In mid-May, the Kaiser Family Foundation estimated that 27 million Americans may lose employment-based health insurance because of the coronavirus pandemic. Those numbers add up to a bleak reality: Suddenly, more and more of us are facing real fears about paying for everything from care should we contract the novel coronavirus to health insurance premiums to prescription drugs, doctor’s visits, and hospital bills. There’s hope. Consumer advocates interviewed for this guide cite medical assistance resources that many people overlook, think they don’t qualify for, or simply haven’t heard of because they aren’t well advertised to the public. Whether it’s hospital financial assistance plans and prescription discounts, help with everyday health expenses for people with chronic medical conditions, or more affordable health insurance options you may not have considered, there are ways to manage existing medical debt and cover the cost of the healthcare you and your family need now. “Don’t let concerns about medical bills keep you from getting the care you need,” says Caitlin Donovan, a spokesperson for the National Patient Advocate Foundation. “Skipping medications and putting off appointments, tests, and treatments can lead to worsening health problems and higher medical bills. There are plenty of resources and strategies you can use to reduce your bills and make payments easier.” “If you’re having trouble paying medical bills, it’s always worth reaching out and asking about all types of assistance,” says Andrea Bopp Stark, a staff attorney with the National Consumer Law Center (NCLC) who has studied hospital financial assistance programs across the United States. “For example, plenty of people don’t know that nonprofit hospitals are required by law to provide charity care and financial assistance programs and that many for-profit hospitals also have programs. Don’t assume you don’t qualify. Ask.” Here’s what you should know.
What Types of Medical Assistance Programs and Resources Are Out There?
Plenty! The following are some types of resources that may be available to you.
Hospital Charity Care and Financial Assistance Programs
In the United States, nonprofit hospitals are required under federal tax law to offer programs that cover all or part of the cost of new and existing medical bills for people who meet eligibility requirements, says Bopp Stark, who authored a January 2020 report on the topic published by the National Consumer Law Center (NCLC). Many for-profit hospitals have similar programs, she found. And 10 states require all hospitals within their borders to provide free care or some level of assistance to eligible patients. These are California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Rhode Island, and the state of Washington. Eligibility depends on your income and, in some cases, personal and family financial assets. These policies generally cover people who have no health insurance or who are underinsured (by definition, people who have medical insurance coverage but still have trouble paying for medical expenses) and whose incomes are low enough to qualify. People who are underinsured include those struggling to pay off big medical bills (despite insurance coverage), often due to high-deductible health plans, limited policies, or high out-of-pocket costs. Income eligibility varies from program to program, according to the NCLC report from earlier this year. If you’re eligible, these programs cover costs for emergency care and medically necessary inpatient care, too. The savings can be substantial. You may qualify for charity care that covers all hospital costs or requires you to pay only 20 to 80 percent of the bill, the NCLC report found. RELATED: Elective Does Not Mean Optional, and Everything Else You Need to Know About Surgery During the Pandemic Note that eligibility rules vary from hospital to hospital and from state to state, so it’s important to check with your hospital’s billing office if you have concerns about a previous bill or an upcoming expense. “You can receive financial assistance for existing medical bills and for upcoming expenses for medically necessary procedures and emergency care,” she says. You can apply for charity care even if your hospital bill has been sent to a collection agency, if you’re being sued by the hospital for nonpayment, or if you’ve already paid the bill but suspect you might qualify for help, according to a November 2019 report from Northwest Justice Project, a Washington state–based nonprofit that provides free legal services to low-income individuals. It’s also worth asking about financial assistance if you have a bill or will undergo a procedure at a same-day surgery center, too, Bopp Stark says. Charity care assistance plans may not cover everything on your bill. In New Jersey, for example, fees for doctors, anesthesiology, some radiology services, and outpatient prescription drugs may not be eligible for reductions under the state’s hospital care payment assistance program, according to an August 2016 fact sheet about the program from the New Jersey Department of Health. You can find out more by contacting the billing department of the hospital or surgery center that provided your care or where you or a family member will soon receive care, Bopp Stark suggests. “Don’t assume you don’t qualify,” she says. “The hospital won’t automatically tell you if you could get financial help. It’s up to you.” RELATED: How the Coronavirus Crisis Is Affecting Women and Women’s Health Policies
Independent Charity Patient Assistance Programs
These programs aim to help cover copayments, coinsurance, and deductibles for all medications prescribed for you to treat and manage a specific, diagnosed disease. The program may cover all medications prescribed for you for a specific disease, such as COVID-19, hepatitis B and C, cervical cancer, or hemophilia. Large independent charity patient assistance programs include the HealthWell Foundation, Patient Access Network Foundation, Good Days, Patient Advocate Foundation Co-Pay Relief, Patient Services Incorporated, CancerCare Co-Payment Assistance Foundation, National Organization for Rare Disorders and the The Assistance Fund. Each offers programs for individual diseases and conditions.
