Health Provider Financial Assistance

What is health provider financial assistance?

Hospital financial assistance helps you pay for needed medical treatment. Health providers offer discounted care to patients who meet certain income thresholds and sometimes asset thresholds. Income thresholds can vary from $18,864 to $262,000, with the median policy income threshold being between $78,600 and $104,800 for a family of 4.

When determining if a patient qualifies, hospitals may also choose to look at monetary asset value. This generally does not include retirement accounts, pensions, or their primary residence — only assets that can be easily converted to cash. The general requirement is that they will consider 50% of monetary asset value after $10,000. About 25% of policies have no asset requirement.

What types of discounts are available?

The type of the discount usually comes in three forms: (1) free care (called Charity Care), (2) medicare, medicaid or government provider rate, or (3) discount off of hospital sticker prices (gross charges before discount) or amounts generally billed (AGB) (which is the average reimbursement for that service from all payers).

For the most part, one can expect that when their bill exceeds a specific portion of their income, regardless of insurance, their hospital will offer a catastrophic care discount, a key form of financial assistance. This number tends to vary from 2% to 30%, but most hospitals have it at 10% of yearly income. Catastrophic care discounts are also offered to both insured and uninsured patients.

If you’re in California, Clinic Price Check makes it easy to check if you qualify. Use our financial assistance calculator, and let us do the work for you.

Do note the Affordable Care Act mandated that all hospitals must provide you a rate less than the amounts generally billed (AGB) if you qualify for financial assistance. You can always ask a hospital for the AGB discount rate to compare to the price that you received.

Concepts and Definitions:

Monetary Asset Value: Some hospitals consider assets when determining if you qualify for financial assistance. In general, monetary asset value does not include non-monetary assets ro retirement accounts, pensions and the like, they generally consider 50% of asset value after $10,000.

Uninsured: Some hospitals only offer financial assistance to the uninsured. However, almost all have a Catastrophic Care discount for uninsured or insured patients. Basically, the amount paid cannot go over a certain percentage of income, usually 10%, but sometimes 3-5%.

Charity Care: Charity Care is free care.

Financial Assistance: Financial assistance is a partial discount on services, usually the top level discount is to the Medicare rate or the rate that Medicare reimburses hospitals for services.

Catastrophic Care Discount: A catastrophic care discount is a discount given when the cost of medical care exceeds a certain portion of income, it’s usually 10%, but varies by provider.

Medicare/Medicaid Reimbursement Rate: This is the rate that Medicare or Medicaid reimburses hospitals for the care they provide to their patients. Medicare and Medicaid cap rates for procedures, related to how much it costs a hospital to provide services and is generally a good price for a health service.

Sticker Prices: Sticker prices are the gross charges of a hospital before discounts, sometimes called Chargemaster rates.

Amounts Generally Billed: The amounts generally billed is a measure of the average reimbursement a provider gets from most, if not all payers, to the hospital. The more government payers that a hospital has, generally the lower the AGB for you.