Kaiser permanente medical financial assistance program application

Program Description

Kaiser Permanente’s Medical Financial Assistance program provides financial assistance for qualifying patients who need help paying for emergency or medically necessary care they receive in a Kaiser Permanente facility or by a Kaiser Permanente provider.  Patients must fill out an application to apply and must meet the eligibility requirements listed below to qualify.

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

For eligibility requirements and other information, please visit Kaiser Permanente’s national MFA web page: http://kp.org/mfa/scal

Need Help?

For help or questions about the medical financial assistance application process, please call 866-399-7696, or speak to a financial counselor within the Admitting Department at any Kaiser Permanente hospital.

• What's new? »
• Who is eligible? »
• What does the program cover? »
• How do I apply? »
  • Apply online »
• How do I appeal? »
• Other programs and resources »
• Need help? »
• Leer esto en español »

Having trouble paying for your Kaiser Permanente medical and pharmacy expenses?

Kaiser Foundation Health Plan and Kaiser Foundation Hospitals, 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 patients who are uninsured or underinsured and have low incomes, when the ability to pay for services is a barrier to accessing emergency and medically necessary care. Patients must meet the eligibility requirements explained below to qualify.

What's new?

As of August 1, 2022, when applying for medical financial assistance, award amounts will be based on your gross household income (before taxes) as a percentage of the federal poverty level. If your household has a higher income, you may qualify for an award equal to a maximum of 50% of your share of eligible medical expenses. Households with lower incomes can qualify for an award covering up to 100% of their share of eligible medical costs.

Beginning October 1, 2022, patients with Medicare Part D who are approved for a partial MFA award, will be expected to pay the remaining pharmacy balance at the point of sale or when ordering by mail. 

Award amounts will be based on your household income as a percentage of the 2022 federal poverty levels:

• 100% of your share of eligible costs for households with incomes at or below 200% of the federal poverty level
• 50% of your share of eligible costs for households with incomes between 201% and 300% of the federal poverty level

Visit aspe.hhs.gov/poverty to find the guidelines for larger households.

Note: Past MFA award recipients aren’t guaranteed future awards. Kaiser Permanente reserves the right to change the terms and conditions of the MFA program at any time. The MFA award is not a covered benefit and will not impact your existing plan coverage.

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 (such as 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 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 for Hawaii.

How can I get program information?

Copies of the MFA policy, application forms, instructions, and plain language summaries (such as 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:

Request program information electronically: Electronic copies of program information are available by email upon request. Call 1-808-432-7940 or 1-800-598-5928 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
3288 Moanalua Road
Honolulu, HI 96819

Honolulu Medical Office Building
1010 Pensacola Street
Honolulu, HI 96813

Waipio Medical Office Building
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 through Friday, 8:30 a.m. to 5 p.m. Hawaii time, at 1-808-432-7940 or 1-800-598-5928.

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

Kaiser Permanente
Attention: MFA Program – Business Services 
3288 Moanalua Road
Honolulu, HI 96819

How do I apply?

You can apply for medical financial assistance through Kaiser Permanente during or following a course of care or treatment received from Kaiser Permanente. To be eligible for the program, you must demonstrate an immediate need caused by a bill for an outstanding balance for Kaiser Permanente services, a scheduled appointment with Kaiser Permanente, or a pharmacy prescription ordered by a Kaiser Permanente provider for eligible services and meet income qualifications.

When you apply, you will be asked to list your household size and total gross household income, which will be validated by an external data source. Applying online is the quickest and easiest way to apply. If your income recently changed or you prefer to submit current financial documentation, you can fax or mail your MFA program application, along with your supporting financial documentation, as specified below. 

Important: Any missing or unclear information may delay the application process or result in a denial.

What should I expect after I apply?

After we review your completed application, we’ll send you a decision within 30 days of receipt. If it is not approved, we will provide a reason for the denial and instructions on how to appeal the decision if you disagree. 

How do I get financial assistance?

Where can I get financial assistance for medical bills Philippines?

What is DOH Medical Assistance Program?