Rural Health Clinic & Professional Services

NOTICE MEDICAL CARE FOR THOSE WHO CANNOT AFFORD TO PAY

 

In accordance with 22 MSRA 396-F (1) and the rules of the State of Maine, this hospital is required to provide Free Care to patients whose income falls below the poverty income guidelines.

 

Size of Family                    2021 Income Guidelines

1……………………………….$19,320

2……………………………….$26,130

3……………………………….$32,940

4……………………………….$39,750

5……………………………….$46,560

6……………………………….$53,370

7……………………………….$60,180

8……………………………….$66,990

Add $6,720 for each additional person.

If you believe you qualify for Free Care, please apply at the Cashier Office.

Before providing Free Care, the hospital will ask for information about your income and also ask you to show that insurance or a governmental medical assistance program will not pay for your care.

 Proof of income (FOR THE LAST 3 MONTHS) is needed at the time of application.

 Services that are not medically necessary are not provided as free care (ex. dental, circumcision, sterilization)     

 

Sliding Fee Scale for those who cannot pay.

Size of Family If your income is in one of these

columns:

1 19,320 21,252 23,184 25,116 27,048
2 26,130 28,743 31,356 33,969 36,582
3 32,940 36,234 39,528 42,822 46,116
4 39,750 43,725 47,700 51,675 55,650
5 46,560 51,216 55,872 60,528 65,184
6 53,370 58,707 64,044 69,381 74,718
7 60,180 66,198 72,216 78,234 84,252
8 66,990 73,689 80,388 87,087 93,786
You Pay:  

0%

 

20%

 

40%

 

60%

 

80%

Of total bill.

 

If you believe you may qualify for the Sliding Fee Discount, please apply at the Cashier’s Office.  Before providing the discount, we will ask for information about your income.  Also, you will be asked to show proof you are not covered by insurance or a government assistance program.  Proof of income will be needed at time of application.

 

Revised:  01/22/2021