Avera Health Financial Assistance: Free Care at 200% FPL + Sliding Scale Discounts (2026 Guide)
Avera Health is a major Catholic health system based in Sioux Falls, South Dakota. Sponsored by the Benedictine and Presentation Sisters, Avera operates 37 hospitals and over 200 clinics across five states (SD, MN, IA, NE, and ND). Their financial assistance program provides 100% free care for patients at or below 200% FPL, sliding scale discounts at 201-250% FPL, and additional hardship consideration above 250% FPL. Both insured and uninsured patients can apply.
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Quick Eligibility Summary
Who Qualifies for Avera Financial Assistance?
100% Free Care (Charity Care)
Patients with household income at or below 200% of the Federal Poverty Level qualify for complete charity care. Your entire bill is written off. For a single person in 2026, 200% FPL is approximately $31,920/year. For a family of four, that is approximately $65,600/year.
Sliding Scale Discounts (201-250% FPL)
Patients with income between 201% and 250% FPL are eligible for discounted care on a sliding scale. The discount percentage decreases as your income rises within this range. Your exact discount is determined by Avera Patient Financial Services based on your household income and size.
Hardship Consideration (Above 250% FPL)
Patients with income above 250% FPL may still qualify for financial assistance through Avera's hardship review process. If your medical bills are significant relative to your financial resources, or if you have experienced a financial setback such as job loss or major unexpected expenses, Avera will evaluate your situation on a case-by-case basis.
Insured Patients Welcome
You do not need to be uninsured to apply. Avera Health financial assistance covers both insured and uninsured patients. If you have insurance but are struggling with deductibles, copays, or coinsurance, you may still qualify for help based on your income and financial situation.
Avera vs Sanford Health: Financial Assistance Comparison
In much of South Dakota, Minnesota, and the surrounding region, Avera Health and Sanford Health are the only two major hospital systems. Many patients want to know how their financial assistance programs compare.
Avera Health
- Free care: up to 200% FPL
- Sliding scale: 201-250% FPL
- Hardship review above 250% FPL
- Catholic mission (Benedictine/Presentation Sisters)
- 37 hospitals, 200+ clinics
Sanford Health
- Free care: similar threshold around 200% FPL
- Discount tiers vary by facility
- Secular nonprofit system
- Largest rural health system in the US
- 46 hospitals, 200+ clinics
Key takeaway: Apply to whichever system treated you. If you received care at both Avera and Sanford, submit separate applications to each system. The programs are comparable but not identical, and each system evaluates applications independently.
Need Help with an Avera Bill?
CareRoute can help you understand your options, draft appeal letters, and navigate the financial assistance application process. Our tools are designed to help patients advocate for themselves effectively.
Try Bill DefenseCatholic Mission and Your Rights
Avera Health is a Catholic health system sponsored by the Benedictine and Presentation Sisters. As a Catholic institution, Avera follows the Ethical and Religious Directives (ERDs) for Catholic Health Care Services, which include an explicit obligation to provide care to the poor.
Why this matters for your financial assistance application:
- The ERDs create a moral and institutional obligation to assist patients who cannot pay
- If your FA application is denied, you can reference the Catholic mission in an appeal letter
- Catholic health systems are accountable to their sponsoring religious orders on charity care
- Avera also has IRS 501(r) obligations as a tax-exempt nonprofit organization
Tip: In an appeal letter, you can write something like: "As a Catholic health system guided by the Ethical and Religious Directives, Avera Health has a mission to serve those who cannot afford care. I respectfully ask that my application be reconsidered in light of this mission."
Five-State Coverage and Different Legal Protections
Avera Health operates across South Dakota, Minnesota, Iowa, Nebraska, and North Dakota. While the Avera financial assistance policy is the same everywhere, each state has different laws protecting patients from medical debt. Understanding your state's protections gives you additional leverage.
South Dakota
Unlimited homestead exemption: Your home is fully protected from medical debt judgments. Even if Avera sues and wins, they cannot force the sale of your primary residence. South Dakota also has a 6-year statute of limitations on medical debt.
South Dakota medical bill rightsMinnesota
Debt Fairness Act: Minnesota law caps interest on medical debt at 0% and limits collections practices. Hospitals must also screen patients for financial assistance eligibility before pursuing collections.
Minnesota medical bill rightsIowa
Iowa has a homestead exemption (up to 1/2 acre in a city or 40 acres in a county) protecting your home from medical debt judgments. Iowa also provides wage garnishment protections for lower-income workers.
