Sliding Scale Discount Calculator
Self-pay discounts should be fair, written, and the same for everyone. Measure income against the poverty guidelines and apply a sample sliding scale.
Practices that serve self-pay patients need a fair, written way to discount charges — applied the same way to everyone. This calculator measures a patient’s income against the Federal Poverty Guidelines, then applies a clearly labeled sample sliding scale. Adopt the structure, set your own tiers in your financial assistance policy, and document every determination the same way.
Calculate the discount
The sample sliding scale
The tiers below are a sample sliding scale — a starting structure your practice can adapt in its own written financial assistance policy. They are not a government schedule: programs with formal sliding-fee requirements (such as HRSA-funded health centers) follow their own prescribed structures, and every practice should have counsel review its policy.
| Household income (as % of FPL) | Sample tier | Discount on charges | Patient pays |
|---|---|---|---|
| Up to 150% of FPL | Tier A | 100% | 0% |
| Over 150% up to 200% of FPL | Tier B | 80% | 20% |
| Over 200% up to 250% of FPL | Tier C | 60% | 40% |
| Over 250% up to 300% of FPL | Tier D | 40% | 60% |
| Over 300% of FPL | — | 0% | 100% (standard self-pay rates) |
The guideline figures used (2025 Federal Poverty Guidelines)
This calculator uses the 2025 Federal Poverty Guidelines published by the U.S. Department of Health and Human Services for the 48 contiguous states and DC: $15,650 for a household of one, plus $5,500 for each additional person — so a household of four sits at $32,150. Alaska and Hawaii have higher guidelines; if your practice serves patients there, adjust the base figures in your policy accordingly. Whatever tiers you adopt, three disciplines make a sliding scale defensible: a written policy approved before it is applied, uniform application (same income documentation, same tiers, same approvals for everyone), and a determination note in the patient’s file showing household size, income, the guideline, and the tier applied. Pair the discount with a payment plan for the remaining balance and self-pay collection stops being improvised — which is the entire point.
Frequently asked questions
Which poverty guidelines does this calculator use?
The 2025 Federal Poverty Guidelines (HHS) for the 48 contiguous states and DC: $15,650 for a household of one and $5,500 for each additional person. HHS updates the guidelines annually, and Alaska and Hawaii use higher amounts. When new guidelines are published, update your policy’s figures and the determination forms that go with them.
Are the discount tiers official?
No — they are a clearly labeled sample sliding scale that a practice can adapt. Only specific programs (for example, HRSA-funded health centers under the Uniform Data System) have prescribed sliding-fee structures. Every other practice sets its own tiers in a written financial assistance policy and applies them uniformly.
What income documentation should we collect?
Your policy should name it — commonly recent pay stubs, the prior year’s tax return, or a signed income attestation where documents do not exist. Keep the documentation (or the attestation) with the determination note in the patient’s file, and set a re-determination interval, typically annually or when the patient reports a change.
Disclaimer: This tool is provided for educational and planning purposes only. It is not billing, coding, legal, or financial advice, and it does not replace the rules of any specific payer. Requirements and figures change over time — always verify against current CMS guidance and your own payer contracts before acting on a result.