formats include large print, Braille, and audio.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at Kaiser Permanente medical facilities.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 404-949-5112 (TTY: 1-800-255-0056) Monday through Friday, 8:30 a.m. to 4:30 p.m. Eastern time.
For in-person assistance with application questions, you can schedule an appointment with a financial counselor at any designated medical center, including Cascade, Crescent, Cumberland, Glenlake, Gwinnett, Panola, Southwood, Sugar Hill–Buford, or Town Park. Financial counselors are available at these locations Monday, Wednesday, and Friday, 8:30 a.m. to 4 p.m. Eastern time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente
Attention: Patient Financial Services
Nine Piedmont Center
3495 Piedmont Rd., NE
Atlanta, GA 30305-1736
Apply by fax
Fax your completed application to 1-877-899-5635
Apply by mail
Mail completed application to:
Kaiser Permanente MFA Program
Nine Piedmont Center
3495 Piedmont Rd., NE
Atlanta, GA 30305-1736
Drop it off
Drop off your completed application at the Patient Business Office at any Kaiser Permanente medical office.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
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.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 404-949-5112.
Accessible alternative formats include large print, Braille, and audio.
For help with the medical financial assistance application or other questions, please call 404-949-5112, or speak to a business office supervisor in the Patient Business Office at your local Kaiser Permanente medical office.
Patients affected by the wildfires on Maui are encouraged to contact us at 1-808-432-7940 or 1-800-598-5928 to speak with a financial counselor to determine eligibility and apply for Medical Financial Assistance.
See below for more information or to access program materials.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at the Admitting, Emergency Room, and Patient Financial Advisors departments at any Kaiser Permanente medical office in Hawaii.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 808-432-7940 or 1-800-598-5928 Monday through Friday, 8:30 a.m. to 5 p.m, Hawaii time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente
Attention: MFA Program — Business Services
3288 Moanalua Road
Honolulu, HI 96819
Apply by fax
Fax your completed application to 808-432-7950.
Apply by mail
Mail completed application to:
Kaiser Permanente
Attention: MFA Program — Business Services
3288 Moanalua Road
Honolulu, HI 96819
Drop it off
Drop off your completed application at any Kaiser Permanente facility.
Meet with a financial counselor
Meet with a financial counselor at the Moanalua Medical Center, or the Waipio, Honolulu, or Mapunapuna medical office buildings, Monday through Friday, 8:30 a.m. to 5 p.m. Hawaii time.
Be prepared to provide all the information listed on your application.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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 $2,885 |
$2,886 to $4,328 |
2 | Up to $3,917 |
$3,918 to $5,875 |
3 | Up to $4,948 |
$4,949 to $7,423 |
4 | Up to $5,980 |
$5,981 to $8,970 |
5 | Up to $7,012 |
$7,013 to $10,518 |
6 | Up to $8,043 |
$8,044 to $12,065 |
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.
See the list of providers for Hawaii.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service (and copays 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, also known as an adjustment, to gross charges is 62% for hospital charges.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at Kaiser Permanente medical facilities.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 1-844-412-0919 Monday through Friday, 9:30 a.m. to 3:30 p.m. Eastern time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente MFA Program
2101 East Jefferson St.
Rockville, MD 20852-9468
Apply by fax
Fax your completed application to 1-855-414-1713.
Apply by mail
Mail completed application to:
Kaiser Permanente MFA Program
2101 East Jefferson St.
Rockville, MD 20852
Drop it off
Drop off your completed application at Member Services at any Kaiser Permanente medical center.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines.
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.
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.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
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.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-844-412-0919.
Accessible alternative formats include large print, Braille, and audio.
For help with the medical financial assistance application or other questions, please call 1-844-412-0919, or speak to an MFA specialist in the MFA Department or the Administration Office at your local Kaiser Permanente Medical Office.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at the Admitting, Emergency Room, and Patient Financial Advisors departments at any Kaiser Permanente medical office in Oregon or Southwest Washington.
Counselors are available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Counselors can be reached at 503-813-2000 or 1-800-813-2000 (TTY 711). Monday through Friday, 8 a.m. to 6 p.m. Pacific time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente
Attention: Financial Counselors
500 NE Multnomah St.
Portland, OR 97232
Apply by fax
Fax your completed application to 1-877-829-3547.
Apply by mail
Mail completed application to:
Kaiser Permanente
Attention: Financial Counselors
500 NE Multnomah St.
Portland, OR 97232
Drop it off
Drop off your completed with the Registration (check-in) staff at any Kaiser Permanente facility, Monday through Friday, 8 a.m. through 6 p.m. Pacific time.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines.
