How to Get a Medical Baseline Rate on Your Utility Bill

What a medical baseline rate is and who can get one

A medical baseline rate is a lower electricity or gas rate for households where someone has a medical condition that requires constant use of electric or gas equipment to stay safe. Instead of paying the standard rate for all your power use above a certain threshold, you pay a reduced rate on usage that your utility company considers medically necessary.

The program exists because conditions like sleep apnea, dialysis, oxygen dependency, and refrigerated medications create non-negotiable power needs. If you run a CPAP machine eight hours a night, a nebulizer several times daily, or a refrigerator for insulin, you cannot simply cut back when bills rise. Medical baseline recognizes that reality by lowering the rate on the amount of electricity or gas your condition requires.

Most utilities in California offer this program — it is the most common state with medical baseline protections. Some other states have similar programs under different names. Your utility company determines the baseline amount (usually 50 to 70 percent of your average household usage, depending on the utility and season), and you pay the lower rate on everything up to that amount. Usage above the baseline is charged at the standard rate.

Key Takeaways

• You need a letter from a doctor stating that someone in your household has a medical condition requiring continuous electric or gas equipment, not just a diagnosis.
• Contact your utility company directly — they handle medical baseline requests, not a separate government office.
• The application process takes two to four weeks from the time the utility receives your doctor's letter.
• Once approved, the rate reduction applies to your next billing cycle and continues as long as you stay with that utility and the medical need remains.
• You do not need to prove income or disability status — only that the medical equipment is medically necessary and in active use.

Getting a letter from your doctor

Your doctor does not need to fill out a special form. The utility company will accept a simple letter on the doctor's letterhead stating that you (or someone in your household) have a medical condition that requires continuous or regular use of specific electric or gas equipment, and that this equipment is medically necessary.

The letter should name the equipment — for example, "continuous positive airway pressure (CPAP) machine," "oxygen concentrator," "dialysis machine," "refrigeration for insulin," or "nebulizer." It does not need to describe your diagnosis in detail or state how many hours per day you use it, though that information can help. The utility company mainly needs confirmation that the equipment is medically necessary, not optional.

Call your doctor's office and ask to speak with the person who handles medical letters or prior authorization requests. Many offices can send this letter within a few days. If your regular doctor is unavailable or retired, a nurse practitioner, physician assistant, or specialist who treats your condition can write the letter instead. The utility company does not require the letter to come from a primary care physician.

Contacting your utility company and submitting your request

Call your electric or gas utility's customer service number — it is on your bill. Ask specifically for the medical baseline program or medical rate reduction program. Some utilities call it "medical baseline," others call it "medical necessity rate" or "health and safety rate." The representative will tell you whether your utility offers the program and what they need from you.

Most utilities ask you to mail or upload the doctor's letter along with a simple form they provide. Some utilities now accept uploads through their website or customer portal; others still require mailed documents. Ask the representative which method is fastest for your utility and get a mailing address or upload link before you hang up.

Include a copy of your most recent utility bill with your submission so the utility can match your account. Write your account number on the doctor's letter itself. If you are submitting by mail, keep a copy of everything you send and note the date you mailed it.

What happens after you submit your request

The utility company will review your doctor's letter to confirm that the medical equipment qualifies. They are not checking whether your diagnosis is severe enough — they are checking whether the equipment itself is something that requires continuous power. A CPAP machine, oxygen concentrator, dialysis equipment, and refrigerated medications all may have access to. A humidifier or heating pad typically does not.

If the utility approves your request, they will send you a letter confirming the medical baseline rate and the baseline amount (the kilowatt-hours or therms you can use at the lower rate each month). This usually takes two to four weeks. Your new rate will appear on your next billing cycle after approval.

If the utility denies your request, they will explain why in writing. Common reasons are that the equipment does not meet their definition of medically necessary, or that the doctor's letter did not clearly state that the equipment is medically necessary. You can resubmit with a more detailed letter from your doctor if this happens.

How the rate reduction shows up on your bill

Your utility bill will show two rates: the medical baseline rate (lower) applied to usage up to your baseline amount, and the standard rate applied to anything above that. For example, if your baseline is 400 kilowatt-hours per month and you use 550, you pay the reduced rate on the first 400 and the standard rate on the remaining 150.

The baseline amount itself may vary by season. Many utilities set a higher baseline in summer (when air conditioning use is expected) and a lower one in winter. Your bill will show which baseline applies to that billing period.

The rate reduction continues month to month as long as you stay with that utility. You do not need to reapply each year unless the utility specifically asks you to. If you move to a different utility company, you will need to apply to that utility separately — medical baseline does not transfer between providers.

If your utility does not offer medical baseline

Not all states regulate utility rates the way California does. If your utility company tells you they do not have a medical baseline program, ask whether they offer any other rate reduction for medical equipment use — some utilities have programs under different names, or they may make exceptions for specific high-need equipment.

If your utility genuinely does not offer any medical rate reduction, you may be able to deduct some of your utility costs on your taxes if you itemize deductions and the equipment is prescribed by a doctor. This is a tax question, not a utility question, so speak with a tax professional or call the IRS helpline to understand whether your situation qualifies.

You can also contact your state's Public Utilities Commission to ask whether medical baseline protections exist in your state or whether you can request one. Some states have advocacy organizations that push utilities to adopt these programs.

Keeping your medical baseline active

Once approved, your medical baseline rate continues automatically. You do not need to reapply each year or provide updates unless your utility asks. However, if you stop using the medical equipment, you should notify your utility so they can remove the medical baseline rate — continuing to claim it when you no longer need it could be considered fraud.

If you move to a different address within the same utility's service area, your medical baseline will transfer to your new account. Notify the utility of your move, and confirm that the medical baseline rate is applied to your new account's first bill.

If you change utilities (for example, if you move to a different service area), you will need to reapply to the new utility with a new doctor's letter. Keep a copy of your original doctor's letter so you can show it to the new utility or ask your doctor to send another one.

Frequently Asked Questions

Do I need to prove my income to get medical baseline?

No. Medical baseline is based only on medical need, not income. You do not need to provide tax returns, proof of disability, or any financial information. The utility company only needs the doctor's letter confirming that the equipment is medically necessary.

What if I use multiple pieces of medical equipment?

List all of them in the doctor's letter. The utility will calculate your baseline amount based on the total power needs of all the equipment combined. One letter covering multiple devices is simpler than submitting separate requests.

Can someone else submit the request on my behalf?

Yes. A family member, caregiver, or advocate can call the utility, submit the forms, and handle the paperwork. The doctor's letter must still come from the doctor, but you do not have to be the one to mail it or upload it. Give the person helping you a copy of your account number and most recent bill.

What if my doctor retires or leaves the practice?

You will need a new letter from a different doctor — your current primary care doctor, a specialist who treats your condition, or any licensed physician who is familiar with your medical equipment use. The utility does not require the letter to come from the same doctor who originally approved it.

How much money will I save?

The savings depend on your utility company's rates, your baseline amount, and how much you use above the baseline. A household using a CPAP machine might save $10 to $30 per month; a household running an oxygen concentrator or dialysis equipment might save more. Contact your utility to ask what your baseline amount would be and calculate the difference between the medical baseline rate and the standard rate.