Health insurance members may be subject to different forms of payment, including co-pays, co-insurance or deductibles. Under certain conditions, a cost-share waiver exempts the patient from their normal payment responsibility.
Many insurance providers have initiated cost-share waivers as a way to help out members experiencing financial hardship during the Covid-19 pandemic.
Cost-share waivers vary depending on the payer and plan. To get the most accurate information, members should call their insurance company to determine their payment responsibility.
Which services does the waiver cover?
Most current cost-share waivers are related to the ongoing pandemic. Included services may be directly related to Covid-19 treatment, such as certain charges during inpatient stays, while others may apply to preventive services, such as the cost of the Covid-19 vaccine or a primary care visit.
What is an example of a cost-share waived service?
Let’s say Jane’s insurance plan requires a $20 copay for each primary care visit. On Jan. 1, Jane learns she’s eligible for a cost-share waiver for all primary care visits until Jan. 31.
While Jane would typically pay the copay out of pocket, she now pays a grand total of $0 so long as visits are with a PCP and take place before Jan. 31.
What are the benefits of a cost-share waiver?
It’s a win-win situation for insurance payers, providers and patients. Preventative measures may save insurance payers on costs, for example, a primary care visit that catches a patient’s Covid-19 symptoms early may prevent an ER visit later. Providers may see patients who otherwise may not have been able to meet their cost-shares, and patients can access care at a more affordable price.
Are cost-share waivers indefinite?
Cost-share waivers have an expiration date. Since deadlines can change, it’s important to note when a waiver ends and a different payment responsibility starts.
How does someone qualify?
Waiver or no waiver, members should try to always connect with their insurance companies and clarify payment responsibilities before seeing a new provider or beginning a new treatment. During the phone call, members can also ask if they qualify for any applicable cost-share waivers. The representative will determine which, if any, are assigned to the specific plan, how long they will run and address any limitations.
Outside the Huddle
Cost-Sharing Waivers and Premium Relief by Private Plans in Response to COVID-19 (Nov. 2020 Update) | KFF
14 insurers extending COVID-19 cost-sharing waivers into 2021 | Becker’s Hospital Review
Aetna helps members access COVID-19-related care through new and extended waivers | CVS Health
Coronavirus (COVID-19) Information for Individuals and Families | Cigna
Reviewed by Geetika Rao, MPH | Edited by Nidhi Mahagaokar, MPH and Paris Ghazi | Fact checked by Julia Radossich, PA-C