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

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 Answer

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.