Can Hospitals Pay Patients' Health Insurance Premiums?

Cheryl Clark, for HealthLeaders Media , September 30, 2013

The pitfalls include the chance that the practice violates federal anti-kickback rules, because it could be seen as a quid pro quo for a patient to sign up for a particular plan with a network that includes one hospital, especially if the plan and the hospital are integrated and have the same name.

"That would raise some eyebrows," Lott says. And of course, there could be no stated or implied expectation that the patient would only get care from the benefactor healthcare system.

Another issue might be that the practice would encourage a kind of adverse selection, weighting health plans down with the costliest, sickest patients in these products; hospitals aren't likely to pay these premiums for so-called "healthy young invincibles."

"You would want to target high-risk patients, those with chronic diseases, and those on the very, very high end of the subsidy program. Those are the people you would want to cover," Lott says.

But there are ways it might be done to benefit both the hospital and the patient, Lott says.

The hospital, or even a group of hospitals, could contribute to a scholarship fund for certain high risk patients, those whose hospitalization probability might be determined by traditional actuarial calculations. "You'd basically be establishing a profile, and that would be easy to do," Lott says.

County health departments know who those individuals are, especially in counties that operate safety net hospitals, and could work with exchanges to determine which patients might receive this financial boost, he says.

"This has to be a true charitable transaction, counting toward a hospital's charitable contribution," he adds.

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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?




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