Top Menu

Menu
Menu

Sliding Fee Scales

Notice to patients: Community Health Centers of the Rutland Region serves all patients regardless of income or insurance status. Discounts for pharmacy services provided by CHCRR or one of the contracted pharmacies 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.

Medical & Behavioral Health Sliding Fee Scale

100%Discount

$10 Nominal Fee to be
collected at time of Service
0-100%

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,490
2 $0—$16,910
3 $0—$21,330
4 $0—$25,750
5 $0—$30,170
6 $0—$34,590
7 $0—$39,010
8 $0—$43,430

For each additional person
add $4,420

75%Discount

Greater of $20 nominal or 25% collected at time of service
101-135%

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,491—$16,862
2 $16,911—$22,829
3 $21,331—$28,796
4 $25,751—$34,763
5 $30,171—$40,730
6 $34,591—$46,697
7 $39,011—$52,664
8 $43,431—$58,631

For each additional person
add $4,420

50%Discount

Greater of $20 nominal or 50% collected at time of service
136-170%

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,863—$21,233
2 $22,830—$28,747
3 $28,797—$36,261
4 $34,764—$43,775
5 $40,731—$51,289
6 $46,698—$58,803
7 $52,665—$66,317
8 $58,632—$73,831

For each additional person
add $4,420

25%Discount

Greater of $20 nominal or 75% collected at time of service
171-200%

If your income falls between

Family Size Federal
Poverty Level
1 $21,234—$24,980
2 $28,748—$33,820
3 $36,262—$42,660
4 $43,776—$51,500
5 $51,290—$60,340
6 $58,804—$69,180
7 $66,318—$78,020
8 $73,832—$86,860

For each additional person
add $4,420

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—$12,490
2 $0—$16,910
3 $0—$21,330
4 $0—$25,750
5 $0—$30,170
6 $0—$34,590
7 $0—$39,010
8 $0—$43,430

For each additional person
add $4,420

75%Discount

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

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,491—$16,862
2 $16,911—$22,829
3 $21,331—$28,796
4 $25,751—$34,763
5 $30,171—$40,730
6 $34,591—$46,697
7 $39,011—$52,664
8 $43,431—$58,631

For each additional person
add $4,420

50%Discount

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

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,863—$21,233
2 $22,830—$28,747
3 $28,797—$36,261
4 $34,764—$43,775
5 $40,731—$51,289
6 $46,698—$58,803
7 $52,665—$66,317
8 $58,632—$73,831

For each additional person
add $4,420

25%Discount

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

If your income falls between

Family Size Federal
Poverty Level
1 $21,234—$24,980
2 $28,748—$33,820
3 $36,262—$42,660
4 $43,776—$51,500
5 $51,290—$60,340
6 $58,804—$69,180
7 $66,318—$78,020
8 $73,832—$86,860

For each additional person
add $4,420

Dental Sliding Fee Scale

100%Discount

$10 Nominal Fee collected at time of service.  Lab fees additional cost to patient.
0-100%

If your income falls between

Family
Size
Federal
Poverty Level
1 $0—$12,490
2 $0—$16,910
3 $0—$21,330
4 $0—$25,750
5 $0—$30,170
6 $0—$34,590
7 $0—$39,010
8 $0—$43,430

For each additional person
add $4,420

75%Discount

Greater of $25 nominal or 25% collected at time of service. Lab fees additional cost to patient.
101-135%

If your income falls between

Family
Size
Federal
Poverty Level
1 $12,491—$16,862
2 $16,911—$22,829
3 $21,331—$28,796
4 $25,751—$34,763
5 $30,171—$40,730
6 $34,591—$46,697
7 $39,011—$52,664
8 $43,431—$58,631

For each additional person
add $4,420

50%Discount

Greater of $25 nominal or 50% collected at time of service. Lab fees additional cost to patient.
136-170%

If your income falls between

Family
Size
Federal
Poverty Level
1 $16,863—$21,233
2 $22,830—$28,747
3 $28,797—$36,261
4 $34,764—$43,775
5 $40,731—$51,289
6 $46,698—$58,803
7 $52,665—$66,317
8 $58,632—$73,831

For each additional person
add $4,420

25%Discount

Greater of $25 nominal or 75% collected at time of service. Lab fees additional cost to patient
171-200%

If your income falls between

Family Size Federal
Poverty Level
1 $21,234—$24,980
2 $28,748—$33,820
3 $36,262—$42,660
4 $43,776—$51,500
5 $51,290—$60,340
6 $58,804—$69,180
7 $66,318—$78,020
8 $73,832—$86,860

For each additional person
add $4,420

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.

Print Friendly, PDF & Email