Medical Financial Assistance Program

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

Kaiser Foundation Hospitals and Kaiser Foundation Health Plans, 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 low income, uninsured, and underinsured patients when the ability to pay for services is a barrier to accessing emergency and medically necessary care. Patients must meet the eligibility requirements below to qualify.

What's new?

Beginning March 1, 2022, all current 50% awards will now be applied to outpatient pharmacy. If you have a 50% MFA award, you are expected to pay the remaining pharmacy balance at point of sale or when ordering by mail.  All Medicare patients approved for MFA will continue to receive a temporary 100% award for pharmacy until further notice.

*Family income based on the 2022 federal poverty levels:

  • 100% of your share of eligible medical costs for households with incomes at or below 200% of the federal poverty level
  • 50% of your share of eligible medical costs for households with incomes between 201% and 300% of the federal poverty level
Household/family size Income at or below 200% Income between 201% and 300%
1 $27,180 $27,181 to $40,770
2 $36,620 $36,621 to $54,930
3 $46,060 $46,061 to $69,090
4 $55,500 $55,501 to $83,250
5 $64,940 $64,941 to $97,410
6 $74,380 $74,381 to $111,570

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. The MFA award is not a covered benefit and will not impact your existing plan coverage.

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 (i.e. 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 (e.g., 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. postal mail.

Download program information: Electronic copies of program information are available:
 

Medical Financial Assistance Policy (English) Spanish
Program Summary (English) Spanish
Program Application  (English) Spanish

Request program information electronically: Electronic copies of program information are available by email upon request. Call 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:  404-949-5112, or TTY: 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 to quickly determine MFA eligibility. Counselors are available at the following medical office buildings to assist patients:

  • 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

Request program information by U.S. postal 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?

If you meet the eligibility requirements, you can apply in any of these ways.
 

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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 fill out and submit the form below. Once submitted, you will receive instructions via email on how to complete your application. 
     

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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.

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Call us

  • Call us at 404-949-5140 (TTY 711), Monday through Friday, 8:30 a.m. to 4:00 p.m. EST.
  • Be prepared to provide the information listed on the MFA application.
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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
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Fax it

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

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

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.

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 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 housing, childcare, or food, Thrive Local Connections 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 404-949-5112, or speak to a Business Office Supervisor within the Patient Business Office.