Financial Assistance & Billing

Schedule 2: CoxHealth Financial Assistance Income and Discount Schedule

Table I: Family Income Ranges for Financial Assistance

Family Size 100% FPL 150% FPL 200% FPL 250% FPL 300% FPL
Family Size 1 Person 100% FPL $13,590 150% FPL $20,385 200% FPL $27,180 250% FPL $33,975 300% FPL $40,770
Family Size 2 People 100% FPL $18,310 150% FPL $27,465 200% FPL $36,620 250% FPL $45,775 300% FPL $54,930
Family Size 3 People 100% FPL $23,030 150% FPL $34,545 200% FPL $46,060 250% FPL $57,575 300% FPL $69,090
Family Size 4 People 100% FPL $27,750 150% FPL $41,625 200% FPL $55,500 250% FPL $69,375 300% FPL $83,250
Family Size 5 People 100% FPL $32,470 150% FPL $48,705 200% FPL $64,940 250% FPL $81,175 300% FPL $97,410
Family Size 6 People 100% FPL $37,190 150% FPL $55,785 200% FPL $74,380 250% FPL $92,975 300% FPL $100,000
Family Size 7 People 100% FPL $41,910 150% FPL $62,865 200% FPL $83,820 250% FPL $100,000 300% FPL $100,000
Family Size 8 People 100% FPL $46,630 150% FPL $69,945 200% FPL $93,260 250% FPL $100,000 300% FPL $100,000

Additional Information

  1. CoxHealth may make a presumptive determination that a patient is eligible for financial assistance based on Medicaid eligibility.
  2. FPL (Federal Poverty Level) is determined yearly by the U.S. Department of Health and Human Services.

Financial Assistance – Table II: Amount of Discount and Patient Responsibility

FPL 100% or less 101-150% 151-200% 201-250% 251-300%
FPL NHSC Clinic Site Services 100% or less 101-150% 151-200% 201-250% 251-300%
FPL Nominal Fee 100% or less $35.00 101-150% n/a 151-200% n/a 201-250% n/a 251-300% n/a
FPL Copay 100% or less n/a 101-150% $40.00 151-200% $45.00 201-250% $50.00 251-300% n/a
FPL Cost Share % 100% or less 0% 101-150% 10% 151-200% 15% 201-250% 20% 251-300% n/a
FPL Discount 100% or less 100% 101-150% 90% 151-200% 85% 201-250% 80% 251-300% n/a
Non-NHSC Clinic Site
Non-NHSC Clinic Site Copay $35.00 $40.00 $45.00 $50.00 n/a
Non-NHSC Clinic Site Cost Share % 5% 10% 15% 20% n/a
Non-NHSC Clinic Site Discount 95% 90% 85% 80% n/a
Home Care Medical Equipment
Home Care Medical Equipment Copay $50.00 $40.00 $45.00 $50.00 n/a
Home Care Medical Equipment Cost Share % 5% 10% 15% 20% n/a
Home Care Medical Equipment Discount 95% 90% 85% 80% n/a
Hospital Services
Hospital Services Copay
Hospital Services Physician Services in Hospital Inpatient, ER or Outpatient $60.00 $65.00 $70.00 $75.00 n/a
Hospital Services Inpatient Hospital $300 per stay $300 per stay $300 per stay $300 per stay $300 per stay
Hospital Services Emergency Room $100 per visit $100 per visit $100 per visit $100 per visit $100 per visit
Hospital Services Outpatient Hospital $25 per visit $25 per visit $25 per visit $25 per visit $25 per visit
Hospital Services Cost Share % 5% 10% 15% 20% 25%
Hospital Services Discount 5% 90% 85% 80% 75%

Terminology

  • Copay - Nominal fee due from the patient before a discount is applied
  • Cost Share % - Percentage of balance remaining for which patient is responsible after copay is applied
  • Discount - Percentage of balance discounted (written off) after the copay is applied
  • FPL - Federal Poverty Level - determined yearly by U.S. Department of Health and Human Services
  • NHSC Site - Clinic sites who participate in the National Health Service Corp program which supports funding for healthcare professionals in health professional shortage areas
  • Nominal Fee - Small fee due from patient in lieu of a copay and cost share %

Updated 02/2022

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