What is “ Share of Cost ”? Your “ share of cost ” is the amount of medical bills that you must have before Medicaid can pay any of your other incurred medical bills for you. Your ” share of cost ” works like a deductible on a health insurance policy. Your “ share of cost ” is based on your family’s monthly income.
This amount is related to how much your income exceeds the traditional Medicaid income limits. The more money you make, the more your share-of-cost will be. If your household income changes, or if the number of people in your household changes, your share-of-cost will also change.
Many private practices are unable to accept Medicaid patients because the reimbursement rate still lags far behind private insurance. Also, the Medicaid credentialing and claims process is so burdensome that it would require extra dedicated staff just to manage the administrative aspects.
Individuals who qualify for Medicaid often don’t have to pay a monthly premium for the benefits, but there are some exceptions. Otherwise, the program provides 100 percent coverage for most medical expenses and does not require payment of premiums or deductibles.
Eliminating Medicaid Spend Downs and Cost Shares Another common way to eliminate this fee is to join a Medicaid Buy In Program. If you are currently in a program that is not a waiver program, joining a waiver program can eliminate your share-of-cost .
“ Share of Cost ” is the amount you agree to pay for health care before Medi-Cal starts to pay. This is called “meeting your share of cost .” Your Share of Cost is a set amount based on how much money you make. After you meet your share of cost , Medi-Cal pays for your care the rest of that month.
To receive share of cost Medi-Cal, beneficiaries must contribute to their health care expenses by paying a share of the cost of the services they receive each month. Once they meet the full share amount, they are “certified” and Medi-Cal will cover all other costs for that month.
As an example, in California , the Medicaid program is called Medi-Cal . In Massachusetts, it is called MassHealth. The Medically Needy Pathway to Medicaid eligibility is intended to assist individuals whose income exceeds the Medicaid limit, but who have unusually high medical expenses that they cannot afford.
If you live in a state with a medically needy program, then you can use medical expenses you incur to reduce, or “spend down,” your income to qualify for Medicaid. States establish a spend-down period, during which they look at your income and expenses to see whether you qualify for coverage.
Second, there may be differences in the characteristics of physicians who predominantly serve patients with a certain insurance status. A study of hospitals in Florida has found some evidence that, compared to other patients in the same hospital, uninsured and Medicaid patients are treated by lower-quality physicians .
Low payment rates are often cited as the main reason doctors don’t want to participate in Medicaid . Doctors also cite high administrative burden and high rates of broken appointments. Under the Affordable Care Act, primary-care doctors who see Medicaid patients received a temporary pay raise.
The Emergency Medical Treatment and Active Labor Act While a doctor has every right to deny treatment for various reasons, they can ‘t refuse to treat a person with life-threatening or serious injuries even if they don’t have health insurance or the ability to pay.
Medicaid covers a lot of the same medical services a traditional health insurance plan would. Hospital care and doctor visits are paid for with low or no copays for adults and children alike. Though states determine their own Medicaid benefits, they are required to cover certain services.
A Medicaid copay is also known as an out-of-pocket cost. These costs are decided at the state level administration of the Medicaid program. A state can decide that there are going to be copays associated with various medical services that are covered by Medicaid .
If you inherit money , you are legally obligated to report it to Medicaid . On the other hand, if you inherit money and do not report it , you will be required to pay Medicaid back for the services and benefits that were provided during any period of ineligibility.