How Sliding-Scale Fees Work
A sliding-scale fee means the clinic sets what you pay from your household income and family size. If your income is low, many visits and basic services are free; if you earn more, you pay a reduced fee instead of the full price. This guide explains how that works and how to get the lowest fee you qualify for.
How the fee is set
At your first visit, the clinic asks for your household income and how many people live in your household, usually on a short form. It uses those two numbers to place you on a tier of its fee schedule. If you make very little, many visits are free. If you earn more, you might pay $20–$60 for a visit instead of the $200–$400 a private clinic would charge.
"Free clinic" vs. sliding-scale clinic
The phrase "free clinic" can be misleading. Most "free" clinics are actually sliding-scale clinics: completely free for the lowest income tier, and very low cost for everyone else. A handful of clinics, usually volunteer-run, are truly free for all patients regardless of income. Both kinds are listed on freeclinics.us, and each clinic's page shows its fee structure.
The federal rules at community health centers
Many of the clinics in this directory are federally funded community health centers. Federal rules set the minimum discounts they must offer, based on the federal poverty guidelines:
- At or below 100% of the poverty guidelines: a full discount. The health center may charge a small flat "nominal" fee instead, which must be less than the fee in its first discounted tier.
- Between 100% and 200%: partial discounts that shrink as income rises, in at least three tiers.
- Above 200%: no discount is required, though some health centers offer one anyway.
Health centers must also operate so that no patient is denied service because they can't pay, and they assess eligibility on income and family size only. Source: HRSA Health Center Program Compliance Manual, Chapter 9: Sliding Fee Discount Program.
Volunteer-run free clinics, hospital clinics, and health-department clinics set their own policies, so their fees and income limits vary. Ask the clinic when you call.
What to bring to get the lowest fee
- Photo ID — any government-issued ID.
- Proof of income — a recent pay stub, an unemployment award letter, or a clinic-provided self-attestation form if you are paid in cash.
- Proof of address — a utility bill or any piece of mail.
If you don't have these, most clinics will still see you; they may charge their standard sliding-scale rate until you can verify your income. For the full check-in process, see Your First Free Clinic Visit.
If you have insurance
Sliding-scale fees are not only for the uninsured. At community health centers, patients who qualify for a sliding-fee discount and also have insurance are charged no more out of pocket than their sliding-scale tier would cost, subject to legal and contractual limits. If you might qualify for free coverage, see How to Apply for Medicaid.