Financial Assistance Application Checklist

Application Checklist

If you fail to provide the requested information your application will be deferred for 30 days. If you do not respond in 30 days, your application will be denied. Please make sure you sign and date the application.

How Do I Submit My Application?

Your completed application, proof of income and 4506-T EZ form can be submitted via mail, fax or email.

Attn: Financial Counselor
Mount Desert Island Hospital
PO Box 8, Bar Harbor, ME 04609

Fax: 207-288-8608

Email: financialcounselor@mdihospital.org

Have You Applied for Insurance on the Health Insurance Marketplace?

If you have applied for insurance on the Health Insurance Marketplace (healthcare.gov), you will be asked to provide information regarding coverage, if not, you may be asked to complete a Marketplace Application.

If you would like help completing a Marketplace Application, enrollment assistance is available.

Need Help?

If you have questions or need assistance completing the Financial Assistance Application, please call us at 207-288-5082 x 1202.

MDI Hospital

MDI Hospital
17 Hancock Street
Bar Harbor, ME 04609
207 288-5081

At Mount Desert Island Hospital, we provide comprehensive care for you and your family through our hospital in Bar Harbor and a network of health centers across Mount Desert Island.