As we all are learning what a new “norm” may look like for a while, one of the issues we are also dealing with are new words in health care.
With the loss of employer-sponsored insurance for the newly unemployed, we wrote a four -part series to provide options offered through the Affordable Care Act/Obamacare during this difficult time. Those options include the marketplace/exchange and Medicaid, if all elements of coverage are met.
In addition to this, we are hearing a phrase — “waiving of cost share” — and wondering, what, exactly does that mean? Let’s see if we can help as it will mean something different based on your health care insurance — traditional Medicare, Medicare Advantage or commercial insurance.
What does waiving of cost share mean? All insurance plans/companies have a patient portion. A deductible is applied first to the allowed charges and then the co-payment amount is applied once the deductible is met. (Example: Patient has a $1,000 deductible/patient portion then a 30% copayment is due for all continuing allowed charges.) Therefore, the waiving means there will not be a patient portion due.
Traditional Medicare: As part of the federal public health emergency, financial assistance to health care providers has a provision that there will be no out-of-pocket cost to the patients for COVID-19 related testing, effective March 18 to the end of the emergency. There is clarification still occurring on the full scope of what are services are waived, so stay tuned.
Other insurance plans, including Medicare Advantage: Remembering that Medicare Advantage coverage rules are determined by the individual Medicare Advantage plans, so it is important to contact each plan and ask: “Are you waiving ALL the out of pocket costs for ALL services related to my COVID-19 testing?” This same question should be asked of every commercial insurance plan as there are hundreds of plans in the United States (There are 36 independent Blue Cross Blue Shield companies, such as: BC of Idaho, Anthem BCBS of Nevada, Premera BC of Washington). Within each one, there are different types of insurance packages with different rules for coverage.
With the additional stress impacting our lives, be sure to get clear, concise answers on this important question. Additionally, as federal funding is being allocated to help keep the health care providers solvent, there may be additional rules that are issued.
After over 40 years in health care reimbursement, the current environment is challenging, even for me. Don’t be afraid to ask for help — from your insurance plans, your health care providers — and realize the answers may change over time. Be patient as it does take “a village” to stay strong during this time.
Day Egusquiza is the president and founder of the Patient Financial Navigator Foundation Inc. — an Idaho-based family foundation. For more information, call 208-423-9036 or go to pfnfinc.com. Do you have a topic for Health Care Buzz? Please share at firstname.lastname@example.org.
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