Glossary Section 4-Understanding Healthcare Savings and Assistance Programs
Navigating the healthcare system can feel like learning a new language. Knowing the right terms matters. It can help you
- Understand what your insurance will and won't cover.
- Know what questions to ask about your health insurance, financial assistance, or income.
- Avoid unexpected costs.
- Get financial help.
- Advocate for yourself or your patients when insurance companies deny coverage or when bills don't add up.
This glossary is a tool you can use whenever you aren't sure about a word or term. It covers health insurance basics, prescription drug coverage, billing, the approvals and appeals process, financial assistance, and income support.
Remember, health policy, program eligibility, and insurance rules change all the time. It is a good idea to check with your insurance company, job, healthcare providers or other federal/state agencies about your specific needs or questions about your coverage.
Key Terms
Charity Care/Financial Assistance Programs: Charity care and financial assistance programs help lower or even eliminate medical bills for patients who meet certain financial criteria. Non-profit hospitals/providers are required by federal regulations to offer charity care and financial assistance programs to help eligible patients access the care they need. These programs help make healthcare more accessible and affordable for those who are uninsured or those who are underinsured with high out-of-pocket expenses.
These programs can vary from one hospital to another, and each has its own eligibility requirements. Not all providers at each facility work with the charity care program. For-profit and private practices usually do not have these types of programs.
Co-pay Assistance: A financial assistance program that helps patients pay for their medication co-pays. These programs can be offered by pharmaceutical (drug) companies (often through co-pay cards) or non-profit organizations and foundations. Co-pay assistance can lower the costs of medications, including those given at infusion centers (IV medications or injections). Eligibility for these programs depends on things like your diagnosis, income, and insurance coverage. It’s important to note that these programs may not always be open for new enrollments, and funding availability can vary. Co-pay organizations and foundations include Cancer Care, Blood Cancer United, HealthWell Foundation, Patient Advocate Foundation (PAF), Patient Access Network Foundation (PANF), GoodDays, Accessia Health, and The Assistance Fund.
Co-pay Card: A type of financial assistance for prescription medications that can lower your copay at the pharmacy or infusion center. To be eligible for a copay card, you must have commercial insurance (such as employer/union-sponsored, private, or marketplace plans). There may also be limits on the amount of financial assistance you can receive each year through a copay card. If you have insurance through government-sponsored plans like Medicare, Medicaid, TRICARE, or CHAMPVA, you are not eligible for copay cards.
Crowdfunding: A way to raise money to help cover medical expenses by collecting contributions from other people, often through an online platform like GoFundMe. Fundraising campaigns can be organized by yourself, friends, family, or other supportive individuals. When setting up a fundraising campaign, be sure to discuss who will manage the funds and what you plan to do with any extra contributions once your bills are covered. It's important to note that these contributions are not tax-deductible for those who give funds. These funds should be identified as a “gift” (not income) to ensure that your eligibility for programs like SSI, Medicaid, or SNAP is not affected by an increase in reported income.
Flexible Spending Account (FSA): A special account that lets you set aside pre-tax money (taken out of your paycheck before your taxes, which lowers your taxable income) to pay for certain eligible health expenses. These can include copayments, prescription medication costs, and some over-the-counter products. These funds must be used before the end of the year, or you lose them. Remember, the year may be defined as “fiscal year,” ending June 30th, or “calendar year,” ending December 31st. Some employers have a special extension or carryover.
Health Savings Account (HSA): A special type of savings account that lets you set aside pre-tax money (taken out of your paycheck before your taxes, which lowers your taxable income) to pay for certain eligible health expenses. To have an HSA, you must also have a high-deductible health plan (HDHP). HSA funds can be used for medical expenses, including copays, co-insurance, prescription medications, and some over-the-counter products. Unlike FSAs, HSA money rolls over from year to year, and you keep it for life, even if you change jobs. HSAs can also support longer-term savings for healthcare costs in retirement. Funds in your HSA can also be invested and grow over time. There are some possible downsides to HSAs, including enrolling in a high-deductible plan, which may not work well if you expect high medical costs. There are also limits to how much you can contribute, which may not cover all your healthcare needs.
Patient Assistance Program (PAP): A financial assistance program offered by the pharmaceutical (drug) company to help people who cannot afford their prescription medications. Eligibility for these programs depends on income, insurance status, and diagnosis. You may also have to show that all other sources for financial assistance are not available and that paying for these medications is an added financial burden for you and your family. Each drug company has its own rules, application process, and requirements for its medications.