What Does No Cost Share Mean in Health Insurance?

Health insurance also called health coverage, is meant to support various patients to pay their medical expenses. In most cases, medical expenses get too high that a person cannot cater to the medical bills via a credit card. Health insurance is generally purchased through health insurance marketplaces or health exchanges, whether private coverages or public government-funded welfare programs.

So, can the health insurance provider cover the whole medical expenses for their members? Yes. This is also called no-cost share insurance. To learn more about no-cost insurance, you can check the San Angelo Insurance explaining no-cost insurance. Here is the real meaning of no-cost insurance.

What is No-Cost Insurance?

In normal circumstances, the patient is required to pay part of the cost in medical coverage, also known as cost-sharing. The cost-sharing will include aspects like deductibles, coinsurance, and copayments. However, a no-cost share, also called zero cost-sharing, implies the opposite of this program. 

Patients under zero cost-sharing don’t pay the deductibles, the coinsurance, and the copayments when getting insurance benefits from their respective health insurance providers. Still, they don’t need referrals from their health providers while receiving their health benefits. 

So, what do the terms deductible, coinsurance, and copayments stand for?

Deductibles

A deductible in health insurance is the initial amount you’re subject to pay for certain services before the health coverage comes to your rescue. Deductibles vary in size depending on your health plan, are generally pre-calculated, and apply once a year for most health plans. For example, while some health plans can have as low as $300 or $500 deductibles, others can go up to $5000.

Once you finish paying your deductibles, your health plan starts paying your medical expenses partially for the remainder of the year. But only if the plan doesn’t include copayments, which you must then pay until you reach the out-of-pocket limit.

Coinsurance

Unlike deductibles and copayments (discussed below), coinsurance has no specific amounts. Instead, they are calculated as percentages of the total costs. That means if your health insurance plan demands a 10% coinsurance, the plan will only cover 90% of the total, leaving the rest 10% for you. The payment also starts after fully paying the deductibles and runs until you meet the limit amount. 

Copayments

Copayments resemble deductibles, as you are subject to a set amount, but only for specific services. For example, you can pay your doctor a 45-dollar fee for a visit, whether or not you’ve completed paying the deductibles. The health plan provider covers the rest in charge. On the other hand, copayments are typically smaller than deductibles. For instance, a health plan can have $2 500 deductibles but only have $25 copayments in various services.

Various health benefits fall into the zero insurance coverage. A patient under no-cost share can benefit from any program that facilitates their well-being. Examples of these benefits are drug reviews, checkups, medical consultations, and all forms of surgery necessary for medical purposes. 

On the flip side, procedures and treatments like cosmetic surgeries meant for personal interests are not liable for a no-cost share program. That means that the coverage only stands for patients who exhibit significant and validated medical-related conditions. Therefore, patients need to demonstrate the urgency of their medical condition and ensure the condition abides by the no-cost shared health insurance standards. 

Do you Qualify for a No-Cost Share?

Besides knowing which conditions are treatable under the no-cost share program, you must understand which category of patients fits the no-cost share program. For starters, the program only works for those federally recognized communities, which exhibit certain poverty levels as outlined under eligibility guidelines by the federal government. 

Another liable group is the ANCSA members (Alaska Native Claims Settlement Act), whose earnings are strikingly low per the federal poverty level. That means their income level is equal to that of the federal poverty line. In essence, this group qualifies for a premium tax credit, which is another qualifying factor for the no-cost share program. 

However, federal community shareholders are not eligible if their earnings exceed the federal government’s specified range. So, you must be eligible for a premium tax credit for you to qualify as a no-cost shareholder. That also stands for applicants who are either members of the federally recognized communities or hold shares with the ANCSA. One of the requirements for such people is that they must agree to have their earnings assessed and verified to qualify for enrollment in the process.