Grace Periods for Paying Health Insurance Premiums and Other Medical Assistance From Private Insurers
Most commercial health insurance plans (such as the one you might have through your employer or private plans you buy for yourself) cancel coverage 30 days after you miss a premium payment, according to HealthInsurance.org, a consumer health insurance information website. If you have a subsidized Affordable Care Act health insurance policy purchased on the Health Insurance Marketplace, the grace period is 90 days, according to HealthCare.gov. But as of May 15, 2020, 16 states enacted longer grace periods for people with commercial health plans. Some of these extensions apply only to people facing financial hardship related to the COVID-19 pandemic; others apply to everyone, according to the Kaiser Family Foundation. Note, however, that currently many of these extended grace period rules are set to end in late May or early June. And when the grace period ends, you’re responsible for paying all owed premium amounts. RELATED: Answers to Your Top COVID-19 Questions Some insurance companies that got on board include Florida Blue, the state’s Blue Cross and Blue Shield company, which extended the grace period for unpaid health, vision, and dental policies to May 31 and delayed disenrolling people from Medicare Advantage programs for nonpayment until the next enrollment period begins. Other insurers that have lengthened grace periods include Highmark and Providence Health Plans. Do read the fine print; longer grace periods don’t exist for all plans with these insurers. Contact your insurer right away if you’re having difficulty paying your monthly premium to see what rules apply to your specific plan. And note that you have the right to appeal your health insurance company’s decision to terminate your policy if you believe they wrongfully did so, according to HealthCare.gov.
Government-Sponsored Medical Assistance: Subsidized Insurance, Medicare, and Medicaid
The Affordable Care Act (enacted in 2010) provides subsidized health insurance options to individuals and families with incomes of up to 400 percent of the federal poverty level. The Affordable Care Act also requires these insurance plans (and those available to individuals with higher incomes) to offer various standard services; both subsidized and nonsubsidized plans are available through the Health Insurance Marketplace. If you already have a Health Insurance Marketplace policy and receive a subsidy to help cover your premiums, be sure to update your income information if your wages have dropped or you lost your job. You may qualify for more savings. Learn more about how to update your information on the HealthCare.gov website (which is part of the Centers for Medicare and Medicaid Services). Getting a subsidy through the Health Insurance Marketplace reduces the average premium for a 40-year-old earning $30,000 a year from $315 to $812 (depending on your state of residence) to about $199, according to the Kaiser Family Foundation Health Insurance Marketplace Calculator. Your new income level may also qualify you or your children for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You can enroll in Medicaid (the nation’s tax-funded health insurance program for people with low incomes) or CHIP (the nation’s tax-funded health insurance program for children from lower-income families, run through Medicaid and also through state programs) at any time. Apply through the Health Insurance Marketplace or through your state’s Medicaid agency (find both links via HealthCare.gov). Eligibility for Medicaid and CHIP are based on your household income and the size of your household and varies by state. Find out if you might qualify with the HealthCare.gov calculator. And find out more about both programs at Medicaid.gov. Medicare is the nation’s government-sponsored health insurance program for adults age 65 and older and for some younger adults with disabilities or those with chronic kidney disease that requires dialysis or a kidney transplant. (Read more about the differences between Medicaid and Medicare below.) If you lose your commercial, employer-based health insurance because of a layoff, you have 60 days to sign up for a Health Insurance Marketplace plan — and possibly receive a subsidy to help cover your premiums. Find out more about this Special Enrollment period at HealthCare.gov. Note that the special enrollment period does not apply to people who have had their health insurance canceled because of nonpayment. Additionally, the state-run health insurance exchanges in 11 states and the District of Columbia have announced that they’ve reopened so that any uninsured state resident can enroll to purchase health insurance through the Health Insurance Marketplace during the pandemic. States that have reopened their health insurance exchanges are California, Colorado, Connecticut, Maryland, Massachusetts, Minnesota, Nevada, New York, Rhode Island, Vermont, Washington state, and the District of Columbia. The HealthCare.gov website was updated in mid-April to make it easier for consumers to find important information on how to best take advantage of updated special enrollment period rules put in place in response to the COVID-19 pandemic, says Shelby Venson, a spokesperson for the Centers for Medicare and Medicaid Services. This includes the addition of a webpage on HealthCare.gov specifically for COVID-19 information as it relates to exchange coverage, Venson says.
