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Coinsurance in the Mandatory Medical Program

In some cases, the PMO determines the payment of a co-insurance as solidarity payment for consultations, studies, and special procedures. It helps to reduce the prices of health plans that in turn contain all the elementary benefits. Its value is regulated by the Ministry of Health, and must be:

  • $ 4 for those patients up to 15 years old and over 65 years old
  • $ 7 for beneficiaries between 16 and 64 years old

The payment of these co-insurances must be made in advance of the provision of the consultation or treatment in the place where the health agent determines it. This information should be provided to the affiliate in advance, ideally at the time of affiliation.

Conclusion

We hope that this information has been useful to you in asserting your health rights. Remember that all social works and health companies in Argentina must comply with what is required by the Ministry of Health regarding the PMO. If you have questions, leave us a comment!

Mental health

It is very common to wonder what the PMO includes in terms of mental health. Fortunately, the coverage is very comprehensive and includes care, prevention, and treatment, including medication.

Include up to 30 visits per calendar year, no more than 4 per month, for outpatient care. It includes psychological, psychiatric, psycho-pedagogical consultation, individual and group psychotherapy, family, couple.

Additionally, up to 30 days of psychiatric confinement must be covered per calendar year.

Cancer Treatment

Without a doubt, where a member finds himself the most obstacles is when seeking treatment for cancer patients. The high cost of these procedures means that practically all social and prepaid works request authorizations and validations.

By law, the following must be covered:

  • All consultations, studies, and procedures for the diagnosis and treatment of the disease;
  • 100% chemotherapy clinical support;
  • 100% coverage in medications;
  • 100% in hospitalization;
  • Guaranteed access to a therapeutic companion;
  • 100% in palliative care.

In addition, preventive programs for different types of cancer should be offered regularly.

From deductibles to copays: we explain the terminology of health insurance.

Health insurance helps you stay healthy and cover medical expenses when you are sick or injured. But what do those words mean that insurance companies and their providers use?

To help you understand your insurance more thoroughly, below, we explain thoroughly what the most used terms mean:

 Monthly payment: 

  • Like home and auto insurance, medical insurance requires a monthly payment so that your coverage is not interrupted. This is called a monthly payment. The amount of your monthly payment varies depending on the plan you have chosen and, in general, it is reset every year.

Cost-sharing: 

  • This term refers to medical or pharmacy expenses that you and your insurer pay together. Some health plans require cost-sharing, others do not. This depends on the plan you have. Types of cost-sharing include.

Deductible:

  • This is the amount you contribute each year before your insurance begins to pay for covered services. Once you reach the amount of your deductible, your plan covers your costs.

Coinsurance:

  • Some plans require you to pay a percentage of certain medical costs while they pay the rest. This is called coinsurance.

Copays:

  • These are fixed fees that you pay participating providers when you receive treatment in their offices, urgent or emergency care, or other supplies or services, such as prescription drugs or exams.

Maximum out-of-pocket expense:

  • This is an amount established by your insurer as the maximum you will pay in a year. When your deductible, coinsurance, and copayments reach your annual out-of-pocket maximum, your plan will pay for everything else (except for your monthly payment).

To make sure everyone can get the help they need to stay healthy, organizations like Molina Healthcare offer a wide range of plans at different prices, all with access to quality healthcare.

We hope these explanations are of help to you.