In accordance with the Mercy Health System mission to provide clinically excellent, compassionate for all, with special concern for the poor and disadvantaged, Maine residents may be eligible for financial assistance if family size and income fall within Mercy Health System of Maine guidelines.
Important Notice
Financial Assistance Medical Care For Those Unable To Pay
Fee Discount Schedule for Mercy Health System of Maine
Family
Size |
Federal
Poverty Level
&
DHS Guideline |
MHSM
100% Free Care
(no co payment) |
MHSM
100%
Care |
MHSM
50%
Free Care |
MHSM
40%
Free Care |
MHSM
30%
Free Care |
MHSM
20%
Free Care |
MHSM
10%
Free Care |
| 1 |
$10,830 |
$16,245 |
$16,246- $21,659 |
$21,660 - $22,744 |
$22,745 - $22,829 |
$23,830 - $24,909 |
$24,910 - $25,994 |
$25,995 - $27,075 |
| 2 |
$14,570 |
$21,855 |
$21,856 - $29,139 |
$29,140 - $30,599 |
$30,600 - $32,054 |
$32,055 - $33,509 |
$33,510 - $34,969 |
$34,970 - $36,425 |
| 3 |
$18,310 |
$27,465 |
$27,466 - $36,619 |
$36,620 - $38,454 |
$38,455 - $40,284 |
$40,285 - $42,114 |
$42,115 - $43,944 |
$43,945 - $45,775 |
| 4 |
$22,050 |
$33,075 |
$33,076 - $44,099 |
$44,100 - $46,304 |
$46,305-
$48,509 |
$48,510 - $50,714 |
$50,715 - $52,919 |
$52,920 - $55,125 |
| 5 |
$25,790 |
$38,685 |
$38,686 - $51,579 |
$51,580 - $54,159 |
$54,160 - $56,739 |
$56,740 - $59,319 |
$59,320 - $61,894 |
$61,895 - $64,475 |
| 6 |
$29,530 |
$44,295 |
$44,296 - $59,059 |
$59,060 - $62,014 |
$62,015 - $64,969 |
$64,970 - $67,919 |
$67,920 - $70,874 |
$70,875 - $73,825 |
| 7 |
$33,270 |
$49,905 |
$49,906 - $66,539 |
$66,540 - $69,869 |
$69,870 - $73,194 |
$73,195 - $76,519 |
$76,520 - $79,849 |
$79,850 - $83,175 |
| 8 |
$37,010 |
$55,515 |
$55,516 - $74,019 |
$74,020 - $77,719 |
$77,720 - $81,424 |
$81,425 - $85,124 |
$85,125 - $88,824 |
$88,825 - $91,525 |
Each
additional
person |
$3,740.00 |
$5,610.00 |
$6,300.00 |
$7,480.00 |
$7,850.00 |
$8,230.00 |
$8,600.00 |
$8,970.00 |
Mercy Health System of Maine's financial assistance policy is 2.0 times the Federal Poverty Guideline, and up to 2.5 times the Federal Poverty Guideline on a sliding scale basis (including applicable co-pay). The State of Maine requires charity care at 1.5 times the DHS poverty level. Final determination will be made based upon all income, expense, and asset information submitted in the Financial Assistance Application/Disclosure in accordance with the Charity Care Policy.
If you believe you might be eligible for financial assistance, please call Mercy's Financial Assistance Office (207) 822-2558 or toll free within Maine 1-800-293-6583 (ask for extension 2558); contact us by email; or visit our office, located at Mercy Hospital, 144 State Street, on Level B1, Monday through Friday, 8:00 am - 4:30 pm Financial assistance is provided only for services that are medically necessary. A Mercy representative will ask for information about your income, health insurance, or other supplemental income, such as government subsidy.
Download the financial assistance letter and application.
* Subject to information provided in Financial Assistance Application/Disclosure