Can Medicaid Patients Pay Cash? Out-of-Pocket, Self-Pay Explained

Can Medicaid patients pay cash? Medicaid patients are often responsible for out-of-pocket costs like copayments and spend-down deductibles. Sometimes patients can save money by paying directly out-of-pocket for health care services. Medicaid patients may be able to pay with cash by using self-pay if cash is accepted by the care provider. Below, we have what you need to know about out-of-pocket Medicaid costs and how self-pay works.

How Medicaid Determines Out-of-Pocket Costs

Medicaid is a joint federal-state health services program for low-income adults, children, pregnant women, elderly adults, and people with disabilities. Your enrollment in Medicaid and the amount you pay out of pocket is determined by your Modified Adjusted Gross Income (MAGI), your medical status, and the state you live in. States set the rate for each service and can require income-based copayments, coinsurance, deductibles, and other charges for both inpatient and outpatient services. (A chart on Medicaid.gov outlines the maximum copayment that Medicaid can charge based on what the state pays for the service.)

Not all Medicaid enrollees pay out-of-pocket costs; those in greater poverty will pay lower co-payments. There are also circumstances and population groups for whom out-of-pocket fees will not be assessed. These include:

  • Emergency services
  • Family planning services
  • Pregnancy-related services
  • Services for children
  • Services for terminally ill individuals
  • Services for individuals living in an institution
  • Hospice patients
  • Those who have received services from the Indian Health Service or tribal health programs
  • Those enrolled in the Breast and Cervical Cancer Treatment Program

It’s important to note that for Medicaid patients, services cannot be withheld if you can’t afford your copayment.

Spend-Down Medicaid Services

If your income exceeds the poverty level, you may still qualify for Medicaid, but you will be required to pay a specific portion of your medical expenses. This out-of-pocket cost is known as a deductible or spend-down amount, and payments toward this required contribution must be reported to Medicaid before enrollment is active. You will not be considered a Medicaid patient until the deductible is paid in full. Beware: Medical providers can bill patients and even take debt collection measures while the patient is not yet an active Medicaid enrollee.

How to Pay Directly Out of Pocket, Using Self-Pay

Payment arrangements for out-of-pocket Medicaid costs are determined by the medical entity providing care. You may be able to pay these costs using cash, a personal check, a credit card, or a debit card, depending on what your care provider accepts. In some instances, you may decide to self-pay — or pay directly out-of-pocket for health care — which can be cheaper than your Medicaid deductible or copay. Cash may also be accepted in these instances, depending on your provider.

Patient Financial Tiers and Self-Pay

Cost should not be the primary concern when it comes to health care. Yet, it’s important to understand how patients are billed and how prices are set. When addressing patient financial tiers, Lester Poris, the manager of credit and collections for the Children’s National Medical Center, reported: “At our facility, we have one financial class for straight self-pay (no insurance) and one for self-pay balance after insurance has paid its portion. We also have a financial class for those patients who are on payment plans.”

Prices are determined by the coverage of the patient because states have the right to establish self-pay costs, which may be higher or lower than your Medicaid spend-down or copay for a specific service.

According to The Self-PayPatient, a resource for uninsured Americans or those with high-deductible health insurance:

“Paying directly for health care can result in big savings, especially when seeking treatment at providers and facilities that cater to self-pay patients. This applies to people who are uninsured, have high-deductible plans, or who have more comprehensive health insurance plans that don’t cover a particular treatment or provider.”

Saving Money with Self-Pay

Choosing self-pay sometimes means withholding your insurance information, including Medicaid. This means it can take a bit of finagling to make sure you get the best price for your care. Most medical providers won’t show you their different pricing options before letting you decide whether to bill your insurance or not, though facilities that cater to self-pay patients may be more open.

To find out the difference in price, The Self-Pay Patient recommends that instead of withholding your insurance information, be vague about it by using phrases like: “I’ll be paying for this myself” or “My insurance isn’t going to be covering this.” For providers who don’t usually accept cash, the self-pay rate may be higher than using your insurance, but you can always ask if a medical center or provider offers cash discounts.

The biggest downfall for those with insurance looking to take advantage of self-pay options is that if you choose to withhold insurance information to secure a cash rate, the payment won’t apply to your spend-down or annual out-of-pocket spending limit.

In Summary

Can you pay out of pocket if you have Medicaid? Medicaid patients are often required to make out-of-pocket payments or required to pay an annual spend-down amount before insurance coverage applies. In some instances, Medicaid patients are protected from such charges. When comparing costs, self-pay may end up being cheaper than your Medicaid co-pay or deductible. Since payment methods vary by the care provider, you should explore your options with your physician’s office, though cash may be accepted for both out-of-pocket Medicaid costs and self-pay services.

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