Financial Assistance
If you do not have health insurance or you are unable to pay your hospital bill, you may qualify for medical assistance, Medicare or financial assistance. Financial assistance may cover your inpatient and/or outpatient hospital-related charges partially or in full. Applicant(s) for financial assistance must agree to complete the application for uncompensated care and assist Hospital staff by furnishing information required to complete the financial assistance application.
If you have Medicare or health insurance, the financial assistance program will not pay for any amounts that are covered by those insurers. Applicant(s) will be expected to exhaust all other payment sources as a condition for approval. For example, you might be eligible for Medicaid or Medicare. Therefore, you will be required to apply for those programs before seeking financial assistance.
If you have any questions, please call (833) 958-2198 and we will be able to assist you.
View the Full Policy (PDF)
- Jefferson Financial Assistance Plain Language Summary (PDF)
- Jefferson Health Enterprise Uninsured Self Pay Discount Policy (PDF)
- Federal Poverty Level Guidelines
- Provider Listings (PDF)
Financial Assistance
Portuguese (Brazil) Versions
View the Full Policy (Política de assistência financeira) (PDF)
- Financial Assistance Plain Language Summary (Política de assistência financeira — Resumo em linguagem simples) (PDF)
- Jefferson Uninsured Self-Pay Program (Política de descontos para pacientes não segurados/particulares) (PDF)
- Compassionate Care Application Guidelines (Compassionate Care Do Jefferson Health Guia De Solicitação) (PDF)
- Compassionate Care Application Form (Formulário de solicitação e informações) (PDF)
- NJ Hospital Assistance Program Letter (Programa de assistência hospitalar de Nova Jersey) (PDF)
- NJ Hospital Assistance Program Checklist (Programa de assistência hospitalar de Nova Jersey Lista de verificação da documentação necessária) (PDF)
- NJ Compassionate Care Application Form (Programa de assistência para pagamento por atendimento hospitalar de Nova Jersey)(PDF)
Portuguese (EU) Versions
View the Full Policy (Política de Assistência Financeira) (PDF)
- Financial Assistance Plain Language Summary (Política de Assistência Financeira - Resumo em Linguagem Simples) (PDF)
- Jefferson Uninsured Self-Pay Program (Política de Desconto de Sem Seguro/Pagamento por conta própria) (PDF)
- Compassionate Care Application Guidelines (Compassionate Care Do Jefferson Health Guia Para Inscrição) (PDF)
- Compassionate Care Application Form (Formulário e Informações sobre a Inscrição) (PDF)
- NJ Hospital Assistance Program Letter (Programa de Assistência Hospitalar de Nova Jérsia) (PDF)
- NJ Hospital Assistance Program Checklist (Programa de Assistência do New Jersey Hospital Lista de verificação de documentos necessários) (PDF)
- NJ Compassionate Care Application Form (Programa de Assistência de Pagamento de Cuidados do New Jersey Hospital) (PDF)
Chinese Versions
View the Full Policy (经济援助政策与计费和收款政策) (PDF)
- Financial Assistance Plain Language Summary (经济援助政策 - 简明语言概述) (PDF)
- Jefferson Uninsured Self-Pay Program (无保险/自费折扣政策) (PDF)
- Compassionate Care Application Guidelines (Jefferson Health 同情护理 申请指南) (PDF)
- Compassionate Care Application Form (Jefferson Health 同情护理 申请表格和信息) (PDF)
- NJ Hospital Assistance Program Letter (的新泽西医院援助计划) (PDF)
- NJ Hospital Assistance Program Checklist (新泽西医院援助计划 所需文件清单) (PDF)
- NJ Compassionate Care Application Form (新泽西医护费用援助计划) (PDF)
Gujarati Versions
View the Full Policy (નાણાકીય સહાય પોલિસી અને બિલિંગ અને કલેક્શન પોલિસી) (PDF)
- Financial Assistance Plain Language Summary (નાણાકીય સહાય નીતિ – સ્પષ્ટ ભાષા સારાંશ) (PDF)
