PRIMARY CARE FOR UNINSURED PATEINTS
You may be eligible for a sliding fee discount on participating services, even if you have insurance. Our sliding fee discount, which is based on your household income, is available to all patients who qualify. Please take the time to complete and sign the following sliding fee application. Your Sliding Fee Application must be completed within 30 days. If supporting documentation is not received within that time frame, you will be responsible for the full amount or submit a new application. Please be aware we require two forms of financial information for each adult in the household. If you filed a 2023 Federal Income Tax return, we are required to have a signed copy on file.
- Please submit a signed 2023 Federal Income Tax return with W-2 forms attached.
(if filing jointly, both signatures are required)
- Please also submit any pertinent schedules, such as Schedule C, D, E, or F.
- If you no longer have a copy of your taxes, you can request a return transcript by calling the IRS at 1-800-829-1040 or online at the following address: http://www.irs.gov/Individuals/Get-Transcript
Please provide a second form of income documentation for each adult in the household.
- Employment paystubs for the last four weeks
- Unemployment statement
- TANF statement
If you are not required to file a tax return, please submit two of the following documents as proof of income:
- Three recent months of consecutive bank statements showing direct deposit of income
- Annual Social Security Benefit Statement (if you do not have a benefit statement, you
can request a copy by calling Social Security at 1-800-772-1213)
For Uninsured Patients | |||||
Household Size | Income Group A | Income Group B | Income Group C | Income Group D | Income Group E |
1 – Annually | $0 – 14,580 | $14,581 – 21,870 | $21,871 – 25,515 | $25,516 – 29,160 | $29,161+ |
1 – Monthly | $0 – 1,215 | $1,216 – 1,823 | $1,824 – 2,126 | $2,127 – 2,430 | $29,161+ |
2 – Annually | $0 – $19,720 | $19,721 – $29,580 | $29,581 – $34,510 | $34,511 – $39,440 | $39,441+ |
2 – Monthly | $0 – 1,643 | $1,644 – 2,465 | $2,466 – 2,876 | $2,877 – 3,287 | $39,441+ |
3 – Annually | $0 – $24,860 | $24,861 – $37,290 | $37,291 – $43,505 | $43,506 – $49,720 | $49,721+ |
3 – Monthly | $0 – 2,072 | $2,073 – 3,108 | $3,109 – 3,6253 | $3,626 – 4,143 | $49,721+ |
4 – Annually | $0 – $30,000 | $30,001 – $45,000 | $45,001 – $52,500 | $52,501- $60,000 | $60,001+ |
4 – Monthly | $0 – $2,500 | $2,501 – 3,750 | $3,751 – 4,375 | $4,376 – 5,000 | $60,001+ |
5 – Annually | $0 – $35,140 | $35,141 – $52,710 | $52,711 – $61,495 | $61,496 – $70,280 | $70,281+ |
5 – Monthly | $0 – 2,928 | $2,929 – 4,393 | $4,394 – 5,125 | $5,126 – 5,857 | $70,281+ |
What you will pay per month* | |||||
includes | Income Group A | Income Group B | Income Group C | Income Group D | Income Group E |
Medical Tele-medicine Nutritional | $28 | $56 | $84 | $112 | $140 |
Visits unlimited for the month
DIABETES PREVENTION For Pre-Diabetics
Having pre-diabetes means your blood glucose (sugar) levels are higher than normal—but not high enough to be diagnosed as diabetes. Pre-diabetes can lead to heart disease, stroke, and type 2 diabetes, the most common form of diabetes. Pre-diabetes can often be reversed. Learn more about Prediabetes. [https://youtu.be/w0NDVI4M_Bs]
If you are prediabetic, our Diabetes Prevention Program (DPP) offers a curriculum by the Centers for Disease Control (CDC) to prevent Type 2 Diabetes. When you join Meridian’s a lifestyle change program, you’ll learn, laugh, share stories, try new things, and build new habits—all while lowering your risk of type 2 diabetes and improving your health. The course is virtual online once weekly for 6 months and then once monthly for 6 months. This program is a proven method to manage your health and Lifestyle and to ensure the sickness of “diabetes” is prevented. Once fully “diabetic”, your Body does NOT produce enough insulin for digestion anymore.
Meridian’s CDC-recognized diabetes prevention lifestyle change program can help you build healthy new habits that last a lifetime.
If you are unsure, if you are pre-diabetic, take the test https://www.cdc.gov/prediabetes/takethetest/
Give your results to your doctor or come call our office for confirmation. Once confirmed, pre-diabetic you may be eligible to enroll in the DPP program at no cost to you. It is important to reverse course if you have pre-diabetes. This course will help.
OVERDOSE RESPONSE PROGRAM
Meridian Community Health Foundation offers Overdose Response Education. You can get training and a free naloxone container to administer in the event of a suspected overdose. If you or family member is dependent on opiates such as heroin or similar pills, this education would be beneficial in saving a life in case of potential overdose.
Learn how to use naloxone https://howtoadministernaloxone.maryland.gov/en/index.html
you can also get fentanyl test strips to test your drugs for fentanyl. It may be a matter of life or death. Learn how to use fentanyl test strips https://youtu.be/hwF6986Sd3o