2024 federal poverty guidelines | ||||
---|---|---|---|---|
If your household or family size is: | 100% award for gross monthly household income at or below 200% of FPG | 75% award for gross monthly household income between 201% and 300% of FPG | 50% award for gross monthly household income between 301% and 350% of FPG | 25% award for gross monthly household income between 351% and 400% of FPG |
1 | Up to $2,510 | $2,511 to $3,765 | $3,766 to $4,393 | $4,394 to $5,020 |
2 | Up to $3,407 | $3,408 to $5,110 | $5,111 to $5,962 | $5,963 to $6,813 |
3 | Up to $4,303 | $4,304 to $6,455 | $6,456 to $7,531 | $7,532 to $8,607 |
4 | Up to $5,200 | $5,201 to $7,800 | $7,801 to $9,100 | $9,101 to $10,400 |
5 | Up to $6,097 | $6,098 to $9,145 | $9,146 to $10,669 | $10,670 to $12,193 |
6 | Up to $6,993 | $6,994 to $10,490 | $10,491 to $12,238 | $12,239 to $13,987 |
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.
See the list of providers for the Northwest.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service and Medicaid fee-for-service (and copays 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, also known as an adjustment, to gross charges is 64% for hospital charges.
For help with the medical financial assistance application or other questions, please call 1-800-813-2000.
To request a link to the online application, please provide your full name and email in the form below. Once submitted, you will receive instructions via email on how to start a new application.
You can also use the form to add information to an existing application. You can also use it to start an appeal.
You can download the program application, plain-language summary, policy, and other documents. These include translated and screen reader-accessible versions. Program information is also available at Kaiser Permanente medical facilities.
Our staff is available by telephone to provide information, determine MFA eligibility, or help with the MFA application process. Staff can be reached at 1-800-442-4014 (TTY 711), Monday through Friday, 8 a.m. to 5 p.m., Pacific time.
You can request program information by mail. Information requests can be mailed to:
Kaiser Permanente MFA Program
P.O. Box 34584
Seattle, WA 98124-1584
Apply by fax
Fax your completed application to 206-877-0640.
Apply by mail
Mail completed application to:
Kaiser Permanente MFA Program
P.O. Box 34584
Seattle, WA 98124-1584
Drop it off
Drop off your completed application at the Business Office or check-in desk at any Kaiser Permanente facility.
Meet with a financial counselor
Meet with a financial counselor at the Business Office or check-in desk at any Kaiser Permanente facility.
Staff is also available at the Bellevue, Capitol Hill, Olympia, Silverdale, and Tacoma medical centers.
Be prepared to provide all the information listed on your application.
Medical Financial Assistance award amounts are based on your household income as a percentage of the federal poverty guidelines:
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 | 75% award for gross monthly household income between 201% and 250% of FPG | 50% award for gross monthly household income between 251% and 300% of FPG |
1 | Up to $2,510 |
$2,511 to $3,138 |
$3,139 to $3,765 |
2 | Up to $3,407 |
$3,408 to $4,258 |
$4,259 to $5,110 |
3 | Up to $4,303 |
$4,304 to $5,379 |
$5,380 to $6,455 |
4 | Up to $5,200 |
$5,201 to $6,500 |
$6,501 to $7,800 |
5 | Up to $6,097 |
$6,098 to $7,621 |
$7,622 to $9,145 |
6 | Up to $6,993 |
$6,994 to $8,742 |
$8,743 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.
See the list of providers for Washington.
If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision.
Start an appeal application by providing your full name and email address in the form. Once submitted, you will receive instructions via email on how to file an appeal.
You will need to provide:
You may also file an appeal if your medical expenses exceed 10% of your annual gross household income over the previous 12 months.
To do this, you should provide the following:
You will not be refunded for any payments you make before an appeal is approved.
You have 30 days to file an appeal. After 30 days, you will be asked to submit a new application.
To appeal for a larger award you may appeal at any time before the award end date.
If you didn’t provide the requested financial documentation or if your income changed, you can submit additional documentation. See the “What information will I need to apply” section above for the required income documentation.
To submit your appeal via fax or mail, complete and return the Appeal Request form included with your award letter along with supporting documentation:
Send copies of official documents; originals are not required.
Write the following information on the first page of your proof of income:
Once we receive the requested documentation, we’ll send you a letter regarding the decision on your appeal within 30 days. If you file an appeal without including any additional information with your request, we’ll automatically deny your appeal. All appeal decisions are final.
A patient who has received eligible hospital services at a Kaiser Permanente facility and is eligible for the MFA program but has not received an MFA award or has declined an MFA award, is not charged more than the amounts generally billed for those services. Amounts generally billed, or AGB, is based on the lowest average of the amounts that were paid to a Kaiser Permanente facility by Medicare fee-for-service and Medicaid fee-for-service (and copays) 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, also known as an adjustment, to gross charges is 46% for hospital charges.
Interpreters are available to you at no cost. The application, policy, and policy summary may be available in your language. For more information, call 1-888-901-4636.
Accessible alternative formats include large print, Braille, and audio.
For help with the medical financial assistance application or other questions, please call 1-800-442-4014 or speak to staff at the Business Office or at the check-in desk at any Kaiser Permanente medical facility.