What happens if I can't pay the surgery co-payment?

6 answers | Last updated: Jun 15, 2017
Peppers9 asked...

Is there some way to get financial assistance to pay the co-pay for me to have gastric by-pass surgery? My husband and I are both on disability and money is very tight and for serious health reasons I must have the surgery now. Medicare covers the surgery part, but for the co-pay, neither my own nor anyone else's that I am aware of helps with that part, and the hospital is telling me if it is not paid by the time of surgery that I cannot get the surgery. Please help, I am only 42 and after the surgery I may be able to go back to work.

Expert Answers

If it's the hospital that's telling you that you have to pay the "co-pay" before they'll allow you to have the surgery, what they're probably talking about is not actually the copayment but the Medicare Part A hospital deductible amount, which is $1,068 for each period (known as a "benefit period") of hospitalization.

There may also a copayment under Medicare Part B for coverage of the amounts charged by the surgeon; that copayment is 20 percent of the amount Medicare Part B approves for the doctor's services, but payment of it is between you and the doctor, not the hospital.

If you can't pay the deductible, there are a couple of places you can check to see about getting financial help. You mention that you have some other insurance. Usually, any health insurance for someone on Medicare covers the Medicare Part A deductible. This is certainly true if you have Medicare supplement health insurance, commonly known as a Medigap policy. Check your insurance policy closely to see if it covers the Medicare Part A hospital deductible.

You might also qualify for Medicaid coverage, which could pay the entire deductible. To qualify for Medicaid, you must have very low income and few assets other than the house you live in. Even if you have not qualified for Medicaid before, the costs of this surgery may allow you to qualify temporarily. To find out about Medicaid eligibility in your state, go online to any search engine and enter "Medicaid" and the name of your state. This will take you to the main Web site for the Medicaid program in your state, which will give you contact information to find out more about the program and eligibility for it. Or, you can call the Eldercare Locator toll-free at 800-677-1116.

You can also talk to a an experienced health insurance counselor, for free, at your local office of the Senior Health Insurance Assistance Program (SHIP) or Health Insurance Counseling and Advocacy Program (HICAP). Enter "SHIP" or "HICAP" and the name of your city or state in an online search engine. Call and set up and appointment to talk to an advisor there. It's free, and they may know of local programs that could help you with this payment.

Community Answers

Disgruntled american answered...

While most of the above answer is correct, UNLESS you are going into a nursing home permanently, if you have medicare, you can't get Medicaid coverage. I can't afford the co-pays to even see my doctor. So basically, I'm going to die of cancer because pulling $50 co-pays from a $900 income that is supporting 2 people can't happen.

A fellow caregiver answered...

My mom had both medicare and medicaid. Medicaid is based on income.

Kisharha answered...

You can definitely receive medicaid while on medicare, I currently have both. In my state they can also help with any medical bills in the prior 3 months before you applied, as well. You can also get medicaid, or help through them, if you already have private insurance. I'd also like to add that it never hurts to apply if you are struggling with medical bills. There is no penalty for applying and being denied as long as you are truthful.

A fellow caregiver answered...

In response to "Kishara." For those of us on SSDI, NO WE CANNOT "definitely get Medicaid if [we] are on Medicare" unless we earn less than $1020.00 per month. So it is essentially a death sentence to someone such as myself who only gets $25 per month over that threshold if I need hospitalization or life saving surgery. Now, if I wasn't on Medicare at all, I'd qualify for Medicaid. Insidious. Meantime, I spent my many working years contributing to Congress's superior healthcare for the duration of their lives.

A fellow caregiver answered...

PS: Your best bet is to call the Medicare office. That's who I called for clarification.