Financial Assistance

NORTHERN LIGHT MAYO HOSPITAL AND PRIMARY CARE PRICING LISTS 

Northern Light Mayo Hospital has a Financial Assistance Policy that provides patients who qualify with full or partial discounts on their medical bills from Mayo. To seek financial assistance, patients must complete an application as summarized below. Please see our Financial Assistance Policy or contact Northern Light Mayo Hospital, Patient Financial Services Counselor, for more information:


To Qualify

Financial assistance is available to patients that meet income guidelines. It will cover, as shown below, all or part of emergency and medically necessary care. Cosmetic and elective services may not be eligible for assistance. Generally, financial assistance is available for patients whose family incomes are at or below 225% of the Federal Poverty Guideline (FPG).


Amount of Financial Assistance

A 65% discount is available for patients with family incomes above 175% and at or below 225% of FPG. A 100% discount (free care) is available for patients with family incomes at or below 175% FPG. A patient eligible for financial assistance will not be billed more than amounts generally billed to Medicare for emergency or medically necessary care.

2019 FEDERAL POVERTY GUIDELINE (FPG) TABLE

HOUSEHOLD SIZE 2019 FPG UP TO 175% OF FPG 176% TO 225% OF FPG
1 $12,490 $21,858 $28,103
2 $16,910 $29,593 $38,048
3 $21,330 $37,328 $47,993
4 $25,750 $45,063 $57,938
5 $30,170 $52,798 $67,883
6 $34,590 $60,533 $77,828
7 $39,010 $68,268 $87,773
8 $43,430 $76,003 $97,718
+/Person $4,420 $7,735 $9,945
Discount  100% 100% 65%


How to Apply

Patients seeking financial assistance must complete an application and may be asked to provide certain documents. You may obtain free copies of Northern Light Mayo Hospital’s PATIENT FINANCIAL ASSISTANCE APPLICATION 2019 online, within the patient and visitors/patients/free care section. You can also get free paper copies in person or by mail, at any registration area in the Hospital or our doctor’s offices, or by visiting or contacting Northern Light Mayo Hospital:

In Person
Northern Light Mayo Hospital front desk, patient financial counselors office, registration areas.

By Phone
(207) 564-1615 or (207) 564-8401

By Mail
Northern Light Mayo Hospital
ATTN: Patient Financial Counselor
897 W Main St.
Dover-Foxcroft, ME 04426

If you need more information about our Financial Assistance Policy or assistance with the application, you may visit Northern Light Mayo Hospital’s  Patient Financial Counselor from Monday – Friday (except holidays), 8:00 am – 4:30 pm. You may also call the above phone numbers.

To learn more about our Billing Policy, Billing and Collections Policy 8/18


Summary of Financial Assistance forms: