HEALTH SAFETY NET CO-PAYS BEGIN

Co-pays go into effect for Health Safety Net (HSN) patients beginning on Monday, March 3rd. Here are the details regarding the new co-pay requirements:

  1. There are no co-pays on any services for anyone under age 19.
  2. All adults have co-pays of $1 and $3 on pharmacy services. This includes anyone over age 18 on Primary or Partial HSN. For those on Partial HSN, these co-pays do not count against a patient's Partial HSN deductible.
  3. There are also some co-pays for medical services at hospitals for adults over age 18 who are between 101% Federal Poverty Level and 200% Federal Poverty Level. These co-pays are only for services received at hospitals, not at hospital licensed health centers or at off campus hospital practices.
    1. Outpatient visits, including therapy visits - $5
    2. Inpatient admissions - $50
    3. Emergency room visits - $50 (not applicable if patient is admitted)
    4. There are no co-pays for outpatient ancillary only visits (x-rays, lab work, etc) that do not involve a face to face visit with a medical clinician.
  4. There is a $250 annual cap on HSN co-pays ($200 on prescription drug co-pays and $50 on medical services co-pays). It is the responsibility of the patient and provider to track co-pays. It's unclear how providers will be able to do this, since a patient may be getting services at other facilities.

Effective March 3rd, the MassHealth REVS system will display a patient's Federal Poverty Level and two new restrictive messages related to co-pay requirements:

1) HSN MEDICAL AND PHARMACY COPAYS MAY BE APPLICABLE. FPL IS _________.

2) HSN PHARMACY COPAYS MAY BE APPLICABLE. FPL IS ________ .

Note:  The Health Safety Net does not provide co-pay coverage for patients with Health Safety Net as Secondary coverage. For example, a patient on Blue Cross with HSN Secondary is responsible for his Blue Cross co-pays. The only exception is for Medicare patients, including those on Medicare Advantage. Those patients may still use their HSN Secondary to cover their co-pays; however, they will be subject to HSN co-pays as described above.

-Adapted from "Health Safety Net Co-Pays", e-mail from Kim Simonian, MPH, Community Benefit Programs, Partners HealthCare, February 29, 2008 .

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