Affordable Care Program

Are You Eligible for Our Affordable Care Program?

Our Affordable Care Program offers significant discounts to patients from households living at or below 250% of the federal poverty level. To determine if your household qualifies, an eligibility screening is conducted. Eligibility is based on the total number of people living in the household and total annual household income.

Piedmont Regional Dental Care offers a two-tiered Affordable Care Program for financially eligible, uninsured individuals in designated areas.

Tier 1: Low-income, uninsured residents of Albemarle, Buckingham, Culpeper, Fluvanna, Greene, Louisa, Nelson, Orange, or Madison counties, or the city of Charlottesville, may be eligible to receive dental care at 50% off the standard rates, plus applicable laboratory fees.

Tier 2: Low-income, uninsured residents of Culpeper or Orange County may be eligible to receive urgent dental care with a $25 co-payment per visit. This fee may be waived, for urgent care only, if the patient is unable to pay.

Urgent dental care is limited to treatment needed to address issues such as:

• Severe toothache

• Dental abscess

• Loose or knocked-out teeth

• Broken tooth

• Large crack or chip in a tooth

Financial eligibility is assessed annually based on gross household income and family size, determined by the number of related and/or economically interdependent individuals in the household. Required financial documentation includes the following:

  • Active patient registration card from Free Clinic of Culpeper, The Greene Care Clinic, Madison Free Clinic, Orange County Free Clinic, or Central Virginia Health Services, Inc. in Louisa

  • Most recent tax return

  • Social Security statement

  • 1099 income form

  • Disability statement

  • W-2

  • One month of recent pay stubs (or less with year-to-date income on the paystub)

  • Other documents providing verified income from a public or private agency (e.g., food stamp letter or unemployment statement)

  • For applicants with no income, a support letter must be provided.

Income limits are as follows:

Family Size Monthly Income Limit Annual Income Limit
1 $3,137.50 $37,650
2 $4,258.33 $51,100
3 $5,379.17 $64,550
4 $6,500.00 $78,000
5 $7,620.83 $91,450
6 $8,741.67 $104,900
7 $9,862.50 $118,350
8 $10,983.33 $131,800