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Adventist Health Clearlake — Financial Assistance & Charity Care
Clearlake, Lake County, CA
Under California law (the Hospital Fair Pricing Act), Adventist Health Clearlake must offer free or discounted care to patients who can't afford their bills. Here's who qualifies and how to apply — you can apply even if your bill already went to collections.
Do you qualify for FREE care?
Adventist Health Clearlake provides free (charity) care to patients at or below 200% of the Federal Poverty Level. If your yearly household income is at or below the amount for your household size, you likely qualify for 100% free care:
| Household size | Yearly income at or below | You likely qualify for |
|---|---|---|
| 1 person | $31,920/yr | 100% free care |
| 2 people | $43,280/yr | 100% free care |
| 3 people | $54,640/yr | 100% free care |
| 4 people | $66,000/yr | 100% free care |
| 5 people | $77,360/yr | 100% free care |
| 6 people | $88,720/yr | 100% free care |
| 7 people | $100,080/yr | 100% free care |
| 8 people | $111,440/yr | 100% free care |
Discounted care
Patients up to 400% of the Federal Poverty Level qualify for discounted care — you'd owe no more than the amount generally billed to insured patients:
| Household size | Yearly income at or below | You likely qualify for |
|---|---|---|
| 1 person | $63,840/yr | discounted care |
| 2 people | $86,560/yr | discounted care |
| 3 people | $109,280/yr | discounted care |
| 4 people | $132,000/yr | discounted care |
| 5 people | $154,720/yr | discounted care |
| 6 people | $177,440/yr | discounted care |
| 7 people | $200,160/yr | discounted care |
| 8 people | $222,880/yr | discounted care |
What you'll need to apply
- Recent pay stubs from within 6 months before or after first billed (or in preservice when application submitted)
- Copy of Federal Income Tax Return (Form 1040) for patient and spouse/domestic partner from year first billed or 12 months prior to first billed
- Documentation of monetary assets may be required if seeking reduction of Medi-Cal/Medicare Share of Cost (for Medicare bad debt reimbursement); assets NOT considered in determining Charity Care/Discounted Care eligibility
How to apply
📞 (844) 827-5047When you call, say: “I'd like to apply for financial assistance (charity care) for a hospital bill. Can you send me the application and tell me which documents I need?”
Based on this hospital's policy effective 04/25/2025.
Not sure if you qualify?
Answer 3 quick questions and get a personalized plan plus a ready-to-send request letter — free, in your language.
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