• Medicare Er Copayment
• Medicare Doctor Copay
• Medicare Er Copay List
• Medicare Er Copay Card
• Copay For Medicare Part A
• Medicare Er Copay Program

Published April 2, 2020

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

• Copay cards for patients. HCP for physicians. Start Saving Today with the Xtampza ® ER Co-pay Card! Present this co-pay card along with your prescription.
• A typical co-pay for emergency room services for an insured person is around $250, which may or may not be waived if you are admitted to the hospital. 2 However, with the advent of high-deductible health plans in recent years, even insured persons may have to foot the entire bill if they have not met the plan's annual deductible.
• Out of Pocket Costs States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on.

The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.

Fortunately, Medicare generally covers you when you need emergency care. Here are answers to your top questions about Medicare coverage and the Emergency room (ER). Is Medicare coverage available for ambulance trips to the emergency room? CDC statistics show that about 40% of all ER visits by those 65 and over begin in an ambulance.

Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.

Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.

COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.

These services can typically come with costs such as copays and deductibles.

With waived coinsurance and deductibles for COVID-19 treatment, savings can add up

Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.

Medicare Er Copayment

Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).

While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.

Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:

• Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
  There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days.
  
• Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
  After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.

For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.

“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna¹

“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.

Cigna’s cost-sharing waiver expires May 31, 2020.

“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”²

Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.

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Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.

Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.

“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”³

Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.

Overview

Historical information about copayments can be found on the 'Historical' tab

Information about copayments proposed for members in the Adult Group with income above 106% FPL, subject to approval by the Centers for Medicare and Medicaid Services can be found in the Proposed Copay Changes section of this page. More information will be posted here when available.

Medicare Doctor Copay

* NOTE: Copays under this section are copays charged under Medicaid (AHCCCS). This section does not describe copay requirements under Medicare.

Some people who get AHCCCS Medicaid benefits are asked to pay copays for some of the AHCCCS medical services that they receive. Copays can be mandatory (also known as required) or optional (also known as nominal) as explained below. Some people and certain services are exempt from copays which means that no mandatory or optional copays will be charged as explained below.

Copays are not charged to the following persons:

• People under age 19
• People determined to be Seriously Mentally Ill (SMI) by the Arizona Department of Health Services
• Individuals up through age 20 eligible to receive services from the Children's Rehabilitative Services program
• People who are acute care members and who are residing in nursing homes, or residential facilities such as an Assisted Living Home and only when the acute care member’s medical condition would otherwise require hospitalization. The exemption from copays for acute care members is limited to 90 days in a contract year
• People who are enrolled in the Arizona Long Term Care System (ALTCS)
• People who are Qualified Medicare Beneficiaries
• People who receive hospice care
• American Indian members who are active or previous users of the Indian Health Service, tribal health programs operated under P.L. 93-638, or urban Indian health programs
• People in the Breast & Cervical Cancer Treatment Program
• People receiving child welfare services under Title IV-B on the basis of being a child in foster care or receiving adoption or foster care assistance under Title IV-E regardless of age.
• People who are pregnant and throughout the postpartum period following the pregnancy
• People in the Adult Group (for a limited time*)

*For a limited time persons who are eligible in the Adult Group will not have any copays. Members in the Adult Group include persons who were transitioned from the AHCCCS Care program as well as individuals who are between the ages of 19-64, and who are not entitled to Medicare, and who are not pregnant, and who have income at or below 133% of the Federal Poverty Level (FPL) and who are not AHCCCS eligible under any other category. Copays for persons in the Adult Group with income over 106% FPL are planned and can be found on the Proposed Copay Changes tab. Members will be told about any changes in copays before they happen.

In addition, copays are not charged for the following services for anyone:

• Hospitalizations
• Emergency services
• Family Planning services and supplies
• Pregnancy related health care and health care for any other medical condition that may complicate the pregnancy, including tobacco cessation treatment for pregnant women
• Well visits and preventive services such as pap smears, colonoscopies, and immunizations
• Services paid on a fee-for-service basis
• Provider preventable services
• Services received in the emergency department

People with Nominal (Optional) Copays

Individuals eligible for AHCCCS through any of the programs below may be charged nominal copays, unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Nominal copays are also called optional copays. If a member has a nominal copay, then a provider cannot deny the service if the member states that s/he is unable to pay the copay. Members in the following programs may be charged nominal copays unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Members in the following programs may be charged a nominal copay by their provider:

• State Adoption Assistance for Special Needs Children who are being adopted
• Receiving Supplemental Security Income (SSI) through the Social Security Administration for people who are age 65 or older, blind or disabled
• SSI Medical Assistance Only (SSI MAO) for individuals who are age 65 or older, blind or disabled

Medicare Er Copay List

Ask your provider to look up your eligibility to find out what copays you may have. You can also find out by calling your health plan member services representative. You can also check your health plan's website for more information.

AHCCCS members with nominal copays may be asked to pay the following nominal copays for medical services:

Detailed service codes and category description that comprise each of the above categories are outlined on the attached Document

Medical providers will ask you to pay these amounts but will NOT refuse you services if you are unable to pay. If you cannot afford your copay, tell your medical provider you are unable to pay these amounts so you will not be refused services.

Some AHCCCS members have required (or mandatory) copays unless they are receiving one of the services above that cannot be charged a copay or unless they are in one of the groups above that cannot be charged a copay. Members with required copays will need to pay the copays in order to get the services. Providers can refuse services to these members if they do not pay the mandatory copays. Mandatory copays are charged to persons in Families with Children that are no Longer Eligible Due to Earnings - also known as Transitional Medical Assistance (TMA)

Adults on TMA have to pay required (or mandatory) copays for some medical services. If you are on the TMA Program now or if you become eligible to receive TMA benefits later, the notice from DES or AHCCCS will tell you so. Copays for TMA members are listed below.

Medicare Er Copay Card

Detailed service codes and category description that comprise each of the above categories are outlined on the attached Document

Copay For Medicare Part A

The amount of total copays can not be more than 5% of the family’s total income during a calendar quarter (January-March, April-June, July-September, and October-December). If this 5% limit is reached, no more copays will be charged for the rest of that quarter. AHCCCS has a process to track cost sharing. If a member thinks that the total copays they have paid are more than 5% of the family's total quarterly income and AHCCCS has not already told them, the member should send copies of receipts or other proof of how much they have paid to:

Medicare Er Copay Program

AHCCCS
801 E. Jefferson
Mail Drop 4600
Phoenix, Arizona 85034

If a member’s income or circumstances have changed, it is important to contact the eligibility office right away.

NOTE: The information posted on this webpage describing proposed copays is being updated. AHCCCS is working with CMS to revise the State Plan Amendment for copays that AHCCCS plans to charge members in the future. This webpage, and the link to the revised State Plan Amendment, will include the updated changes to copays when they become available. AHCCCS will also provide additional public notice of the changes to copays that AHCCCS will be proposing to charge members.