Continuing on Employer-Sponsored Health Insurance With COBRA After You’ve Lost Your Job
There’s another option if you’ve lost a job with health insurance and want to stay on your current plan, but it’s expensive. You may be able to keep your employer-sponsored plan for 18 months under a federal rule called the Consolidated Omnibus Budget Reconciliation Act (COBRA). The catch: You’ll have to pay the full cost of premiums plus a 2 percent fee, according to the U.S. Department of Labor. That can add up, but may be worthwhile for a month or two while you weigh other options or if you’ve already reached your deductible or out-of-pocket limit and are paying low prices for medical care as a result.
New and Updated Medical Assistance Resources for COVID-19 Care
According to an April 2020 poll from Gallup, one in seven Americans said they’d skip medical care related to the novel coronavirus if they had symptoms due to medical-bill fears. Federal legislation and health insurance companies are taking steps to reduce the likelihood of that care avoidance from happening. The federal Families First Coronavirus Response Act, which went into effect April 1, 2020, requires all health insurance plans — whether they’re private, government-sponsored (Medicaid/Medicare), military, or purchased through the Healthcare Insurance Marketplace, subsidized or not — to pay for COVID-19 tests and doctor’s fees associated with testing with no out-of-pocket costs to consumers such as copays or meeting your deductible first, according to the Kaiser Family Foundation. The act also requires employers to pay for sick leave and family leave if you become infected with or must care for a family member with COVID-19, according to the U.S. Department of Labor. In addition, large health insurers including Aetna, Anthem, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealthcare announced earlier this spring they were waiving patient costs for coronavirus treatment. That could save you an estimated $1,300 in out-of-pocket costs for treating a severe infection, according to data published in March by the Kaiser Family Foundation. Insurers set end dates on this extra benefit that range from late May to September, so contact your health insurer to see if waivers are still in effect. Additionally, some of the independent charitable patient assistance programs mentioned above have set up funds specifically for people with COVID-19. Medicare is the federal health insurance program for 61 million Americans, mostly adults age 65 and older as well as some younger adults with disabilities or permanent kidney failure, according to Medicare.gov. Medicaid is administered by states, providing health coverage to low-income adults, children, pregnant women, elderly adults, and people with disabilities, according to Medicaid.gov. If you don’t meet the stricter eligibility requirements for Medicaid, you may be eligible for government-subsidized health insurance (thanks to the Affordable Care Act) through the Health Insurance Marketplace. And beyond those options, other sources of medical assistance are available, as outlined in this guide. They range from prescription drug discounts and assistance plans to health insurance premium subsidies to financial help from hospitals, pharmaceutical companies, foundations, and private companies.
Do I Qualify for These Medical Assistance Resources?