- Jefferson Uninsured Self-Pay Program (વીમા-રહિત/સ્વ-ચુકવણી ડિસ્કાઉંટ પોલિસી) (PDF)
- Compassionate Care Application Guidelines (જેફરસન હેલ્થ કંપેશનેટ કેર અરજી માહિતી પુસ્તિકા) (PDF)
- Compassionate Care Application Form (જેફરસન હેલ્થ કંપેશનેટ કેર અરજી ફોર્મ અને માહિતી) (PDF)
- NJ Hospital Assistance Program Letter (એનજેએચએપી)(PDF)
- NJ Hospital Assistance Program Checklist (ચેકલિસ્ટ)(PDF)
Korean Versions
View the Full Policy (재정 지원 정책 및 청구 및 징수 정책) (PDF)
- Financial Assistance Plain Language Summary (재정지원 정책 – 이해하기 쉽게 작성된 요약문) (PDF)
- Jefferson Uninsured Self-Pay Program (무보험/자기부담 할인 정책) (PDF)
- Compassionate Care Application Guidelines (Jefferson Health Compassionate Care 신청 안내서) (PDF)
- Compassionate Care Application Form (Jefferson Health Compassionate Care 신청서 및 정보) (PDF)
- NJ Hospital Assistance Program Letter (뉴저지주 병원 지원 프로그램(NJHAP))(PDF)
- NJ Hospital Assistance Program Checklist (뉴저지주 병원 지원 프로그램 필수 서류 체크리스트)(PDF)
- NJ Compassionate Care Application Form (뉴저지주 병원 치료비 지원 프로그램) (PDF)
Russian Versions
View the Full Policy (Политика финансовой помощи и Политика выставления счетов и взыскания задолженностей) (PDF)
- Financial Assistance Plain Language Summary (Политика финансовой помощи: обзор на доступном языке) (PDF)
- Jefferson Uninsured Self-Pay Program (Политика предоставления скидок незастрахованным лицам/лицам, оплачивающим услуги из собственных средств) (PDF)
- Compassionate Care Application Guidelines (Jefferson Health Compassionate Care РУКОВОДСТВО ПО ПОДАЧЕ ЗАЯВЛЕНИЯ) (PDF)
- PA Compassionate Care Application Form (Форма заявления и информация) (PDF)
- NJ Hospital Assistance Program Letter (PDF)
- NJ Hospital Assistance Program Checklist (NJHAP Контрольный список требуемой документации)(PDF)
- NJ Compassionate Care Application Form (ЗАЯВЛЕНИЕ ОБ УЧАСТИИ) (PDF)
Spanish Versions
View the Full Policy (Ver la política completa) (PDF)
- Financial Assistance Plain Language Summary (Política de asistencia financiera – Resumen en términos sencillos) (PDF)
- Jefferson Uninsured Self-Pay Program (Política de descuento para pacientes de pago propio/no asegurados) (PDF)
- Compassionate Care Application Guidelines (Atención Compasiva De Jefferson Health guía De Solicitud) (PDF)
- PA Compassionate Care Application Form (Atención Compasiva de Jefferson Health Formulario de solicitud e información) (PDF)
- NJ Hospital Assistance Program Letter (Programa de Asistencia Hospitalaria de New Jersey) (PDF)
- NJ Hospital Assistance Program Checklist (Programa de Asistencia Hospitalaria de New Jersey Lista de verificación de la documentación necesaria) (PDF)
- NJ Compassionate Care Application Form (Programa de asistencia para el pago de la atención hospitalaria de New Jersey) (PDF)
Vietnamese Versions
View the Full Policy (Chính Sách Hỗ Trợ Tài Chính và Chính Sách Lập Hóa Đơn và Thu Nợ) (PDF)
- Financial Assistance Plain Language Summary (Chính Sách Hỗ Trợ Tài Chính – Bản Tóm Tắt Bằng Ngôn Ngữ Đơn Giản) (PDF)
- Jefferson Uninsured Self-Pay Program (Chính Sách Giảm Giá Cho Người Không Có Bảo Hiểm/Tự Thanh Toán) (PDF)
- Compassionate Care Application Guidelines (CHĂM SÓC CỨU TRỢ CỦA Jefferson Health HƯỚNG DẪN NỘP ĐƠN ĐĂNG KÝ) (PDF)
- PA Compassionate Care Application Form (Chăm Sóc Cứu Trợ Của Jefferson Health Biểu Mẫu Đơn Đăng Ký & Thông Tin) (PDF)
- NJ Hospital Assistance Program Letter (Chương Trình Hỗ Trợ Tại Bệnh Viện Của New Jersey (NJHAP))(PDF)
- NJ Hospital Assistance Program Checklist (Chương Trình Hỗ Trợ Tại Bệnh Viện Của New Jersey Danh Sách Kiểm Tra Tài Liệu Bắt Buộc)(PDF)
- NJ Compassionate Care Application Form (Chương Trình Hỗ Trợ Thanh Toán Chăm Sóc Tại Bệnh Viện Của New Jersey) (PDF)
For additional information or to request an application for financial assistance, please contact the Single Billing Office at (833) 958-2198.