SpiritLife’s Financial Assistance Program helps eligible persons receive medically necessary rehabilitation services at no cost or reduced cost, depending on their family income. Please see the following income range table to determine your eligibility and share of covered charges.
| Income range less than or equal to | ||||
| Family Size | Category A | Category B | Category C | Category D |
| 1 | $12,880 | $25,760 | $38,640 | $51,520 |
| 2 | $17,420 | $34,840 | $52,260 | $69,680 |
| 3 | $21,960 | $43,920 | $65,880 | $87,840 |
| 4 | $26,500 | $53,000 | $79,500 | $106,000 |
| 5 | $31,040 | $62,080 | $93,120 | $124,160 |
| 6 | $35,580 | $71,160 | $106,740 | $142,160 |
| 7 | $40,120 | $80,240 | $120,360 | $160,480 |
| 8 | $44,660 | $89,320 | $133,980 | $178,640 |
| For each additional family member, add: | $4,480 | $8,960 | $13,440 | $17,920 |
If your income is less than or equal to the amount in Category A, and you do not have assets exceeding $10,000 individual or $15,000 couple, you are eligible for no-cost healthcare services. These figures are defined by the Department of Health & Human Services guidelines for the current year.
The patient’s share of charges is as follows:
- Category A: 0%.
- Category B: 25%.
- Category C: 50%.
- Category D: 75%.
Click below to download our financial assistance application. After completing the application email it to: dblake@spiritlifeinc.org