CUBA MEMORIAL HOSPITAL, INC

"FPL LEVEL 200% 300% 400% 1 $30,120 $45,180 $60,240 2 $40,880 $61,320 $81,760 3 $51,640 $77,460 $103,280 4 $62,400 $93,600 $124,800 5 $73,160 $109,740 $149,320 6 $83,920 $125,880 $167,840 7 $94,680 $142,020 $189,360 8 $105,440 $158,160 $210,880 Each add’l person add: $10,760 $16,140 $21,520 Discount on Charges 100% 90% 80% Patient Share 0% 10% 20% Form #:"

documented · checked 2026-10-11 · [PDF] Financial Assistance Summary - Cuba Memorial Hospital

"Cuba Memorial Hospital will require a completed Financial Assistance application and proof of income such as a tax return or pay stubs. We may also request a Medicaid denial letter but not required."

documented · checked 2026-10-11 · [PDF] Financial Assistance Summary - Cuba Memorial Hospital

"You will receive a letter from Cuba Memorial Hospital (usually within 30 days after completion and submission of documentation) telling you if you have been approved and the level of discount received"

documented · checked 2026-10-11 · [PDF] Financial Assistance Summary - Cuba Memorial Hospital

"Please contact our Facilitated Enroller at 716-375-6080 for free confidential assistance."

documented · checked 2026-10-11 · [PDF] Financial Assistance Summary - Cuba Memorial Hospital