Iowa medical bill rightsNebraska
Medical Debt Relief Act: Nebraska law provides protections against aggressive medical debt collection. The state also has a homestead exemption of $60,000 and prohibits certain collection practices for medical bills.
Nebraska medical bill rightsNorth Dakota
90-day delinquency rule: North Dakota law requires that a debt be at least 90 days delinquent before it can be sent to collections. The state also has homestead protections and limits on wage garnishment.
North Dakota medical bill rightsRural and Critical Access Hospital Facilities
Many Avera facilities are designated as Critical Access Hospitals (CAHs). These are small, rural hospitals that serve as the sole source of care in their communities. Understanding CAH billing can help you navigate your Avera bills more effectively.
What you should know about CAH billing:
- CAHs use cost-based reimbursement from Medicare, which means their charge structures may differ from larger urban hospitals
- Bills from CAH facilities are still covered by Avera's financial assistance policy
- If you were transferred from a CAH to a larger Avera hospital, both facilities' bills may be eligible for assistance
- Some CAH services may be billed separately from the main hospital, so check all your statements
Important: Avera's financial assistance covers all Avera hospitals and employed physician practices, including Critical Access Hospitals. If you received care at a small rural Avera facility, you have the same FA rights as patients at Avera McKennan in Sioux Falls.
Avera eCARE Telehealth and Financial Assistance
Avera Health pioneered rural telehealth through its Avera eCARE program, which connects patients in remote areas to specialists via video conferencing. This program serves hundreds of rural facilities and patients across the region.
Financial assistance for telehealth services:
- Bills from Avera eCARE telehealth consultations are eligible for financial assistance
- The same income thresholds (200% FPL free, 201-250% sliding scale) apply to telehealth bills
- Telehealth bills may come from the originating site (your local facility) and the distant site (the specialist), so review all statements carefully
- If the specialist is an Avera employed physician, their bill is covered under Avera FA
IHS Referral Patients and Avera Financial Assistance
Avera Health, like Sanford Health, regularly receives patients referred through the Indian Health Service (IHS) Purchase/Referred Care (PRC) program. If you are a Native American patient who was referred to Avera from IHS, there are important steps to follow.
Steps for IHS referral patients:
- 1.Confirm your PRC authorization. Make sure your IHS Purchase/Referred Care referral was properly authorized before your Avera visit. PRC coverage depends on timely authorization.
- 2.Contact IHS PRC first. IHS PRC may cover part or all of your Avera bill. File with IHS before applying for Avera financial assistance to avoid paying out of pocket for covered services.
- 3.Apply for Avera FA for any remaining balance. If IHS PRC does not cover the full bill, apply for Avera financial assistance for the remainder. You may still qualify for free or discounted care.
- 4.Inform Avera of your IHS status. Let Avera Patient Financial Services know that you are an IHS beneficiary. This helps them coordinate billing correctly and may affect how your application is processed.
Note: Do not ignore Avera bills while waiting for IHS PRC to process. Contact both Avera and IHS to coordinate, and request that Avera hold your account while IHS processes the claim.
How to Apply for Avera Financial Assistance
Contact Patient Financial Services
Call Avera Patient Financial Services at (605) 322-4500 or visit the financial counseling office at your Avera facility. You can also visit avera.org/patients-visitors/billing-financial-assistance to access forms and information online.
Gather Your Documents
You will typically need: proof of income (recent pay stubs, tax returns, or a statement of no income), proof of household size, government-issued ID, and your Avera medical bills or account numbers. If you are self-employed or have irregular income, gather bank statements and any other documentation of your financial situation.
Complete the Application
Fill out the Avera Health financial assistance application form. Be thorough and accurate. Include all household members and all income sources. If you are applying under the hardship provision (above 250% FPL), include a written explanation of your financial circumstances.
Submit and Keep Copies
Submit your completed application with all supporting documents to Avera Patient Financial Services. You can submit by mail, in person at any Avera facility, or as directed by the financial services team. Keep copies of everything you submit, including a record of when and how you submitted.
Follow Up and Receive Determination
Follow up within 2 weeks if you have not received confirmation of receipt. Avera Health will review your application and notify you of the decision. If approved, the charity care or discount will be applied to your eligible bills retroactively.
If Your Application Is Denied
If Avera Health denies your financial assistance application, you have several options:
- 1.Request a written explanation of the denial reason. Understanding the specific reason helps you address the issue in an appeal.
- 2.Appeal the decision. Ask about the formal appeal process and provide additional documentation that addresses the denial reason. If you missed a document, submit it with your appeal.
