Rosa Clark Sliding Fee Scale 2025
Persons in House-hold |
|---|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
At or below 100% FPL or below |
|---|
0 to $15,650 |
0 to $21,150 |
0 to $26,650 |
0 to $32,150 |
0 to $37,650 |
0 to $43,150 |
0 to $48,650 |
0 to $54,150 |
At or 101% - 125% FPL |
|---|
$15,651 to $19,564 |
$21,151 to $26,439 |
$26,651 to $33,314 |
$32,151 to $40,189 |
$37,651 to $47,064 |
$43,151 to $53,939 |
$48,651 to $60,814 |
$54,151 to $67,689 |
At or 126% - 150% FPL |
|---|
$19,565 to $23,475 |
$26,440 to $31,725 |
$33,315 to $39,975 |
$40,190 to $48,225 |
$47,065 to $56,475 |
$53,940 to $64,725 |
$60,815 to $72,975 |
$67,690 to $81,225 |
At or 151% - 200% of FPL |
|---|
$23,476 to $31,300 |
$31,726 to $42,300 |
$39,976 to $53,300 |
$48,226 to $64,300 |
$56,476 to $75,300 |
$64,726 to $86,300 |
$72,976 to $97,300 |
$81,226 to $108,300 |
Above 200% FPL |
|---|
> $31,300 |
> $42,300 |
> $53,300 |
> $64,300 |
> $75,300 |
> $86,300 |
> $97,300 |
> $108,300 |
For families/households with more than 8 persons, add $5,380 for each additional person.
If household income is over 200% of the Federal Poverty Guidelines, no discount will be provided.
All Insurance Co-pays and all Charges to Self-Pay patients will apply unless the patient qualifies for the Sliding Fee Discounts
Sliding Fee Pay Plans |
|---|
Plan 1 |
Plan 2 |
Plan 3 |
Plan 4 |
Primary Care & Mental/Behavioral Health Visits |
|---|
$0.00 |
$2.00 |
$5.00 |
$10.00 |
Pharmacy |
|---|
$0.00 |
$1.00 |
$2.00 |
$3.00 |