Every program has its own requirements, often based on income, and the number of people in your household. Some also consider your health insurance status and other financial assets. Contact programs for details. Here are some factors to keep in mind about the larger medical assistance resources:
Medicaid and Health Insurance Marketplace plans with premium subsidies Eligibility is based on the number of people in your household (you, your spouse, and dependents) and your household income. Disabilities and family status may also be considered for Medicaid eligibility. Rules also vary by state. In many states (like Delaware, Michigan, and New Hampshire) a family of four with a household income below $36,156 may be eligible for a low-cost or free Medicaid plan, while the same family might qualify for a Health Insurance Marketplace plan with lower monthly premiums with income between $35,156 and $65,500, according to the HealthCare.gov eligibility calculator tool. Find more guidelines on the HealthCare.gov website.Medicare You’re eligible for some Medicare services without paying a premium if you’re age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years (Part A). Most Medicare beneficiaries pay a premium for additional services (Part B) of $144.60 per month or more if your modified adjusted gross income is above $87,000 for individuals or $174,000 for joint tax filers, according to the Medicare.gov. You also qualify before age 65 if you’ve been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months or if you are a kidney dialysis or kidney transplant patient, according to the U.S. Department of Health and Human Services.Hospital financial assistance plans Charity care, which covers your whole hospital bill, and financial assistance, which covers a percentage of the bill, usually have income-based qualifications. Rules vary by hospital system and by state in states that mandate all hospitals provide financial help for those who need it, according to the aforementioned National Consumer Law Center report. For example, nonprofit hospitals in Oregon provide full financial assistance to people whose household income is up to 200 percent of the federal poverty level, and use a sliding scale for incomes between 200 and 400 percent of the federal poverty level, according to the NCLC report. In Kentucky and Kansas, residents of counties with 175,000 to 250,000 people qualify for assistance if they’re uninsured and can’t pay for hospital care. In Indiana, people with a household income that is 75 percent of the federal poverty level qualify for assistance if hospitalized with a severe medical condition.Patient assistance programs from pharmaceutical companies for prescription drugs Eligibility is based on income and sometimes, insurance status. Some programs that provide help paying for specific drugs are only available to those without health insurance or to those whose health plans don’t include prescription drug coverage. For example, the drug company Merck offers more than 40 medications free of charge to eligible consumers, including the diabetes drug Janumet, the asthma medication Singulair, and the human papillomavirus vaccine Gardasil 9 (more information about these programs below).Independent charity patient assistance programs You must meet income requirements (generally below 500 percent of the poverty level), and have a diagnosis for a medical condition covered by the program, according to a study published in 2019 in the Journal of the American Medical Association that analyzed eligibility requirements for 274 major independent charity PAPs. Many require you to have health insurance that also covers the drugs you need.Pharmacy discount cards and copay coupons In general, there are no eligibility rules for pharmacy discount cards. To use copay coupons for a brand-name drug, you must have commercial insurance, not Medicaid, Medicare, or other government-sponsored plans.
How Can I Get Help Paying My Medical Bills?
If you or a loved one will undergo a medically necessary procedure in a hospital, or wind up needing care in the emergency room, ask about hospital charity care and financial assistance, described above. For visits with healthcare practitioners as well as tests and prescription drugs, work with your health insurance company to be sure you’re using in-network providers, testing centers, and pharmacies. If you take a prescription drug that’s expensive, ask your doctor, pharmacist, and insurance company if there’s a less-expensive alternative such as a generic drug or another drug in the same class that may cost less. This is also a great time to try telehealth — health appointments conducted by video with your doctor using your smartphone, tablet, or computer. Many health insurers are offering free telehealth visits for coronavirus symptoms and other health complaints during the pandemic. Check with your health insurer about the details and ask your doctor if she’s providing virtual visits. Other resources to help out include:
Patient Advocate Foundation This nonprofit offers a free case management service to qualifying consumers that takes a comprehensive look at your bills, your income, and your needs so that you can more easily pay for healthcare and other monthly expenses. “Case managers review your medical bills to look for errors, help connect you with programs that help pay for housing, food, utilities, and more, and find more resources to help meet your medical-bill needs,” Donovan says. The PAF also offers grants of $500 to $1,000 toward living expenses for people with specific health conditions, such as heart valve disorders, Merkel cell carcinoma, and COVID-19 care. “We also have a national financial resource directory with thousands of resources across the United States for uninsured and underinsured healthcare consumers,” Donovan says. “You may find a program in your state or for your health condition that fits your needs perfectly.”Free and charitable clinics If you do not have health insurance or if you can’t afford care despite having a health plan, check the nation’s network of 1,400 free and charitable clinics. These medical centers provide medical care as well as dental, vision, mental-health, and prescription-drug services on a sliding scale based on your income. Find one near you through the National Association of Free and Charitable Clinics.
What if I Can’t Afford My Prescriptions?