- 3.Invoke the Catholic mission. As a Catholic health system, Avera has an obligation under the Ethical and Religious Directives to serve those who cannot afford care. Reference this mission in your appeal letter.
- 4.Request hardship consideration. If you were denied based on income alone, ask about the hardship provision for patients above 250% FPL with significant bills.
- 5.Know your state protections. Depending on which state you are in, you may have additional protections. South Dakota protects your home completely. Minnesota caps interest at 0%. Check your state-specific rights.
- 6.Request a payment plan. Even without charity care approval, Avera may offer interest-free or reduced payment plans that make the bill manageable.
- 7.Contact your state Attorney General if you believe the denial violates nonprofit hospital obligations. Avera must comply with IRS 501(r) requirements as a tax-exempt organization.
Denied? Let Us Help You Appeal
CareRoute can help you draft an appeal letter that references Avera's Catholic mission, cites your state-specific protections, and builds a compelling case for reconsideration.
Start Your Appeal with Bill DefenseContact Information
Avera Health has a centralized Patient Financial Services team as well as financial counselors at individual facilities.
Frequently Asked Questions
Who qualifies for free care at Avera Health?
Patients with household income at or below 200% of the Federal Poverty Level qualify for 100% free charity care at all Avera Health facilities. For a single person in 2026, that is approximately $31,920/year. For a family of four, approximately $65,600/year. Both insured and uninsured patients can apply.
How does Avera compare to Sanford Health for financial assistance?
Both Avera and Sanford offer free care at around 200% FPL and are the two dominant systems in the region. The policies are comparable but not identical. Apply to whichever system treated you. If you received care at both, submit separate applications to each. See our Sanford Health guide for details on their program.
Can I use Avera's Catholic mission in an appeal if denied?
Yes. Avera Health is a Catholic system sponsored by the Benedictine and Presentation Sisters, and follows the Ethical and Religious Directives which include an obligation to serve the poor. You can cite this mission in an appeal letter. This is especially effective when combined with documentation of your financial hardship.
Do different states have different protections for Avera patients?
Yes. Avera operates in five states, each with different medical debt laws. South Dakota has an unlimited homestead exemption. Minnesota has the Debt Fairness Act with 0% interest on medical debt. North Dakota has a 90-day delinquency rule. Nebraska has the Medical Debt Relief Act. Iowa has homestead and wage garnishment protections. Check your state-specific rights above.
Are bills from Critical Access Hospitals covered by Avera FA?
Yes. Avera's financial assistance policy covers all Avera hospitals, including Critical Access Hospitals (CAHs) in rural areas. Bills from CAHs may be structured differently due to cost-based reimbursement, but the same eligibility criteria and application process apply. You have the same FA rights at a small rural Avera facility as at Avera McKennan in Sioux Falls.
Can I get financial assistance for Avera eCARE telehealth bills?
Yes. Bills from Avera eCARE telehealth services are eligible for financial assistance under the same policy that covers in-person visits. The same income thresholds apply. Be aware that telehealth visits may generate bills from both the originating site and the distant provider, so review all your statements.
What if I was referred to Avera from IHS?
If you were referred through the IHS Purchase/Referred Care (PRC) program, contact IHS PRC first to confirm coverage. IHS may cover part or all of the bill before Avera FA applies. For any remaining balance after IHS processing, you can apply for Avera financial assistance. Inform Avera of your IHS status and coordinate with both organizations.
Do I need to be uninsured to qualify for Avera financial assistance?
No. Both insured and uninsured patients are eligible. If you have insurance but are struggling with deductibles, copays, or coinsurance, you may qualify for help based on your income and financial situation. Avera evaluates applications from all patients regardless of insurance status.
Can Avera take my home to collect medical debt?
It depends on your state. In South Dakota, your home is fully protected by the unlimited homestead exemption, meaning no creditor (including Avera) can force the sale of your primary residence to collect medical debt. Other states have varying levels of homestead protection. Check your state-specific rights in the section above.
What documents do I need to apply?
You will typically need proof of income (recent pay stubs, tax returns, or a statement of no income), proof of household size, government-issued identification, and your Avera medical bills or account numbers. If you are self-employed, bring bank statements and any business income documentation. Your financial counselor can tell you exactly what is needed for your specific situation.
Related Guides
Your state may provide additional protections for medical bills beyond what Avera Health offers through its financial assistance program.
Last updated: May 2026. Information is based on publicly available Avera Health financial assistance policies. Always confirm current eligibility requirements directly with Avera Patient Financial Services at (605) 322-4500.