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Can Hospitals Pay Patients' Health Insurance Premiums?

Cheryl Clark, for HealthLeaders Media, September 30, 2013

If there are confidentiality issues, or someone thinks this might violate the Health Insurance Portability and Accountability Act's privacy rules, Congress and federal agencies that oversee that law such as the Office of Civil Rights can write an exception or an exemption to allow that, Lott says.

On the issue of adverse selection weighting down these insurance exchange products, Lott says it "absolutely is an adverse selection process. This doesn't work at all well for the pool mix. But the point is, so what?" he says.

"The adverse selection problem is going to occur under Obamacare anyway. I mean, what healthy person is going to be motivated to pay whatever the premium would be per month rather than the $95-per-year penalty?"

Lott says that he believes insurance companies have already thought of that and have factored those costs into the rates for each type of plan.

There's a huge opportunity here. According to the Congressional Budget Office, some 25 million uninsured Americans are expected to qualify for the health insurance exchanges next year, but only 6 million or 7 million are expected to buy in. And many of those who don't are probably the patients who need it the most.

Many hospitals, especially those already serving the uninsured or people who will become uninsured when their employers cancel company coverage, are already training their staff to become certified application counselors. Some are sponsoring health fairs to advertise the benefits of the exchanges and Medicaid, especially in states like Michigan where state just agreed to expand eligibility.

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2 comments on "Can Hospitals Pay Patients' Health Insurance Premiums?"


George Burns (10/3/2013 at 11:53 PM)
It can be done quite easily. You can take some initial guidance from IRS PLR 199915054 and others. Contact me if you need help.

Bill Allison (10/3/2013 at 4:41 PM)
Correct me if I'm wrong but wasn't a precedent set years ago when providers started paying patients COBRA payments to ensure payment for services?