患者协助选择
You may be eligible to receive free Liletta Intrauterine Contraceptive if you:
- Have been prescribed Liletta Intrauterine Contraceptive
- Have limited or no health insurance coverage
- 住在美国
- Are being treated by a licensed U.S. health care provider on an outpatient basis
如果您有保险,我们将根据申请过程中的保险,家庭收入和自付费用的结合来审查您的资格财务需求。为了帮助您了解我们用来评估合格财务需求的收入指南,我们提供了以下表:
房子大小 | 年收入 |
1 | $ 81,540或以下 |
2 | $ 109,860或以下 |
3 | $138,180 or less |
4 | $ 166,500或以下 |
After 4, add $28,320 for each additional dependent family member |
如果您想申请,则应与您的医疗保健提供商合作提交计划申请。为了避免延迟,请按照第一页的说明进行操作,并提交所有请求的信息。请下载下面的应用程序。
Liletta application(西班牙语)
Medicare患者可能有资格Medicare的额外帮助。