What Is a Sliding Scale Fee Structure?

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A sliding scale fee structure is a type of pricing common in medical care. In a sliding scale fee structure, the fee for a health care service or product varies based on the income of the person receiving the service. Patients with higher incomes pay more and those with lower incomes pay less.

A sliding scale fee structure based on federal poverty level might look like this:

If Your Income Is:

The Price Is:

Below federal poverty level


100-149% of FPL


150-199% of FPL


200-249% of FPL


250-349% of FPL


350% of FPL and above


While some may see this as price gouging the wealthy, the practice is intended to make it easier for those with low incomes to afford the health care service. Often, the lowest point on the sliding scale may be zero or a minimal payment.

Sliding scales may not be available to those with health insurance and instead focus on those who are paying for their health care with their own funds. Although commonly seen with charitable organizations and clinics focused on caring for the uninsured or those with low incomes, a sliding scale fee structure can sometimes be seen in drug manufacturer financial assistance programs, hospitals, and family planning clinics.

Sliding scale fee structures have been a critical tool to allow those with lower incomes to access otherwise unaffordable health care services. In the United States, the expansion of the Medicaid program under the Affordable Care Act and the availability of health insurance subsidies for low and modest income residents could potentially decrease the utilization of these programs as a larger share of the population gains health insurance coverage.

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