Managing out-of-pocket hospital costs can be a daunting task, even for those with health insurance. While nonprofit hospitals are obligated to establish financial assistance programs offering free or discounted care to eligible patients, awareness of these programs isn’t widespread. To make it easier for you, we’ve compiled the most commonly asked questions our CareCost guides encounter about hospital financial assistance. Read on to discover how hospital financial assistance works, and how Emry helps patients maintain affordable access to hospital care.
Who qualifies for financial assistance?
Each hospital or health system has their own Financial Assistance Policy, and each policy has its own eligibility criteria and application form. Typically, hospitals consider total household income, family size and sometimes available household assets when determining eligibility for their financial assistance program. Most hospitals offer significant discounts to patients up to 400% of the Federal Poverty Level, which for a family of four is household income below $120,000/year, some up to 500% or $150,000 for a family of four.
Why don’t more people know about financial assistance?
While hospitals are required by law to post their financial assistance policies on their website, most programs are hard to find and navigate on your own.
Why don’t more people apply?
People often refrain from applying for financial assistance due to the following misconceptions and misunderstandings:
- Misconception of Eligibility: There’s a common belief that holding an insurance policy automatically disqualifies an individual from financial assistance. This is not true. Insurance status doesn’t bar individuals from seeking help with medical costs.
- Stigma Associated with “Charity Care”: Hospitals often label their financial aid programs as “Charity Care”, and this can inadvertently create a stigma. Many people, out of a sense of pride, hesitate to accept what they perceive as charity.
- Misunderstood Income Criteria: There’s a prevalent notion that only those in extreme poverty qualify for assistance. This is a misunderstanding. Financial assistance programs cater to a wide range of income brackets, not just those at the lowest end.
- Overwhelmed by the Application Process: When introduced to financial assistance applications, many patients and families feel daunted by the extensive documentation required. The complexity of the language used can lead many to abandon their pursuit of these assistance programs altogether.
Breaking down these barriers and dispelling these misconceptions can ensure that more people benefit from available financial aid programs.
When it comes to hospital financial assistance, is a patient required to pay the deductible amount before financial assistance is given?
No. Hospital financial assistance programs apply to patient balances after insurance pays their portion. This means any deductible or co-pay that the patient is billed for is reduced by the assistance program. For example, if a patient is charged a $2,000 deductible and qualifies for a 75% discount under the hospital’s financial assistance policy, their obligation is then significantly reduced. The initial $2,000 balance would be discounted to $500, and that’s the amount the patient would be responsible for paying. So, financial assistance can alleviate the burden of the deductible, helping patients navigate their healthcare costs more comfortably.
Can patients apply for financial assistance before or after they receive service at a hospital?
Both—but we strongly encourage members to apply for financial assistance at their preferred hospitals prior to receiving care. An approval for financial assistance can save patients thousands of dollars in out-of-pocket costs.
As an Emry client, is the employer or health plan responsible for funding the discount amounts?
No. Nonprofit hospitals are required by federal law to offer income-based financial assistance programs to their patients to justify their tax-exempt status. The transaction that happens when a member applies and is approved for financial assistance is a simple write-off in the hospital’s billing system. (i.e., a $2,000 bill is discounted down to $500 if the member qualifies for a 75% discount.)
Does the Emry Financial Assistance Portal screen for eligibility at hospitals in general or eligibility at the member’s specific hospital?
The Emry Financial Assistance Portal allows patients to select their preferred hospital (or hospitals in their area) and see if their financial and family situation qualifies for a discount according to that specific hospital’s Financial Assistance Policy.
How much time does it take to check eligibility and apply with Emry?
With the Emry Financial Assistance Portal, we’ve simplified the process to make applying as straightforward as possible. Most individuals spend just 4 to 8 minutes, from checking eligibility to submitting their application. To initiate the process, you only need to provide two pieces of information: your income and family size. If you’re eligible and decide to proceed with an application, you’ll need to upload a few more documents, including your previous year’s W2, tax return, recent pay stubs, the last two months of bank statements, and your insurance card (if applicable).