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  • Gregg M. Yamada, MD FACC

How to Avoid Insurance Copayments?

Updated: Nov 13, 2019


WHY ARE YOU CHARGED A COPAYMENT?

Ever get frustrated when you have to pay the doctor or the hospital, imaging center or lab--each and every time a test is ordered, a procedure is performed; for hospital and office visits? Many patients complain about copayments and some even refuse to pay their portion of their bill.


You may not realize that copayments charges are required:

  • Fees for medical services are not up to the hospital or doctor, fees are set by Medicare and Private insurance carriers. Their is a portion of the medical service that insurance pays for and a portion that the patient is responsible for. That is how it works.

  • All physicians (and clinics and hospitals) are required to collect copayments from patients by Medicare and private insurance.

  • For example, Medicare considers the waiving of copayments ‘fraud’ against the US government.

ONE SOLUTION TO AVOIDING COPAYMENTS? ‘MEDICARE FOR ALL’


WHY YOU SHOULD CONSIDER SUPPORTING MEDICARE FOR ALL

  • Everyone should become familiar with a Bill in congress known as Medicare-For-All.

  • Were you aware that a couple 65 years of age, will need an estimated $350,000 to $400,000 dollars to cover copayments, medications, supplemental insurance plans throughout the remainder of their lives.

  • In 2017 the cost of a heart transplant was over $1.4 million dollars. The cost of the transplant anti-rejection medications $1700-$1800/month.

  • Everyone, but the super-rich, can be bankrupted by a major illness.

  • Many of my patients have dual insurance and pay little or no copayments so they have no interest in their future taxes increasing. Therefore, they have no interest in Medicare-For-All.

  • The problem is that if you have children, grandchildren, it is estimated a 35 year old couple will need over $500,000 dollars to cover their healthcare expenses when they reach 65? The rising costs of healthcare will be passed on to your children and grandchildren. Either way, we are going to pay for healthcare costs.

WHAT WOULD YOU OWE UNDER MEDICARE FOR ALL?

· Nothing. Your healthcare would be completely free.

· NO Copayments

· NO Deductibles.

· NO Insurance Premiums.

· NO Supplemental insurance plan premiums.


WHAT SERVICES WOULD BE COVERED BY ‘MEDICARE FOR ALL’?

· ALL Outpatient care.

· ALL Inpatient care.

· ALL Emergency care.

· ALL Dental care.

· ALL Eye care.

· Long term and nursing home

· All Medications.


WILL MEDICARE-FOR-ALL BECOME A REALITY?

  • Probably not.

  • It is highly unlikely that this Bill will become law as written. Such sweeping change will cause taxes to rise and most people are against more taxes.

  • The point of this post? Stay healthy. Do your best to prevent a health issue. This topic sheds light on the importance of preventing the #1 killer of men and women in America--heart disease.

  • Listen to your doctor's advice. Eat a sensible diet. Exercise regularly. Take medications prescribed to you. Follow through with the tests your doctor recommends.

Reference: CNN (online) What 'Medicare for All' Means, Politically and Practically. By Dr. Sanjay Gupta, Chief Medical Correspondent Updated 12:10 PM ET, Tue July 2, 2019

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© 2019 Gregg Yamada MD FACC. All rights reserved.

Disclaimer: This website and my statements are educational only and not intended as medical recommendations or advice for any specific patient or a specific condition. I am a cardiologist, but I am not your cardiologist. You must discuss with your personal cardiologist if information you obtain is pertinent to your specific condition and situation. Never begin a diet or exercise program, or change/modify/discontinue any therapy or treatment without the approval of your personal physician.