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 $14,580 150% FPL $21,870 200% FPL $29,160 250% FPL $36,450 300% FPL $43,740
Family Size 2 People 100% FPL $19,720 150% FPL $29,580 200% FPL $39,440 250% FPL $49,300 300% FPL $59,160
Family Size 3 People 100% FPL $24,860 150% FPL $37,290 200% FPL $49,720 250% FPL $62,150 300% FPL $74,580
Family Size 4 People 100% FPL $30,000 150% FPL $45,000 200% FPL $60,000 250% FPL $75,000 300% FPL $90,000
Family Size 5 People 100% FPL $35,140 150% FPL $52,710 200% FPL $70,280 250% FPL $87,850 300% FPL $100,000
Family Size 6 People 100% FPL $40,280 150% FPL $60,420 200% FPL $80,560 250% FPL $100,000 300% FPL $100,000
Family Size 7 People 100% FPL $45,420 150% FPL $68,130 200% FPL $90,840 250% FPL $100,000 300% FPL $100,000
Family Size 8 People 100% FPL $50,560 150% FPL $75,840 200% FPL $101,120 250% 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 95% 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 04/2023

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