Copayments, Coinsurance for Health Benefits for Immigrant Adults and Seniors Programs to Takes Effect

Lawndale News Chicago's Bilingual Newspaper - Health

New copays and coinsurance for existing enrollees in the Health Benefits for Immigrant Seniors (HBIS) and Health Benefits for Immigrant Adults (HBIA) programs took effect early February, as the Department of Healthcare and Family Services (HFS) previously announced. Most services covered by the HBIA and HBIS programs, which provide health care coverage for individuals who would be eligible for Medicaid coverage if not for their immigration status, will continue to be free for customers, including primary care visits, prescription medications and vaccinations at a pharmacy or doctor’s office. The new copays and co-insurance will apply to the use of non-emergency hospital or surgical center services, like nonemergent elective surgeries, physical therapy and lab work. Copays are fixed amounts paid for health care services covered by a health plan, while coinsurance is a type of cost-sharing where a customer pays a percentage of the total price for a covered health care service, and their insurer pays the remainder. Both copays and coinsurance are common cost-sharing practices used in both commercial insurance and in Medicare. Enrollees should always check with their provider on whether they will be charged out-of-pocket costs for a service. The impact of copays and cost-sharing will vary for participants based on their enrollment in Medicaid Managed Care, which many HBIA and HBIS participants will be transitioning to over the next several months. The copays and coinsurance and the transition to managed care for HBIA and HBIS enrollees are among the cost-saving measures HFS has implemented in order to bring program costs within the budgeted amount for State Fiscal Year 2024.

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