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.

Who is eligible for Financial Assistance and what are the requirements?

The Medical Financial Assistance (MFA) program helps low-income, uninsured, or 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 (FPG). 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 (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.

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 of Hawaii.

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) Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese
Program Summary (English) Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese
Program Application (English) Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese

Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-808-432-7940 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 and Emergency Room Departments in Kaiser Foundation Hospitals. Financial Counselors are also available at Kaiser Permanente medical centers and medical office buildings to provide program information and to quickly determine MFA eligibility. Financial Counselors are available Monday through Friday, 8:30 a.m. to 5 p.m. at the Business Services Office in each of the following Kaiser Permanente facilities:

Moanalua Medical Center (Mapunapuna)
3288 Moanalua Road
Honolulu, HI 96819

Honolulu Medical Office Building (Windward, Hawaii Kai and Ala Moana)
1010 Pensacola Street
Honolulu, HI 96813

Waipio Medical Office Building (Leeward)
94-1480 Moaniani Street
Waipahu, HI 96797

Mapunapuna Medical Office Building 
2828 Pa’a Street
Honolulu, HI 96819

Request program information by telephone: Financial Counselors are available by telephone to provide information, determine MFA eligibility, and assist a patient to apply for MFA. Financial Counselors can be reached Monday – Friday, 8:30 a.m. – 5 p.m. at:

  • Moanalua Medical Center (Mapunapuna) 1-808-432-7940
  • Honolulu Medical Office Building (Windward, Hawaii Kai and Ala Moana) 1-808-432-2020
  • Waipio Medical Office Building (Leeward) 1-808-432-3297
  • Big Island Medical Office Buildings 1-800-598-5928 (toll free)
  • Mapunapuna Medical Office Building 1-808-432-7940

Request program information by mail: A patient can request program information by mail. Information requests can be mailed to:

Kaiser Permanente
Attention: Medical Financial Assistance Unit
Business Services Dept. / Financial Counselors
3288 Moanalua Road
Honolulu, HI 96819

How do I apply?

A patient can apply for the MFA program, during or following the care received from Kaiser Permanente, in several ways including in person with a Financial Counselor, or by submitting a complete paper application.

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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 5 p.m. Hawaii time.

  • Moanalua Medical Center
  • Waipio Medical Office Building
  • Honolulu Medical Office Building
  • Mapunapuna Medical Office Building

Be prepared to provide all the information listed on the MFA application.

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Call us

  • Call us at 1-808-432-7940 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m. Hawaii time.
  • Be prepared to provide the information listed on the MFA application.
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Mail it

  • Complete the MFA application on the following page.
  • Mail your completed application to: 
  • Kaiser Permanente MFA Program Business Services
    3288 Moanalua Road
    Honolulu, HI 96819
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Fax it

  • Complete the MFA application.
  • Fax your completed application to 1-808-432-7950.
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Drop it off

  • Complete the MFA application.
  • Drop off your completed application at the Business Services Office at any Kaiser Permanente facility.

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

Amounts Generally Billed 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 co-pays and deductibles) for emergency or medically necessary services, based on actual claim data from October 1, 2020, to September 30, 2021, 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 2022 AGB reduction to gross charges is 69% 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 1-808-432-5955.

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 1-808-432-7940, or speak to a Financial Counselor within the Business Services Department at the Kaiser Permanente hospital.