Financial Assistance Program Summary
What is financial assistance at Main Line Health?
Free or discounted care for health services or treatments.
Discount is based on household size and gross yearly family income (before deductions or exemptions).
Financial assistance applies if you use any of the following at Main Line Health:
- Emergency department visits
- Inpatient hospitalizations (when you are admitted to a hospital)
- Outpatient services and provider visits
- Home health
- Behavioral or mental health
- Most imaging and lab work
Who we help
You may qualify for financial assistance if you:
- Have insurance
- Do not have insurance
- Are underinsured with limited insurance coverage
- Have medical bills from the last 240 days, based on the date your first billing statement was sent
If you’re approved, financial assistance lasts for one year (12 months).
Ineligible services and situations
You cannot receive financial assistance for the following services or situations:
- Elective cosmetic or plastic surgery done by choice.
- Non-emergent outpatient services with non-participating insurance: You’re not eligible if you choose non‑emergency outpatient services and:
- Your insurance plan does not participate with MLH, and
- You sign a Self‑Pay Waiver agreeing to pay yourself.
- Choosing not to use your insurance: You’re not eligible if you want non‑emergency outpatient services but do not want the bill submitted to your insurance and you sign a Self‑Pay Waiver agreeing to pay yourself.
Need help with your application?
Contact the Main Line Health billing customer service team at 484.337.1970 to discuss your unique circumstances.
If you do not speak English, free language interpreter services are available to you upon request.
How to apply for financial assistance
You can apply:
- Online through MyChart (log in and select "Financial Assistance")
- Drop off your application at one of our Financial Counseling Offices at any Main Line Health hospital
- Through secure fax: 484.227.9005
- Via mail* to:
Attn: Financial Assistance
Main Line Health
3803 West Chester Pike, Suite 160
Newtown Square, PA 19073
*Application cannot be physically dropped off at this address
What to submit when applying
To apply for financial assistance, please provide:
- Main Line Health Financial Assistance Application (Schedule C), and
- Your current IRS Form 1040 tax return, including any schedules that apply (such as Form 1099 or Schedule C for self‑employment income)
Other documentation or notarized letters may be requested to serve as proof of eligibility.
If Social Security is your only source of income
Submit Main Line Health Financial Assistance Application (Schedule C) with:
- Your current year Social Security Benefit Verification letter
- A notarized letter confirming that your only form of income is Social Security and you do not file a Federal Income tax return due to being below the income requirement
Application process
- Complete the Financial Assistance Application (Schedule C)
- Include supporting documents to prove household size and family income
- Note that you must first explore whether you are eligible for some type of insurance benefit that would cover your care (i.e., workers’ compensation, automobile insurance and/or Medical Assistance)
- Once received, the confidential documentation you have provided will be scanned into a secure document imaging system. Any hardcopy paper will be securely shredded.
- Upon review of your application, a determination will be made within 30 business days and you will be notified of the decision by mail and/or your MyChart account.
Main Line Health can arrange a payment plan upon request for any remaining balances that we bill that are not covered by Financial Assistance.
How do we determine family income?
Proof of family income is required and is determined in reference to Federal Poverty Levels (FPL) in effect at the time of the determination.
Federal Poverty Guidelines effective January 2026:
| Size of Family Unit | Yearly Income at or below 300% of the Federal Poverty Guideline = 100% Free Care | Yearly Income between 301–500%, eligible for 86% Discount |
|---|---|---|
| 1 | $47,880 | $47,881 - $79,800 |
| 2 | $64,920 | $64,921 - $108,200 |
| 3 | $81,960 | $81,961 - $136,600 |
| 4 | $99,000 | $99,001 - $165,000 |
| 5 | $116,040 | $116,041 - $193,400 |
| 6 | $133,080 | $133,081 - $221,800 |
| 7 | $150,120 | $150,121 - $250,200 |
| 8 | $167,160 | $167,161 - $278,600 |
| For each additional family member after 8 add: | $17,040 | $28,400 |
This table shall be adjusted in accordance with annually released changes to the Federal Poverty Guidelines
Questions
Call 484.337.1970 to speak to a member of the Main Line Health billing customer service team.
If directed to a Financial Assistance representative, please allow up to three business days for a return call
If you do not speak English, free language interpreter services are available to you upon request.