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?

As of March 1, 2022, 50% awards apply to outpatient, specialty, and mail-order 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.  

Beginning 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 point-of-sale or when ordering by mail. 

*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

If your household or family size is:
2022 federal poverty guidelines
100% award for gross annual income at or below 200% of FPG 50% award for gross annual income between 201% and 300% of FPG
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?

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. 

 
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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 provide your full name and email in 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.
icon of an envelope

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
icon of a fax machine with a sheet of paper in it.

Fax it

  • Complete the MFA application.
  • Fax your completed application to 404-364-4985.
Icon of a sheet of paper and a pen, with writing on it.

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.

How do I appeal?

If your application was recently denied or you believe you qualify for a larger award, you can appeal the decision by providing the following:

  1. A letter indicating why you’re appealing (job loss, for example)
  2. Current financial documentation of your total gross household income to support your appeal; Refer to the table below for the required documentation of your income source

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

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:

  • Proof of income for your annual gross household income
  • Proof of non-Kaiser Permanente medical and/or dental expenses
    • You must provide an itemized bill with the following information:
      • Provider’s name and address
      • Patient’s name
      • Description of services or supplies provided

Any payments you make before an appeal is approved and will not be refunded.

How long do I have to appeal?

  • To appeal a denial:
    • You have 30 days to file an appeal.
    • After 30 days, you will be asked to submit a new MFA 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 you have experienced a change in income, you can provide current or updated documentation, as listed in the financial documentation table above.

How to submit an appeal letter and documentation?

To submit your appeal letter and documentation, please fax or mail using the contact information below:

  • By Fax: 1-404-364-4985​
  • By Mail:
    Kaiser Permanente MFA Program​
    Nine Piedmont Center
    3495​ Piedmont Rd, NE
    Atlanta, GA 30305

Send copies of official documents; originals are not required.

Write the following information on the first page of your proof of income:

  • First and last name
  • Medical record number (if any)
  • Home address
  • Date of birth

How long will it take for my appeal to be reviewed?

Once we receive the requested documentation, we’ll send you a decision about 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 (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.