Your Uninsured Patient Population Is Expanding

Job loss and other factors are driving an insurance coverage gap that may affect your practice. How can you prepare for the coming storm?

Insurance Gap and Your Practice

Experts say that nearly 10% of Americans will lose their health insurance coverage this year due to COVID-related unemployment. For many, this will mean they stop seeking preventive healthcare. For those who require life-sustaining or medically-necessary care, it will change their financial relationship with their practitioners. But how does it impact practices?

Understand the growing insurance coverage gap

Practices must prepare themselves and their patients for what’s coming. Currently, many Americans are receiving unemployment and remain covered by their previous or current employers’ health insurance. Some will become eligible for Medicaid, but many will fall into the coverage gap—that is, the swath of uninsured individuals who earn too much to receive Medicaid and too little to receive tax credits for purchasing Marketplace plans. The Kaiser Family Foundation illustrates this gap with the graphic below.

Source: Rachel Garfield, Kendal Orgera, and Anthony Damico, “The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid,” Kaiser Family Foundation, January 14, 2020

The coverage gap is a complex issue that requires an in-depth examination of states’ approaches to Medicaid expansion in the post-Affordable Care Act era. The takeaway is that this coverage gap leaves around 2 million Americans uninsured. That number is likely to increase. 

Moreover, even cash-based practices have a reason for concern. As patients confront higher out-of-pocket costs for services previously covered by insurance, they may no longer find cash services affordable.

Educate Your Patients

Practices would be wise to begin discussing insurance-related matters with their patients. As a result, practice administrators may need to brush-up on the current state of the health insurance market. For example, patients should understand their options for obtaining health insurance should they lose their jobs. They should also know which insurance plans will allow them to continue seeing their current providers.

The easiest way to educate patients may be to develop relationships with health insurance advisors who, at no cost to patients, can counsel them on Marketplace plan options. Healthcare.gov offers a location-based search for such professionals.

Prepare Your Practice

The most important steps you can take right now involve tasks that, ideally, you undertake already. Or perhaps you list these items on your long list of things you’ve always intended to do. To stay on top of the situation, you’ll need to maintain a consistent and proactive focus on:

  • Keeping patient insurance info updated
  • Verifying insurance coverage info with patients’ insurers
  • Filing claims more regularly and monitoring coverage determinations
  • Establishing policies to uniformly guide the practice in treatment decisions regarding patients who lose their insurance, such as a charity care program with a sliding scale
  • Understanding ethical/legal obligations relating to patient abandonment
  • Reviewing and revising patient registration packets to collect credit cards to keep on-file (these have specific requirements) and obtaining patient’s acknowledgment of practice payment decisions

In summary, thinking proactively about the implications of the insurance coverage gap will benefit you and your patients. For guidance on charity care, patient abandonment, or compliant patient registration materials during this evolving crisis, reach out to us. Schedule a consultation with our Illinois, New York, Connecticut, Florida, Michigan, or Wisconsin healthcare attorneys.

The COVID-19 pandemic is a dynamic and evolving public health emergency. The laws and situation are fluid, and therefore, this article may not reflect the most current situation.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader and should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.

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