How to promote financial assistance programs to employees and their families
Unexpected medical bills, along with the cost of ongoing treatment and medication, can quickly add up and cause financial stress for employees and their families. Financial assistance programs offered by hospitals can provide much-needed support to employees who are struggling to pay for medical expenses and these programs can include discounts, payment plans, and charity care for individuals and families who meet certain income criteria.
By helping educate employees about these programs, employers can help improve access to the care they need and lower the financial burden – with no additional costs to the plan.
How does it work?
Hospitals that are non-profit and/or receive governmental support are required by law to offer financial assistance or “charity care”. In Oregon, all hospitals (both non- and for-profit) are required under the Hospital Financial Assistance Law of 2004. Similarly, the Washington State Hospital Association (WSHA) requires all hospitals in the state to offer sliding scale income-based discounts to patients at or below 400% of the federal poverty level. The state of Washington also has a Charity Care Program that provides financial assistance to eligible patients who receive services at hospitals and clinics that participate in the program. The program is funded by the state and provides assistance to patients with incomes at or below 200% of the federal poverty level.
| Financial Assistance & Charity Care |
| Offered by all Oregon and Washington hospitals |
| Can have employee out-of-pocket costs at hospitals up to 100% waived, even after insurance |
| Simple applications with easy income verification |
Financial Assistance and Insurance.
Financial assistance and charity care programs do not require employees are uninsured. Both programs lower or eliminate employee cost-share, regardless of whether the employee was insured. According to a recent survey by Bankrate, 21% of Americans have no savings at all, while 20% have less than three months’ worth of expenses saved up. This lack of savings can make it difficult for individuals and families to manage unexpected medical expenses. With the average deductible at over $4,000 for an individual and $8,000 for a family (Kaiser Family Foundation Health Cost Survey), even paying the cost share when insured can be a significant financial stressor for employees.
How can we help educate employees about this?
Consider adding information about these programs to your benefit program materials. Work to alleviate the stigma that sometimes follows programs like this by pointing out that the programs can be generous for even middle-income earners and encourage employees to review the financial assistance chart that your RiskPoint team provides. A single person household making at or below an estimated $58,000 per year (HHS, 2023 guidelines) can qualify for financial assistance and have a portion of their hospital bill written off so families with multiple dependents can greatly benefit from completing a simple application.
| 2023 Financial Assistance (HHS, 2023 Guidelines) |
| Persons in Family/Household | 2023 HHS Income Guideline (48 contiguous states and the District of Columbia) |
300% of Income Guidelines | 350% of Income Guidelines | 400% of Income Guidelines |
| 1 | $14,580 | $43,740 | $51,030 | $58,320 |
| 2 | $19,720 | $59,160 | $69,020 | $78,880 |
| 3 | $24,860 | $74,580 | $87,010 | $99,440 |
| 4 | $30,000 | $90,000 | $105,000 | $120,000 |
| 5 | $35,140 | $105,420 | $122,990 | $140,560 |
| 6 | $40,280 | $120,840 | $140,980 | $161,120 |
| 7 | $45,420 | $136,260 | $158,970 | $181,680 |
| 8 | $50,560 | $151,680 | $176,960 | $202,240 |
| 9 | $55,700 | $167,100 | $194,950 | $222,800 |
| 10 | $60,840 | $182,520 | $212,940 | $243,360 |
| 11 | $65,980 | $197,940 | $230,930 | $263,920 |
| 12 | $71,120 | $213,360 | $248,920 | $284,480 |
What’s next?
If you have a member who you suspect may have large hospital bills, work with your RiskPoint team to help identify resources for them. RiskPoint can help the member find and complete their financial assistance applications and also help them connect to external resources that can help negotiate down high hospital bills even when financial assistance is not available. Talk to your RiskPoint team on how you can help members find care that helps them avoid high hospital costs and whether your plan allows that kind of member support. RiskPoint offers a variety of member support services – from assistance with care direction to negotiating direct contracts for members on behalf of your plan – and finding the right solution for your population is part of our process.
Mandi Roney is a Large Group Benefit Account Executive at RiskPoint Insurance Advisors in Lake Oswego, Oregon. Contact Mandi via email at mroney@riskpointins.com.
