Patients and Families
Sliding Fee Scale
It is the policy of the Hurtt Family Health Clinic to provide essential health care services regardless of a patient’s ability to pay. Discounts are available based upon household income and family size for patients without health insurance and for patients with third-party insurance that does not cover, or only partially covers, fees.
The eligibility for discounts is updated at least annually using the Federal Poverty Guidelines (FPG) below. Additional discounts may be available to patients who meet criteria or state or county-funded indigent care programs. Additional discounts are dependent on availability of funds. Patients may apply for a discount at any time.
To apply for eligibility for Sliding Fee Discounts, please fill out the Sliding Fee Application in your new patient registration packet. Click HERE to get started!
For immigration resources and assistance, please click HERE.
| Poverty Level | A 0-100% | B 101-133% | C 134-175% | D 176-200% | E 201%-and up |
|---|---|---|---|---|---|
| Medical | $ 30.00 | $ 45.00 | $ 55.00 | $ 75.00 | No Discount |
| Acupunture | $20.00 | $30.00 | $40.00 | $50.00 | No Discount |
| Behavioral Health | $ 15.00 | $ 25.00 | $ 35.00 | $ 45.00 | No Discount |
| Preventative Dental | $ 40.00 | $ 45.00 | $ 50.00 | $ 60.00 | No Discount |
| Additional Dental | 35% | 40% | 55% | 65% | 100% |
| Dental Basic & Major | 35% | 40% | 55% | 65% | 100% |
| Dental Lab (External) | At Cost for External Lab | At Cost for External Lab | At Cost for External Lab | At Cost for External Lab | At Cost for External Lab |
| Med Room/Dispensary | $5.00 | $6.00 | $7.00 | $8.00 | 100% |
| Medical Supplies | At Cost | At Cost | At Cost | At Cost | At Cost |
2024 Poverty Guidelines – Annual
| Category Family | A 0-100% | B 101-133% | C 134-175% | D 176-200% | E 201%-and up |
|---|---|---|---|---|---|
| 1 | $ 15,060.00 | $ 20,029.80 | $ 25,515.00 | $ 30,120.00 | $ 30,120.00+ |
| 2 | $ 20,440.00 | $ 27,185.20 | $ 34,510.00 | $ 40,880.00 | $ 40,880.00+ |
| 3 | $ 25,820.00 | $ 34,340.60 | $ 43,505.00 | $ 51,640.00 | $ 51,640.00+ |
| 4 | $ 31,200.00 | $ 41,496.00 | $ 52,500.00 | $ 62,400.00 | $ 62,400.00+ |
| 5 | $ 36,580.00 | $ 48,651.40 | $ 61,495.00 | $ 73,160.00 | $ 73,160.00+ |
| 6 | $ 41,960.00 | $ 55,806.80 | $ 70,490.00 | $ 83,920.00 | $ 83,920.00+ |
| 7 | $ 47,340.00 | $ 62,962.20 | $ 79,485.00 | $ 94.680.00 | $ 94.680.00+ |
| 8 | $ 52,720.00 | $ 70,117.60 | $ 88,480.00 | $ 105,440.00 | $ 105,440.00++ |
| For each additional person, add | $5,380.00 | ||||
Tustin
(714)247-0300