Cost-Share Waiver

By Samantha Levine | Last Updated: March 28, 2021

Image by: Lexi Wang

What is a Cost-Share Waiver?

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.

____________________________

Key Takeaways

  • 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

____________________________

Reviewed by Geetika Rao, MPH | Edited by Nidhi Mahagaokar, MPH and Paris Ghazi | Fact checked by Julia Radossich, PA-C