As of February 1, immigrants enrolled in health care programs in Illinois must brace themselves to cough up some cash for certain medical services, with the state's Department of Healthcare and Family Services announcing new cost-sharing measures that come in the form of copays and coinsurance. While the basic health care coverage under the Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) shall remain largely free, those requiring non-urgent hospital services will face additional fees.
These charges won’t apply to all services – primary care visits, prescription meds, and vaccines at pharmacies or doc’s offices are still on the house. But if you’re about to quickly walk into a hospital for non-emergency surgeries or physical therapy, be prepared to open your wallet. The fees bring HBIA and HBIS more in line with mainstream cost-sharing practices, like those seen in commercial insurance and Medicare policies.
How much these copays and coinsurance will set you back depends on whether you're with Medicaid Managed Care or not. Some Managed Care Organizations (MCOs) are playing nice and waiving these freshly minted costs. For example, CountyCare, dominating coverage in Cook County, decided to cut HBIA and HBIS enrollees some slack by dropping all copays and coinsurance.
Enrollees have to be savvy and ask their providers about potential out-of-pocket costs before a service because no one likes a nasty surprise on their bill. And let's not forget that this move to managed care is part of the state’s grand plan to ensure the program’s expenses don’t exceed the budget for the fiscal year. HFS made sure to drop a $100 copay for non-emergency hospital ER services from their plan, following a consultation with the Centers for Medicare & Medicaid Services, which confirmed the state could seek full reimbursement for ER services.
Those facing an emergency can breathe easy – no copays or cost-sharing if you’re in dire need of medical attention. But if it's non-urgent, inpatient stays are subject to a $250 copayment, whereas hospital outpatient services will get a 10% charge of what the HFS would pay. To get a grip on these new charges and what they mean for your wallet, check with your healthcare provider.
The transition to managed care began on Jan. 1, with HBIA and HBIS recipients getting a more coordinated approach to health care, moving away from the previous fee-for-service model. With this change, customers are promised better help connecting with medical care and social services. Enrollment in MCOs is happening in phases, wrapping up by April 1 with information packets dispatched to guide enrollees through the change.
Not everyone's on the MCO boat though. Those with other comprehensive private insurance or caught in the spend-down cycle will stick with the old fee-for-service model, steering clear from MCOs and their mailings.
For more details on the transition and the cost implications, beneficiaries can find additional information here.
