For insured and uninsured patients responsible for an Account Balance on or after February 1, 2015
Size of Family 1 2 3 4 5 6 7 8
250% HHS Poverty Income Guidelines

100% Free Care
$0 - 29,425 0 - 39,825 0 - 50,225 0 - 60,625 0 - 71,025 0 - 81,425 0 - 91,825 0 - 102,225
280% HHS Poverty Income Guidelines

85% Free Care
15% Patient Share
$29,426 - 32,956 39,826 - 44,604 50,226 - 56,252 60,626 - 67,900 71,026 - 79,548 81,426 - 91,196 91,826 - 102,844 102,226 - 114,492
310% HHS Poverty Income Guidelines

75% Free Care
25% Patient Share
$32,957 - 36,487 44,605 - 49,383 56,253 - 62,279 67,901 - 75,175 79,549 - 88,071 91197 - 100,967 102,845 - 113,863 114,493 - 126,759
340% HHS Poverty Income Guidelines

50% Free Care
50% Patient Share
$36,488 - 40,018 49,384 - 54,162 62,280 - 68,306 75,176 - 82,450 88,072 - 96,594 100,968 - 110,738 113,864 - 124,882 126,760 - 139,026
370% HHS Poverty Income Guidelines

35% Free Care
65% Patient Share
$40,019 - 43,549 54,163 - 58,941 68,307 - 74,333 82,451 - 89,725 96,595 - 105,117 110,739 - 120,509 124,883 - 135,900 139,027 - 151,293
400% HHS Poverty Income Guidelines

30% Free Care
70% Patient Share
$43,550 - 47,080 58942 - 63,720 74,334 - 80,360 89,726 - 97,000 105,118 - 113,640 120,510 - 130,280 135,902 - 146,920 151,294 - 163,560

Source: Federal Register, Vol 80, Number 14 (Thursday, January 22, 2015)., Pages 3236-3237

For family size with more than eight (8) members add $4,160 for each additional member.

This sliding scale is based on the 2015 HHS Poverty Guidelines for the 48 contiguous states and District of Columbia.

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