In compliance with the Ohio Hospital Care Assurance Program (HCAP), Cleveland Clinic offers basic, medically necessary hospital-level services free of charge to Ohio residents whose incomes are at or below the Federal Poverty Income Guideline and who are not recipients of Medicaid. Current recipients of the Disability Assistance Program also qualify for HCAP assistance.
In addition to the HCAP program, Cleveland Clinic provides financial assistance to patients who do not have insurance coverage at family income levels up to four times the Federal Poverty Income Guideline. Cleveland Clinic also gives consideration to all patients, whether or not they have insurance and regardless of income level if there are exceptional circumstances. The Cleveland Clinic financial assistance program applies to both hospital and physician services.
| Size of Family Unit |
*(HCAP) 2009 Federal
Poverty Income Level |
Cleveland Clinic Financial
CC Financial Assistance Program
(Family income up to 400%
of Federal Poverty Level) |
| For each additional family member add $3,740 |
| 1 |
$10,830 |
$43,320 |
| 2 |
$14,570 |
$58,280 |
| 3 |
$18,310 |
$73,240 |
| 4 |
$22,050 |
$88,200 |
| 5 |
$25,790 |
$103,160 |
| 6 |
$29,530 |
$118,120 |
| 7 |
$33,270 |
$133,080 |
| 8 |
$37,010 |
$148,040 |
* Assistance is provided by Cleveland Clinic on a sliding scale based on the listed income levels (family income level up to four times Federal Poverty Income Level).
If you received medical services at Cleveland Clinic and feel you would qualify to receive these services without cost or at a reduced cost to you please complete this application and return it to:
The Credit and Collection Department/DD2
Cleveland Clinic
9500 Euclid Avenue
Cleveland OH 44195
If you have any questions or wish to speak with a representative regarding the financial assistance programs at The Cleveland Clinic, please contact the Patient Financial Services Department at 1.866.737.4358, option #2.
Financial Assistance Application
Print and complete a Financial Assistance Application (PDF). Return your completed, signed application to the address on the front of the application.
Si usted tener pregunta en relac'ion con financiero ayuda programa en Cleveland clínica, por favor entrar en contacto con nosotros en 1.866.737.4358, opción # 2.
