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Sliding Fee Scales

Notice to patients: Community Health serves all patients regardless of income or insurance status.

Discounts for essential services provided by Community Health are offered on a sliding fee scale basis adjusted for family size and income. 

Front desk personnel can assist you in applying, or you may apply directly by calling the clinic and asking for the patient outreach coordinator.

For information on how to cover the cost of health care, and create a plan that works for you, check payment options.

Sliding Scale PDF

Medical & Behavioral Health Sliding Fee Scale

100%Discount

$10 medical fee
0-100%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $0 — $12,880
2 $0 — $17,420
3 $0 — $21,960
4 $0 — $26,500
5 $0 — $31,040
6 $0 — $35,580
7 $0 — $40,120
8 $0 — $44,660

For each additional person
add $4,540

90%Discount

Greater of $20 medical fee or 10% balance billed
101-135%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $12,881 — $17,433
2 $17,421 — $23,553
3 $21,961 — $29,674
4 $26,501 — $35,794
5 $31,041 — $41,915
6 $35,581 — $48,036
7 $40,121 — $54,156
8 $44,661 — $60,277

For each additional person
add $4,540

80%Discount

Greater of $20 medical fee or 20% balance billed
136-170%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $17,434 — $21,952
2 $23,554 — $29,660
3 $29,675 — $37,367
4 $35,795 — $45,074
5 $41,916 — $52,782
6 $48,037 — $60,489
7 $54,157 — $68,197
8 $60,278 — $75,904

For each additional person
add $4,540

70%Discount

Greater of $20 medical fee or 30% balance billed
171-200%

If your income falls between

Family Size Federal
Poverty Level
1 $21,953 — $25,826
2 $29,661 — $34,894
3 $37,368 — $43,961
4 $45,075 — $53,029
5 $52,783 — $62,096
6 $60,490 — $71,164
7 $68,198 — $80,231
8 $75,905 — $89,299

For each additional person
add $4,540

Medical & Behavioral Health Sliding Fee Application

Pharmacy Sliding Fee Scale

100%Discount

Acquisition cost + pharmacy dispensing fees + $2.50 admin fee
0-100%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $0 — $12,880
2 $0 — $17,420
3 $0 — $21,960
4 $0 — $26,500
5 $0 — $31,040
6 $0 — $35,580
7 $0 — $40,120
8 $0 — $44,660

For each additional person
add $4,540

75%Discount

Acquisition cost + pharmacy dispensing fees + $5.00 admin fee
101-135%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $12,881 — $17,433
2 $17,421 — $23,553
3 $21,961 — $29,674
4 $26,501 — $35,794
5 $31,041 — $41,915
6 $35,581 — $48,036
7 $40,121 — $54,156
8 $44,661 — $60,277

For each additional person
add $4,540

50%Discount

Acquisition cost + pharmacy dispensing fees + $7.50 admin fee
136-170%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $17,434 — $21,952
2 $23,554 — $29,660
3 $29,675 — $37,367
4 $35,795 — $45,074
5 $41,916 — $52,782
6 $48,037 — $60,489
7 $54,157 — $68,197
8 $60,278 — $75,904

For each additional person
add $4,540

25%Discount

Acquisition cost + pharmacy dispensing fees + $10.00 admin fee
171-200%

If your income falls between

Family Size Federal
Poverty Level
1 $21,953 — $25,826
2 $29,661 — $34,894
3 $37,368 — $43,961
4 $45,075 — $53,029
5 $52,783 — $62,096
6 $60,490 — $71,164
7 $68,198 — $80,231
8 $75,905 — $89,299

For each additional person
add $4,540

Pharmacy Sliding Fee Application

Dental Sliding Fee Scale

100%Discount

$10 dental fee
0-100%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $0 — $12,880
2 $0 — $17,420
3 $0 — $21,960
4 $0 — $26,500
5 $0 — $31,040
6 $0 — $35,580
7 $0 — $40,120
8 $0 — $44,660

For each additional person
add $4,540

90%Discount

$25 dental fee plus 10% of procedure fees
101-135%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $12,881 — $17,433
2 $17,421 — $23,553
3 $21,961 — $29,674
4 $26,501 — $35,794
5 $31,041 — $41,915
6 $35,581 — $48,036
7 $40,121 — $54,156
8 $44,661 — $60,277

For each additional person
add $4,540

80%Discount

$25 dental fee plus 20% of procedure fees
136-170%

If your income falls between

Family
Size		 Federal
Poverty Level
1 $17,434 — $21,952
2 $23,554 — $29,660
3 $29,675 — $37,367
4 $35,795 — $45,074
5 $41,916 — $52,782
6 $48,037 — $60,489
7 $54,157 — $68,197
8 $60,278 — $75,904

For each additional person
add $4,540

70%Discount

$25 dental fee plus 30% of procedure fees
171-200%

If your income falls between

Family Size Federal
Poverty Level
1 $21,953 — $25,826
2 $29,661 — $34,894
3 $37,368 — $43,961
4 $45,075 — $53,029
5 $52,783 — $62,096
6 $60,490 — $71,164
7 $68,198 — $80,231
8 $75,905 — $89,299

For each additional person
add $4,540

Dental Sliding Fee Application

Applying for Sliding Fee

When you come for your appointment to apply for sliding fee scales, please bring the following information with you:

  • Birth Certificate
  • Driver’s license
    with your picture on it or another photo ID showing your current address
  • Proof of Residency
    (postmarked envelope, postcard or envelope, driver’s license issued within the last 6 months, utility bill, lease/rent receipt, property tax records)
  • Proof of income
    including documentation for all wages earned (pay stubs for 4 consecutive pay periods or your tax return from the previous year), social security, worker’s comp, veteran’s benefits, military pay, child support/alimony, income from rent and interest/dividends from bank accounts, pensions and annuities.
  • Proof of Medicaid denial (within the last six months).
    a Navigator can assist with VT Medicaid applications.

Medical & Behavioral Health Sliding Fee Application
Pharmacy Sliding Fee Application
Dental Sliding Fee Application
Payment Options
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