Two-thirds of Americans say their prescription drug prices have increased since 2017 — and half of them said the hikes were substantial, according to a report published by Gallup in April 2020. That can put a dent in your wallet and your health. In an earlier report, published by Gallup in 2019, 23 percent of Americans said they lacked the funds to fill a needed prescription at least once in the previous year. RELATED: A Consumer’s Guide to Drug Discounts If you’re having difficulty affording the medications you or your family needs, the following programs and strategies may help.
Prescription Discount Cards
Available from individual pharmacy chains, third-party drug discount companies, and even some state governments, prescription discount cards could help you save a substantial amount compared with the retail cost of brand-name and even generic drugs. The discount cards could save you up to 80 percent, according to NeedyMeds, a nonprofit that helps connect people to programs that will help them afford their medications and healthcare costs. That can be a big help if you don’t have insurance, if a drug you need isn’t covered by your plan, or even if it is covered but the price is still high. Some of these sites provide drug coupons and price comparisons among local pharmacies that carry the drug you need. Examples of some prescription discount card providers include:
GoodRxUS Pharmacy CardBlink Health
Don’t assume you’re always getting the best deal, though. If you have health insurance or use a pharmacy that offers low-cost generics, your copay could be lower than the discount price on a more costly brand-name version. You can’t use private health insurance or Medicaid or Medicare drug benefits along with a discount card, so you must choose. And know that your out-of-pocket purchase with a card probably won’t count toward your health insurance deductible. Your final cost could vary depending on the pharmacy you use, too. Finally, while most prescription discount cards are free, some charge fees that can range from $12 to $100 a year or involve processing fees for individual purchases, according to NeedyMeds. The bottom line: Do your homework before using one. Ask your pharmacist how you can get the lowest price when you fill or refill a prescription, NeedyMeds recommends. You can also use online drug price trackers available on the websites and apps of some prescription discount cards to find the best deal. RELATED: 5 Ways Your Pharmacist Can Help You Save Money
Prescription Copay Coupons
Also called copay assistance coupons or copay assistance cards, these money-saving coupons provided by drugmakers give you a low price on a brand-name drug. They usually cover pricey brand-name drugs that have no generic version, according to the National Consumers League, a nonprofit consumer protection organization. These free coupons may set limits on the amount of savings you can rack up and may have an expiration date. Copay coupons can be used by people with private insurance — but note that those with government-sponsored plans including Medicaid and Medicare can’t use them. (But some drugmakers offer similar savings plans for some uninsured consumers and those on Medicare, such as the drug company AstraZeneca.) RELATED: Why Is Insulin So Expensive? (and What to Do About It) In the past, copay coupon users could count the full cost of their drug copay (their out-of-pocket cost plus their coupon savings) toward their insurance deductible. That has now ended, under an insurance industry rule called copay accumulator adjustment. Now only your out-of-pocket cost will apply toward your deductible and your out-of-pocket maximum under many health plans if your health plan has instituted this adjustment program. That means it will take longer to reach your deductible or out-of-pocket maximum and all your health costs will be higher until you do, according to the nonprofit group Patients Rising. The practice started in 2018, with innocuous-sounding program names like “Out of Pocket Protection” and “Coupon Adjustment: Benefit Plan Protection.” State legislatures must approve these programs before a health insurance company can put them into place — and some states, like Virginia, have recently passed bills banning the practice, also according to Patients Rising. The practice is spreading. According to a study published in July 2019 in the American Journal of Managed Care, about half of employer-sponsored health plans had instituted copay accumulator programs in 2019 or were planning to do so in 2020 or 2021.
Patient Assistance Programs From Pharmaceutical Companies for Prescription Costs
Some drug manufacturers also run patient assistance programs that offer those who meet insurance and income eligibility requirements access to expensive prescription drugs at a discounted price or for free. Rules and savings vary among pharmaceutical companies, and not all drugs are covered. According to NeedyMeds, there are about 375 such programs in the United States providing $13 billion in no-cost medications to those in need. Find a list of these patient assistance programs on the NeedyMeds website or on the Pharmaceutical Research and Manufacturers of America’s Medicine Assistance Tool. You can also check the website of the maker of a drug you use to see if there’s a patient assistance program for it. Eligibility varies by income and insurance status. Note: Some drugmakers have programs for people with Medicare Part D prescription drug coverage. Find out if your drug is covered on Medicare.gov. RELATED: 5 Myths and Facts About Prescription Drug Prices
