Financial Assistance Program
Financial assistance is offered to all patients served by our facility. Eligibility is determined using the Federal Poverty Guidelines and is based on the number of members in the household and the annual income of the household.
Financial assistance only covers services billed by Madison County Memorial Hospital. Services not covered include, but are not limited to: ambulance, prescriptions, specialty clinic physicians, and durable medical equipment.
All patients, without regard to race, color, sex, age, handicap, religion, national origin, political belief, or payer source are eligible for financial assistance as long as they meet all other criteria stated in the Madison County Memorial Hospital’s Financial Assistance Program Policy.
In order to qualify for assistance, you must:
- Complete application (download form or complete online)
- Provide proof of income for the past year (Federal Income Tax Return required)
- Be willing to pursue all other payment sources, including Medicaid and the Health Insurance Exchange
Applications should be returned to:
Business Office Manager
Madison County Memorial Hospital
300 W. Hutchings St.
Winterset, IA 50273
For more information, or assistance, please call (515) 462-9747, or email firstname.lastname@example.org
APPLY HERE: Online Financial Assistance Application
- Click here to download the Financial Assistance Form.
- Click here to download a copy of Information about Financial Assistance.