Think creatively in order to find oddly labeled programs offering financial assistance before and after any medical surgery. The timing and reason for your operation often dictate the best place to look for help paying the doctor and operating room bills.
Finding monetary aid after an emergency medical surgery is most difficult. You do not have the luxury of time to organize your affairs. Patients with and without insurance should use unique strategies.
Finding help paying for an elective surgery is much easier because you do have the luxury of time. You can schedule the procedure after you choose the ideal health care plan, and pick the optimal tax strategy.
After Emergency Surgery Financial Assistance
Finding financial assistance programs after emergency medical surgery can make your recovery less stressful. Nobody wants to break a bone, need a hernia repair, gallbladder removal, or go under the knife for open-heart surgery – and then have to deal with a large debt.
It can be very difficult to cope with the surprise expenses discovered after emergency medical surgery – particularly if you are unable to work afterward. Follow two types of strategies to find help paying these bills, optimized for whether you are insured or uninsured.
Finding financial aid after emergency surgery will be very challenging without insurance. Uninsured patients are responsible for 100% of the very large charges. In addition, lost income compounds the problem.
Many patients experience a temporary disability while recovering. This common situation opens the door for extra help via settlement programs, temporary disability, collecting unemployment, and charity care.
Request a personal loan to fund medical needs here. An unsecured loan can provide the funding needed to retire unpaid medical bills. Take this step to avoid having medical collection accounts appear on your consumer credit report.
These negative items stay on credit reports for seven years after the date of first delinquency. Patients without insurance have a difficult time disputing medical collection accounts on their file. Take proactive steps to avoid a long-term problem.
Debt settlement programs sometimes offer long-term relief. If you owe more than $10,000 in unsecured debt (credit cards, personal loans, and medical debt), you meet the first qualification for a settlement program. Without insurance, the hospital and surgical charges can easily exceed this amount.
Financial hardship is the second qualifying criteria for a settlement program. The lost income associated with a temporary disability makes it very difficult to retire a very large unexpected medical bill.
Collecting unemployment compensation for health reasons is rarely an option for patients while they recover after a surgery. You are ineligible in any state during the time you are unable and unavailable to work.
Patients may be eligible after they recover if they worked in one of the six states that define a good cause reason to quit as an employee’s own serious medical issue.
The six states with helpful rules are Arkansas, Illinois, Maine, Minnesota, Texas, and Washington.
The options expand if your spouse must terminate his or her employment in order to care for you at home. Twenty-two states define a compelling reason to quit work to include care of a seriously ill family member.
Charity care is another form of monetary aid for patients after their surgery. By law, hospitals and medical centers cannot deny care to anyone with an emergency need.
Many healthcare systems offer income-based discounts for uninsured patients. If you are unable to work after your surgery, make sure to include this new factor in your income projections.
Finding financial assistance after your emergency medical surgery requires a different set of tactics if you are covered by insurance. Now a 3rd party helps to pay most of the bill. However, many insured patients still must cope with the unreimbursed expenses.
Every plan has cost-sharing components, which include copayments, coinsurance, deductibles, and out-of-network charges. The annual maximum out of pocket (MOOP) limits the members’ monetary exposure for in-network fees.
Negotiate out-of-network hospital bills to help lower what you must pay. Many members learn the hard way about out-of-network balance billing after an emergency medical surgery. Many specialty surgeons and anesthesiology groups operate and bill independently of hospitals. Their poor disclosure practices open the door to possible savings.
Temporary disability insurance covers surgery recovery in only five states. You are very fortunate if you work in one of the five states with a mandatory program. The state government-based entitlement could replace a portion of your income while you recover from the procedure.
The five states are California, Hawaii, New Jersey, New York, and Rhode Island. If you bought a private policy before your emergency health need, apply for benefits with the company issuing the policy.
Medicaid is another place to turn if you need help paying for surgery and have no health insurance. This joint federal and state program helps low-income pregnant women, parents, seniors, individuals with disabilities, and other low-income adults.
Medicaid may help pay for surgical costs three months retroactively – even if you were uninsured at the time of the procedure. Two factors make some patients eligible.
- Health problems force many people to stop working – which affects their earnings. A sustained job loss can force many patients below the eligibility income thresholds.
- Some states allow for “medically needy” eligibility. Patients whose incomes are too high to qualify can “spend down” earnings on qualifying medical expenses.
Contact your local county office for more details and exact eligibility in your state.
