Eligibility - The Assistance Fund

You may qualify for assistance. Select a program below and then fill out the form to find out.

Copay Assistance

Health Care Expenses

Insurance Premium and Incidentals

Household Information

We’ll need to know your household size, including you.

We’ll need to know your annual income which we'll verify when you apply.

Insurance coverage

We’ll need to know if you’re insured or not.

Yes

Please select the type of insurance you have or are in the process of securing.

U.S. Residency

Are you a U.S. citizen or a permanent resident?

Yes

U.S. State of Residency

Are you a resident of Alaska, Hawaii or N/A?

Alaska

Hawaii

N/A

Check Eligibility

Household Information

We’ll need to know your household size, including you.

We’ll need to know your annual income which we'll verify when you apply.

Insurance coverage

We’ll need to know if you’re insured or not.

Yes

Please select the type of insurance you have or are in the process of securing.

U.S. Residency

Are you a U.S. citizen or a permanent resident?

Yes

U.S. State of Residency

Are you a resident of Alaska, Hawaii or N/A?

Alaska

Hawaii

N/A

Check Eligibility

Household Information

We’ll need to know your household size, including you.

We’ll need to know your annual income which we'll verify when you apply.

Insurance coverage

We’ll need to know if you’re insured or not.

Yes

Please select the type of insurance you have or are in the process of securing.

U.S. Residency

Are you a U.S. citizen or a permanent resident?

Yes

U.S. State of Residency

Are you a resident of Alaska, Hawaii or N/A?

Alaska

Hawaii

N/A

Check Eligibility

Based on your answers, it’s possible that you might not be eligible at this time. The next step is to give us a call so we can examine your situation.

855-845-3663

Good News!

Based on your answers, it looks like you may be eligible for assistance. The next step is to apply in full.

Apply Now