Elective Surgery Financial Assistance
Finding financial assistance programs before elective surgeries entail an entirely different set of tactics. Elective surgery is a planned, non-emergency procedure, scheduled at an appropriate time for both the doctor and the patient. It may be required or optional.
Unsecured personal loans can fund non-emergency procedures. Since you schedule elective surgeries, you have the luxury of time to optimize your health insurance and tax strategies.
Obtaining coverage is the direct answer for people who need surgery and have no insurance or money and are looking for help paying for it. Your ability to utilize health insurance for financial assistance with elective operations depends on the reason for the procedure, your income level, and the timing around open enrollment.
Open enrollment timing is perhaps the most important factor when using health insurance to help pay for required elective surgical procedures. Since you can schedule the operation at your convenience, set the date after the annual open enrollment. This way you can optimize the plan to reduce your expenses.
The annual open enrollment for individuals begins in November and ends in January each year. Most groups follow a similar schedule, although this often varies. You can enroll any time of year if you experience a qualifying life event – such as loss of coverage via unemployment.
If you are scheduling an elective surgery, a plan with a higher actuarial value could be more cost-effective. You pay a higher monthly premium but will have fewer leftover expenses after the procedure. Examine these features when making your choice.
- Maximum out of pocket
- In-network providers
Your health insurance should help pay for the medically necessary elective surgery. Remember that elective does not always mean optional. It can also mean required. Medically necessary operations include those that prevent, diagnose, or treat an illness, injury, disease or its symptoms.
The trick is figuring out which elective surgical procedures your plan defines as medically necessary, and why. Your surgeon will be motivated to help you make the case for the preapproval.
|Cosmetic||No – appearance only|
|Plastic||Breast reduction||Yes – pain relief|
|Breast reconstruction||Yes – after mastectomy or lumpectomy|
|Weight loss||Bariatric||Maybe – treats comorbidities|
· Sleep apnea
· Heart disease
· High blood pressure
· Type 2 diabetes
|Back & Spine||Scoliosis||Yes – treats disease|
|Spinal fusion||Yes – pain relief|
|Spinal decompression||Yes – pain relief|
|Eyes||Cataract||Yes – treats disease|
|Glaucoma||Yes – treats disease|
|Lasik||No – appearance only|
|Knees||ACL||Yes – treats injury|
|Knee Replacement||Yes – treats disease|
|Dental||Gums||No – requires dental plan|
|Oral||Yes – for anesthesia|
|Jaw||Maybe – depends on reason|
The federal government provides two forms of help paying for medically necessary elective surgical procedures via health insurance. These government subsidies for low-income families can lower the cost of the monthly premiums, and reduce the size of leftover expenses.
The government premium subsidies make it easier for low-income patients to afford purchasing policies that cover most of the costs of required elective surgeries, hospitalization, anesthesia, etc. The subsidies place a cap on the percentage of income a family must spend in premiums for a benchmark plan. These are the figures for 2017.
|% Poverty Level||% Cap on Premiums|
|100 – 133%||2.04%|
|133 – 150%||3.06 – 4.08%|
|150 – 200%||4.08 – 6.43%|
|200 – 250%||6.43 – 8.21%|
|250 – 300%||8.21 – 9.69%|
|300 – 400%||9.69%|
The government cost-sharing subsidies lower the percentage of unreimbursed expenses that low-income patients must pay. Cost-sharing subsidies can take a silver level (70% actuarial value) and have it behave more like a gold (80%) or platinum (90%) level plan by altering the actuarial value.
The actuarial value is the percentage of medical expenses that your plan pays. The patient is responsible for the remainder of out-of-pocket charges. The cost-sharing subsidy amount also depends on income level.
|% Poverty Level||Actuarial %|
|100 – 150%||94%|
|150 – 200%||87%|
|200 – 250%||73%|
The federal government does not offer grants to individuals seeking personal benefits. Be wary of any online resource promising or promoting government grants to help pay for any surgery.
However, patients can use the government tax code to help offset elective surgery costs. Your unreimbursed expenses from many medical procedures are tax deductible.
- Flexible spending accounts offer first dollar tax savings. You must first make a contribution election during the annual open enrollment. Since you can schedule the elective procedure, this should not be a hindrance.
- Itemized medical deductions from Schedule A kick in after they exceed a percentage threshold of adjusted gross income. The percentage changes by year.
- 2017: 7.5%
- 2018: 7.5%
- 2019: 10.0%
- Medicaid retroactive eligibility
- Medically necessary cosmetic procedures
- Medically necessary weight loss
- Premium & cost-sharing subsidies